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∫√‘°“√
486
Abstract Comparison of Adherence of Antiretroviral Therapy between Community Hospitals and Regional Hospitals under the Universal Coverage
Sukhontha Kongsin*, Sukhum Jiamton†, Kanoksak Wongpeng*, Kitiya Prom-On*, Sittikorn Rongsumlee*, Nootchawan Boonruang*, Saranya Boonyai*, Kulyisa Tachapetpaiboon*, Benjaporn Youngviset*, Siriporn Monyarit*
*Research Centre for Health Economics and Evaluation, Faculty of Public Health, Mahidol University, †Depart- ment of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University
Background: The adherence of antiretroviral therapy (ART) higher than 95 % is needed for the effec- tiveness of HIV suppression. prevention of opportunistic infections, reduction chance of HIV transmis- sion and overall health improvement. Aim of the study was to find facility factors related to adherence of ART under the universal coverage. Methods: A cross-sectional study was conducted among 823 HIV- infected individuals who were receiving antiretroviral under National AIDS Program (NAP) in 9 public hospitals in 3 provinces (3 regional and 6 community hospitals). Adherence had been assessed by pill count and self-report using Visual analog scale (VAS). This study was approved by ethical committee of the Ministry of Public Health. Results and discussion: Average adherence from pill-counts and self- report was 87.4% and 49.7 % respectively. Adherence from regional and community hospitals evaluated using pill-count respectively was 82.7 % and 95.2 % while using self-report respectively was 46.3 % and 56.5 %. Logistic regression model shows community hospitals were correlated with higher adherence than regional hospital from self-report by VAS (OR=1.51; 95 % CI:1.13 -2.02, p=0.006) and from pill-counts (OR=4.17; 95 % CI:2.10-8.31, p<0.001). Although ART service in all hospitals was under the same Univer- sal Coverage scheme, the difference of adherence is existed. Related factors might be from patient-staff relationship, ease of travel, ART-one-stop service and exclusively isolate clinic in small hospitals while in large hospitals there are many patients visited under limited service area and not separated from other clinics for receiving ART. Conclusion(s): Regional/general hospital might need substantial supports on budget and personnel as well as the allocation of service space and increasing interest of the clients on adherence on ART.
Key words: Antiretroviral therapy, Adherence, universal coverage (UC), size of hospitals
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Ò. °“√»÷°…“√–¥—∫°“√√—∫ª√–∑“π¬“μâ“π‰«√— ‡Õ¥ åÕ¬à“ß μàÕ‡π◊ËÕß ¡Ë”‡ ¡Õ (Adherence of ARVs therapy)
«‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬„™â ∂‘쑇™‘ßæ√√≥π“ ‰¥â·°à§à“‡©≈’ˬ (Mean) à«π‡∫’ˬ߇∫π¡“μ√∞“π (SD) §à“ Ÿß ÿ¥·≈–§à“μË” ÿ¥ (max and min) ·≈–„™â ∂‘쑇™‘ß«‘‡§√“–Àå ‡™àπ T-test À√◊Õ ANOVA „π
°“√‡ª√’¬∫‡∑’¬∫√–¥—∫°“√√—∫ª√–∑“π¬“μâ“π‰«√— ‡Õ¥ åÕ¬à“ß μàÕ‡π◊ËÕß√–À«à“ß°≈ÿà¡ ‡™à𠇪√’¬∫‡∑’¬∫√–¥—∫°“√√—∫ª√–∑“π
¬“μâ“π‰«√— ‡Õ¥ åÕ¬à“ßμàÕ‡π◊ËÕß ¡Ë”‡ ¡Õ√–À«à“߇滙“¬°—∫
À≠‘ß ‡ªìπμâπ
Ú. °“√»÷°…“ªí®®—¬∑’Ë¡’º≈μàÕ√–¥—∫°“√√—∫ª√–∑“π¬“
μâ“π‰«√— ‡Õ¥ åÕ¬à“ßμàÕ‡π◊ËÕß ¡Ë”‡ ¡Õ (Adherence of ARVs therapy) „™â ∂‘쑇™‘ß«‘‡§√“–Àå ‡™àπ Chi-square ·≈– Binary Logistic regression
º≈°“√»÷°…“
Ò. ¢âÕ¡Ÿ≈∑—Ë«‰ª·≈–°“√®—¥√–∫∫∫√‘°“√¬“μâ“π‰«√— ‡Õ¥ å
¢Õß ∂“π∫√‘°“√
∂“π∫√‘°“√∑’Ë∑”°“√»÷°…“ ª√–°Õ∫¥â«¬ ‚√ß欓∫“≈
»Ÿπ¬å/∑—Ë«‰ª ®”π«π Û ·Ààß ‚√ß欓∫“≈™ÿ¡™π ¢π“¥ ˘ ‡μ’¬ß
488
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°“√®—¥∫√‘°“√§≈‘π‘°¬“μâ“π‰«√— ‡Õ¥ å à«π„À≠à¡’°“√®—¥
∫√‘°“√‡ªìπ§≈‘π‘°¬“μâ“π‰«√— ‡©æ“– ·¬°®“°·ºπ°ºŸâªÉ«¬∑—Ë«‰ª
¡’‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ‡æ’¬ß Ò ·Ààß ∑’Ë®—¥∫√‘°“√√à«¡°—∫
°“√„Àâ∫√‘°“√ºŸâªÉ«¬‚√§‡√◊ÈÕ√—ßÕ◊ËπÊ
√Ÿª·∫∫°“√„Àâ∫√‘°“√¬“μâ“π‰«√— ‡Õ¥ å ¡’ Û √Ÿª·∫∫ §◊Õ Ò. °“√∫√‘°“√·∫∫‡∫Á¥‡ √Á® (One stop service) §◊Õ∫√‘°“√
∑’Ë®ÿ¥Ê‡¥’¬« ‚¥¬‡√‘Ë¡μ—Èß·μà°“√§—¥°√ÕߺŸâªÉ«¬ (¬◊Ëπ∫—μ√ ™—ËßπÈ”
Àπ—°-«—¥ à«π Ÿß) ´—°ª√–«—μ‘ ¥ŸÕ“°“√‡∫◊ÈÕßμâπ æ∫·æ∑¬å √—∫
¬“μâ“π‰«√— °“√μ√«®∑“ßÀâÕߪؑ∫—μ‘°“√ °“√„À⧔ª√÷°…“
‡√◊ËÕß°“√√—∫ª√–∑“π¬“/°“√¥Ÿ·≈ ÿ¢¿“æ·≈–·®°∂ÿ߬“ßÕπ“¡—¬
´÷Ëß¡’‚√ß欓∫“≈™ÿ¡™π Ò ·Ààß∑’Ë®—¥∫√‘°“√„π√Ÿª·∫∫π’È Ú.
°“√„Àâ∫√‘°“√·∫∫ °÷Ëß One stop service §◊Õ ¡’√Ÿª·∫∫°“√
„Àâ∫√‘°“√∑ÿ°¢—ÈπμÕπ‡À¡◊Õπ°—∫ One stop service ¬°‡«âπ
°“√®à“¬¬“ ·≈–°“√μ√«®∑“ßÀâÕߪؑ∫—μ‘°“√ ∑’ËμâÕ߉ª√—∫
∫√‘°“√‡À¡◊ÕπºŸâªÉ«¬∑—Ë«‰ªμ“¡∑’Ë‚√ß欓∫“≈®—¥‰«â„Àâ Û. °“√
„Àâ∫√‘°“√·∫∫ OPD ∑—Ë«‰ª §◊Õ„Àâ∫√‘°“√√à«¡°—∫°“√„Àâ∫√‘°“√
ºŸâªÉ«¬‚√§‡√◊ÈÕ√—ßÕ◊ËπÊ
§«“¡∂’Ë¢Õß°“√„Àâ∫√‘°“√§≈‘π‘°¬“μâ“π‰«√— ®–·μ°μà“ß
°—πÕÕ°‰ªμ“¡¢π“¥¢Õß‚√ß欓∫“≈·≈–®”π«πºŸâμ‘¥‡™◊ÈÕ/
ºŸâªÉ«¬‡Õ¥ å∑’Ë¡“√—∫∫√‘°“√§≈‘π‘°¬“μâ“π‰«√— ¢Õß‚√ß欓∫“≈
·μà≈–·Ààß ‡™àπ‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ®–¡’ºŸâ¡“√—∫∫√‘°“√
§≈‘π‘°¬“μâ“π‰«√— ®”π«π¡“° ®÷ß„Àâ∫√‘°“√ —ª¥“Àå≈– Û «—π
·≈– —ª¥“Àå≈– Ò «—π À√◊Õ‚√ß欓∫“≈™ÿ¡™π∫“ß·Ààß∑’Ë¡’
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®÷ß„Àâ∫√‘°“√‡¥◊Õπ≈– Ú «—𠇪ìπμâπ
¡“μ√∞“π°“√¥Ÿ·≈ºŸâμ‘¥‡™◊ÈÕ/ºŸâªÉ«¬‡Õ¥ å¥â“π∫ÿ§≈“°√ æ∫
«à“‡°◊Õ∫∑ÿ°‚√ß欓∫“≈¡’∫ÿ§≈“°√§√∫∑—Èß ı ¥â“πμ“¡ ∑’˧Ÿà¡◊Õ
°“√„Àâ∫√‘°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‡Õ¥ å ”π—°ß“πÀ≈—°ª√–°—π ÿ¢¿“æ∂â«πÀπâ“ ( ª ™.) °”Àπ¥ ¬°‡«âπ‚√ß欓∫“≈™ÿ¡™π Ò ·Ààß ∑’ˉ¡à¡’·æ∑¬å¡“ª√–®”¢≥–√—∫¬“ À“°ºŸâμ‘¥‡™◊ÈÕ/ºŸâªÉ«¬
¡’§«“¡®”‡ªìπ∑’Ë®–æ∫·æ∑¬åμâÕ߉ªæ∫∑’Ë·ºπ°ºŸâªÉ«¬πÕ°
(OPD)
«‘∏’°“√ª√–‡¡‘π Adherence ¢Õß ∂“π∫√‘°“√ ¡’Õ¬Ÿà Û
«‘∏’¥â«¬°—π §◊Õ Ò. °“√ª√–‡¡‘π·∫∫π—∫‡¡Á¥¬“ (Pill Count) Ú.
°“√ª√–‡¡‘π°“√√—∫ª√–∑“π¬“μâ“π‰«√— ‡Õ¥ å¥â«¬μπ‡Õß (Self- report) ·≈– Û.°“√ª√–‡¡‘π‚¥¬ VAS ‚¥¬ à«π„À≠à„™â«‘∏’
°“√π—∫‡¡Á¥¬“ (pill count) √à«¡°—∫ «‘∏’°“√ª√–‡¡‘π¥â«¬°“√
√“¬ß“πμπ‡Õß (Self report)
√–∫∫°“√μ‘¥μ“¡ºŸâªÉ«¬ ∑ÿ°‚√ß欓∫“≈¡’°“√μ‘¥μ“¡
ºŸâªÉ«¬‚¥¬°“√‡¬’ˬ¡∫â“π·≈–‚∑√»—æ∑å ¡’‚√ß欓∫“≈»Ÿπ¬å Ò
·Ààß∑’ˇæ‘Ë¡™àÕß∑“ß„π°“√μ‘¥μ“¡ºŸâªÉ«¬‚¥¬„™â‰ª√…≥’¬∫—μ√
°“√ª√–™“ —¡æ—π∏å„À⧫“¡√Ÿâ‡√◊ËÕß‚√§‡Õ¥ å·≈–°“√√—∫¬“
μâ“π‰«√— „π‚√ß欓∫“≈»Ÿπ¬å®–¡’°“√ª√–™“ —¡æ—π∏å ºà“π ◊ËÕ
«‘∑¬ÿ ·ºàπæ—∫„À⧫“¡√Ÿâ ®—¥∫Õ√奄À⧫“¡√Ÿâ∑’Ë‚√ß欓∫“≈ „Àâ ÿ¢»÷°…“„π«—π∑’Ë¡“√—∫∫√‘°“√ ‚√ß欓∫“≈™ÿ¡™π à«π„À≠à®–
ª√–™“ —¡æ—π∏å ºà“π·ºàπæ—∫„À⧫“¡√Ÿâ ·≈–„Àâ ÿ¢»÷°…“„π«—π
∑’Ë¡“√—∫∫√‘°“√
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¡’°≈ÿࡇ§√◊Õ¢à“¬ºŸâμ‘¥‡™◊ÈÕ‡¢â“¡“¡’ à«π√à«¡„π°“√„Àâ∫√‘°“√¬“
μâ“π‰«√— ∑—Èß „π‡√◊ËÕß„À⧔ª√÷°…“ºŸâμ‘¥‡™◊ÈÕ/ºŸâªÉ«¬‡Õ¥ å ‡¬’ˬ¡
°≈ÿࡇæ◊ËÕπ∑’˪ɫ¬ μâÕ߇¢â“√—°…“μ—«„π‚√ß欓∫“≈·≈–‡¬’ˬ¡
∫â“πμ‘¥μ“¡°“√√—∫ª√–∑“π¬“μâ“π‰«√— √«¡∑—Èߙ૬ߓπ
∫√‘°“√ºŸâªÉ«¬„π«—π®—¥∫√‘°“√¬“μâ“π‰«√—
¢âÕ¡Ÿ≈∑—Ë«‰ª·≈–°“√®—¥√–∫∫∫√‘°“√¬“μâ“π‰«√— ‡Õ¥ å
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°≈ÿà¡μ—«Õ¬à“ß∑—ÈßÀ¡¥®”π«π ¯ÚÛ §π ‡ªìπ‡æ»™“¬ Û¯¯
§π À√◊Õ√âÕ¬≈– Ù˜.Ò ·≈–‡æ»À≠‘ß ÙÛı §π À√◊Õ√âÕ¬≈–
ıÚ.˘ ¡’Õ“¬ÿ‡©≈’ˬª√–¡“≥ Ù ªï Õ“¬ÿπâÕ¬∑’Ë ÿ¥ ÚÒªï·≈–
¡“°∑’Ë ÿ¥ ˜Ù ªï ª√–¡“≥§√÷ËßÀπ÷Ëß ¡’ ∂“π¿“æ ¡√ §Ÿà ª√–¡“≥Àπ÷Ëß„π “¡¡’ ∂“π¿“æ ¡√ ¡à“¬ À¬à“ ·≈–‚ ¥ ª√–¡“≥√âÕ¬≈– Ú ¡’°“√»÷°…“ Ÿß ÿ¥√–¥—∫ª√–∂¡»÷°…“
®”π«π Ùˆ §π À√◊Õ√âÕ¬≈– ıı.˘ √–¥—∫¡—∏¬¡»÷°…“μÕπ μâπ ®”π«π Òˆˆ §π À√◊Õ√âÕ¬≈– Ú.Ú ¡’√“¬‰¥â¢Õߧ√—«
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μ“√“ß∑’Ë Ò ¢âÕ¡Ÿ≈∑—Ë«‰ª·≈–°“√®—¥√–∫∫∫√‘°“√¬“μâ“π‰«√— ‡Õ¥ å¢Õß ∂“π∫√‘°“√
‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ‚√ß欓∫“≈™ÿ¡™π
¢âÕ¡Ÿ≈/‚√ß欓∫“≈ ¿“§‡Àπ◊Õ ¿“§μ–«—πÕÕ° ¿“§„μâ ¿“§‡Àπ◊Õ °. ¿“§μ–«—πÕÕ° ¿“§‡Àπ◊Õ ¢. ¿“§μ–«—πÕÕ° ¿“§„μâ °. ¿“§„μâ ¢.
‡©’¬ß‡Àπ◊Õ ‡©’¬ß‡Àπ◊Õ °. ‡©’¬ß‡Àπ◊Õ ¢.
®”π«π‡μ’¬ß ˜¯ ¯ˆ˜ ˆı ˘ ˘ Û Û Û Û
≈—°…≥–°“√®—¥∫√‘°“√
§≈‘π‘°‡©æ“–‚√§ ¡’ ¡’ ‰¡à¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
√Ÿª·∫∫°“√∫√‘°“√ °÷Ëß one °÷Ëß one OPD °÷Ëß one °÷Ëß one one °÷Ëß one °÷Ëß one °÷Ëß one stop service stop service ∑—Ë«‰ª ∑—Ë«‰ª ∑—Ë«‰ª stop service stop service stop service stop service
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§≈‘π‘°¬“μâ“π‰«√—
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·æ∑¬å ¡’ ¡’ ¡’ ¡’ ‰¡à¡’ ¡’ ¡’ ¡’ ¡’
‡¿ —™°√ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
欓∫“≈ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
ºŸâ„À⧔ª√÷°…“ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
π—°‡∑§π‘§°“√·æ∑¬å ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
«‘∏’°“√ª√–‡¡‘π Adherence
Pill Count ¡’ ¡’ ‰¡à¡’ ¡’ ‰¡à¡’ ¡’ ¡’ ¡’ ¡’
Self Report ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
Visual analog scale ‰¡à¡’ ‰¡à¡’ ‰¡à¡’ ‰¡à¡’ ‰¡à¡’ ¡’ ‰¡à¡’ ‰¡à¡’ ‰¡à¡’
°“√μ‘¥μ“¡ºŸâªÉ«¬
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„Àâ ÿ¢»÷°…“ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
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„À⧔ª√÷°…“ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’
™à«¬ß“π∫√‘°“√„π«—π ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ¡’ ‰¡à¡’ ¡’
√—∫¬“μâ“π‰«√—
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„π √æ. /‡¬’ˬ¡∫â“π
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(Òˆ.%) (Ò˜.¯%) (ÛÛ.Û%) (Òˆ.¯%) (ÒÙ.˜%) (ÚÒ.Ú%) (˘.Ò%) (Ú.%) (ÙÙ.¯%) (Ú.Ú%)
¡—∏¬¡»÷°…“μÕπª≈“¬ ÚÒ ÒÚ ÒÛ ¯ Ò Ù Ò ı ˆı
(¯.%) (ˆ.˘%) (ÒÒ.˜%) (¯.Ù%) (Ú.˘%) (ˆ.Ò%) (.%) (Û.Û%) (Ò˜.Û%) (˜.˘%)
Õ“™’«»÷°…“/Õπÿª√‘≠≠“ ÒÒ Ú¯ ¯ Û ı Ú Ò Ú ˆ
(Ù.Ú%) (Òˆ.Ò%) (˜.Ú%) (Û.Ú%) (.%) (˜.ˆ%) (˘.Ò%) (Û.Û%) (ˆ.˘%) (˜.Û%)
ª√‘≠≠“μ√’À√◊Õ Ÿß°«à“ ı ˆ ı Û Ò Ú
(Ò.˘%) (Û.ı%) (Ù.ı%) (.%) (.%) (Ù.ı%) (.%) (Û.Û%) (.%) (Ú.Ù%)
√“¬‰¥â¢Õߧ√—«‡√◊Õπ
Mean Û,˘Ú˘ ı,Û˜ ˜,Úı Û,˘ˆ˜ Û,ıÛ Û,Ù¯Ù Ú,ÒÒÚ Û,ÙÛÒ ˆ,ÒÚÙ Ù,ˆÙÛ
º≈°“√ª√–‡¡‘π Adherence Pill Count
<˘ı% Û˘ ÚÒ *NA Ò NA Ò Ú ˆ ˜
(Òˆ.¯¯) (Òˆ.Ùı) (Ò.Ò˘) (Ò.˘Ú) (.) (ˆ.˘) (Úˆ.˘) (ÒÚ.Û˜)
>=˘ı % Ò˘Ú Òˆ NA ¯Û NA ıÒ Ú Ú˜ Ò˜ Ù˘ˆ
(¯Û.ÒÚ) (¯Û.Ùˆ) (˘¯.¯Ò) (˘¯.¯) (Ò.) (˘Û.Ò) (˜Û.˘Ò) (¯˜.ˆÛ)
Self Report
<˘ı% ÒÒı ˘¯ ˜˜ ÛÚ Òı Û ˘ ÚÚ ÒÛ ÙÒÒ
(ÙÛ.¯˘) (ıˆ.ÛÚ) (ˆ˘.Û˜) (ÛÛ.ˆ¯) (ÙÙ.ÒÚ) (Ùı.Ùı) (Ù.˘Ò) (˜Û.ÛÛ) (ÙÙ.¯Û) (Ù˘.˘Ù)
>=˘ı % ÒÙ˜ ˜ˆ ÛÙ ˆÛ Ò˘ Ûˆ ÒÛ ¯ Òˆ ÙÒÚ
(ıˆ.ÒÒ) (ÙÛ.ˆ¯) (Û.ˆÛ) (ˆˆ.ÛÚ) (ıı.¯¯) (ıÙ.ıı) (ı˘.˘) (Úˆ.ˆ˜) (ıı.Ò˜) (ı.ˆ) À¡“¬‡Àμÿ *NA À¡“¬∂÷ß ‰¡à¡’¢âÕ¡Ÿ≈
μ“√“ß∑’Ë Ú ¢âÕ¡Ÿ≈∑—Ë«‰ª¢Õß°≈ÿà¡μ—«Õ¬à“ß
‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ‚√ß欓∫“≈™ÿ¡™π
¢âÕ¡Ÿ≈/‚√ß欓∫“≈ ¿“§‡Àπ◊Õ ¿“§μ–«—πÕÕ° ¿“§„μâ ¿“§‡Àπ◊Õ °. ¿“§μ–«—πÕÕ° ¿“§‡Àπ◊Õ ¢. ¿“§μ–«—πÕÕ° ¿“§„μâ °. ¿“§„μâ ¢. √«¡
‡©’¬ß‡Àπ◊Õ ‡©’¬ß‡Àπ◊Õ °. ‡©’¬ß‡Àπ◊Õ ¢.
μ“√“ß∑’Ë Û √–¥—∫¢Õß ∂“π∫√‘°“√ ·≈–°“√√—∫ª√–∑“π¬“μâ“π‰«√— Õ¬à“ß μàÕ‡π◊ËÕ߇¡◊ËÕ«‘‡§√“–Àå¢âÕ¡Ÿ≈¥â«¬ Binary logistic regression ·∫∫
univariated
Self report (Visual analog scale (VAS))
√–¥—∫ ∂“π∫√‘°“√ Adherence <˘ı% Adherence >=˘ı% OR* ˘ı% CI p-value
®”π«π (√âÕ¬≈–) ®”π«π (√âÕ¬≈–)
‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª Ú˘Ù (ıÛ.˜) ÚıÛ (Ùˆ.Û) Ò
‚√ß欓∫“≈™ÿ¡™π ÒÚ (ÙÛ.ı) Òıˆ (ıˆ.ı) Ò.ıÒ Ò.ÒÛ-Ú.Ú .ˆ
Pill count
√–¥—∫ ∂“π∫√‘°“√ Adherence <˘ı% Adherence >=˘ı% OR* ˘ı% CI p-value
®”π«π (√âÕ¬≈–) ®”π«π (√âÕ¬≈–)
‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ˆı (Ò˜.Û) ÛÒ (¯Ú.˜) Ò
‚√ß欓∫“≈™ÿ¡™π Ò (Ù.¯) Ò˘˘ (˘ı.Ú) Ù.Ò˜ Ú.Ò-¯.ÛÒ <.Ò
¡Ë”‡ ¡Õ (Adherence) ´÷Ëß·∫àßÕÕ°‡ªìπ Ú «‘∏’ æ∫«à“ °“√
ª√–‡¡‘π‚¥¬«‘∏’π—∫‡¡Á¥¬“ (pill count) ¡’ºŸâªÉ«¬∑’Ë¡’√–¥—∫ Ad- herence ¡“°°«à“À√◊Õ‡∑à“°—∫√âÕ¬≈– ˘ı ®”π«π Ù˘ˆ §π À√◊Õ√âÕ¬≈– ¯˜.ˆ ·≈– Adherence πâÕ¬°«à“ √âÕ¬≈– ˘ı
®”π«π ˜ §π À√◊Õ√âÕ¬≈– ÒÚ.Ù ¡’ ®“°«‘∏’°“√ª√–‡¡‘π°“√
√—∫ª√–∑“π¬“μâ“π‰«√— ‡Õ¥ å¥â«¬μπ‡Õß (self-report)
ª√–¡“≥§√÷ËßÀπ÷ËߢÕߺŸâªÉ«¬¡’√–¥—∫ Adherence ¡“°°«à“
À√◊Õ‡∑à“°—∫√âÕ¬≈– ˘ı ·≈–πâÕ¬°«à“√âÕ¬≈– ˘ı ¥—ß· ¥ß„π μ“√“ß∑’Ë Ú
Û. ¢π“¥¢Õß ∂“π∫√‘°“√°—∫°“√√—∫ª√–∑“π¬“μâ“π‰«√—
Õ¬à“ßμàÕ‡π◊ËÕß
®“°°“√»÷°…“ æ∫«à“ ‡¡◊ËÕª√–‡¡‘π Adherence ¥â«¬«‘∏’
492 Self report ‚¥¬„™â Visual analog scale (VAS) „π√–¥—∫
‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ¡’°≈ÿà¡μ—«Õ¬à“ß∑’Ë¡’√–¥—∫ Adherence Ÿß°«à“ ˘ı% §‘¥‡ªìπ√âÕ¬≈– Ùˆ.Û à«π„π√–¥—∫‚√ß欓∫“≈
™ÿ¡™ππ—Èπ æ∫ºŸâ∑’Ë¡’√–¥—∫ Adherence Ÿß°«à“ ˘ı% ª√–¡“≥
√âÕ¬≈– ıˆ.ı ·≈–‡¡◊ËÕ«‘‡§√“–Àå¢âÕ¡Ÿ≈¥â«¬«‘∏’ Binary logistic regression ·∫∫ univariated æ∫«à“ √–¥—∫¢Õß ∂“π∫√‘°“√
¡’§«“¡ —¡æ—π∏å°—∫√–¥—∫ Adherence ‡¡◊ËÕª√–‡¡‘π¥â«¬«‘∏’ Self report ‚¥¬‚√ß欓∫“≈™ÿ¡™π¡’‚Õ°“ ∑’Ë®–æ∫ºŸâ∑’Ë¡’√–¥—∫ Ad- herence ‡ªìπ Ò.ıÒ ‡∑à“¢Õß‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª (OR=
Ò.ıÒ, ˘ı% CI = Ò.ÒÛ-Ú.Ú, p-value=.ˆ) à«π°“√
ª√–‡¡‘π Adherence ¥â«¬«‘∏’π—∫‡¡Á¥¬“(pill count)π—Èπ ®“°
°“√»÷°…“ æ∫«à“ „π√–¥—∫‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ¡’°≈ÿà¡
μ—«Õ¬à“ß∑’Ë¡’√–¥—∫ Adherence Ÿß°«à“ ˘ı% §‘¥‡ªìπ√âÕ¬≈–
¯Ú.˜ à«π„π√–¥—∫‚√ß欓∫“≈™ÿ¡™π æ∫∂÷ß√âÕ¬≈– ˘ı.Ú
∑’Ë¡’√–¥—∫°“√√—∫ª√–∑“π¬“μâ“π‰«√— Õ¬à“ßμàÕ‡π◊ËÕß ¡Ë”‡ ¡Õ ·≈–
‡¡◊ËÕ«‘‡§√“–Àå¢âÕ¡Ÿ≈¥â«¬«‘∏’ Binary logistic regression ·∫∫
univariated æ∫«à“ √–¥—∫¢Õß ∂“π∫√‘°“√¡’§«“¡ —¡æ—π∏å
°—∫√–¥—∫ Adherence ‡¡◊ËÕª√–‡¡‘π¥â«¬«‘∏’π—∫‡¡Á¥¬“ pill count
‚¥¬‚√ß欓∫“≈™ÿ¡™π¡’‚Õ°“ ∑’Ë®–æ∫ºŸâ∑’Ë¡’√–¥—∫ Adherence
¡“°°«à“À√◊Õ‡∑à“°—∫√âÕ¬≈– ˘ı ‡ªìπ Ù.Ò˜ ‡∑à“¢Õß‚√ß æ¬“∫“≈»Ÿπ¬å/∑—Ë«‰ª (OR= Ù.Ò˜, ˘ı% CI = Ú.Ò-¯.ÛÒ, p-value<.Ò) ¥—ßμ“√“ß∑’Ë Û
«‘®“√≥å·≈–¢âÕ¬ÿμ‘
∂“π∫√‘°“√∑’Ë»÷°…“¡’«‘∏’°“√ª√–‡¡‘π°“√√—∫ª√–∑“π¬“
Õ¬à“ßμàÕ‡π◊ËÕß·≈– ¡Ë”‡ ¡Õ (Adherence) ¡“°°«à“ Ò «‘∏’
à«π„À≠à„™â«‘∏’°“√π—∫‡¡Á¥¬“ (pill count) √à«¡°—∫ «‘∏’°“√
ª√–‡¡‘π¥â«¬°“√√“¬ß“πμπ‡Õß (Self report) ‚¥¬¡’‡¿ —™°√
‡ªìπºŸâª√–‡¡‘π·≈–∑”ß“π√à«¡°—∫欓∫“≈ºŸâ√—∫º‘¥™Õ∫ß“π‡Õ¥ å
·μà∫“ß ∂“π∫√‘°“√‰¥â„ÀâÕ“ “ ¡—§√®“°‡§√◊Õ¢à“¬ºŸâμ‘¥‡™◊ÈÕ ‰¥â
¡’‚Õ°“ ‡¢â“¡“¡’ à«π√à«¡‚¥¬‡ªìπºŸâ√à«¡ª√–‡¡‘π ®“°°“√»÷°…“
æ∫«à“°“√„™â«‘∏’ª√–‡¡‘π Adherence ¡“°°«à“ Ò «‘∏’ ‰¥â™à«¬
∑”„Àâ°“√ª√–‡¡‘π‰¥â¥’¢÷Èπ ‚¥¬π”¢âÕ¡Ÿ≈∑’ˉ¥â·μà≈–«‘∏’¡“μ√«®
Õ∫§«“¡∂Ÿ°μâÕß√à«¡°—π ´÷Ëß®“°°“√»÷°…“æ∫«à“ ·μà≈–«‘∏’
ª√–‡¡‘π°Á®–¡’®ÿ¥‡¥àπ∑’Ë·μ°μà“ß°—π
°“√ª√–‡¡‘π¥â«¬°“√π—∫‡¡Á¥¬“ (pill count) ¡’®ÿ¥‡¥àπ μ√ß∑’Ë¡’À≈—°∞“π‡™‘ßª√–®—°…å§◊Õ®”π«π‡¡Á¥¬“ ∑”„Àâª√–‡¡‘π
‰¥â„°≈⇧’¬ß°—∫§«“¡‡ªìπ®√‘ß ·≈–∂⓪√–°Õ∫°—∫ °“√‡ªî¥‚Õ°“
„Àâ¡’°“√æ∫ª–°—π√–À«à“߇®â“Àπâ“∑’Ë·≈–ºŸâ√—∫¬“°Á®–∑”„Àâº≈∑’Ë
‰¥â„°≈⇧’¬ß°—∫§«“¡‡ªìπ®√‘ß ·μà«‘∏’π’È¡’¢âÕ®”°—¥„π∫“ß ∂“π
∫√‘°“√ ‡™àπ ‚√ß欓∫“≈»Ÿπ¬å∫“ß·Ààß ‰¡à “¡“√∂¥”‡π‘π°“√
ª√–‡¡‘π¥â«¬«‘∏’π—∫‡¡Á¥¬“‰¥â ‡π◊ËÕß®“°¡’®”π«πºŸâªÉ«¬∑’Ë¡“√—∫
∫√‘°“√·≈–√—∫¬“®”π«π¡“° «‘∏’ª√–‡¡‘ππ’ȇªìπ°“√‡æ‘Ë¡¿“√–
ß“π·°à‡®â“Àπâ“∑’Ë∑”„Àâ‰¡à “¡“√∂∫√‘À“√®—¥°“√‡√◊ËÕ߇«≈“‰¥â Õπ÷Ëß«‘∏’°“√π—∫‡¡Á¥¬“‰¡à “¡“√∂°√–∑”‰¥â„π°√≥’∑’Ë ºŸâ√—∫º‘¥
™Õ∫‚¥¬μ√߉¡àÕ¬Ÿà Õ’°°√≥’Àπ÷Ëß∑’ˉ¡à “¡“√∂∑”°“√ª√–‡¡‘π
·∫∫π’ȉ¥â§◊Õ°√≥’¡’ºŸâ¡“√—∫¬“·∑π ‡æ√“–μâÕßπ—∫®”π«π¬“∑’Ë
‡À≈◊Õ¡“§◊π ·≈–π”®”π«π‡¡Á¥¬“‰ª§”π«≥À“ Adherence
°“√ª√–‡¡‘π¥â«¬°“√√“¬ß“πμπ‡Õß (self report) ®“°
°“√»÷°…“æ∫«à“¡’°“√ª√–‡¡‘π Ú √Ÿª·∫∫§◊Õ Ò. „™â ¡ÿ¥
∫—π∑÷°ª√–®”μ—« (log book) ´÷Ëß “¡“√∂∫—π∑÷°‡Õ߉¥âßà“¬
¥â«¬μ—«ºŸâ√—∫ª√–∑“π¬“μâ“π‰«√— ‡Õß ‡ªìπ°“√≈¥¿“√–ß“π¢Õß
‡®â“Àπâ“∑’Ë ·μàªí≠À“∑’Ëæ∫§◊Õ¡—°®–‰¥â¢âÕ¡Ÿ≈∑’ˉ¡à‡ªìπ®√‘ß ‰¡à “¡“√∂∫Õ°‰¥â«à“ºŸâªÉ«¬√—∫ª√–∑“𬓮√‘ßÀ√◊Õ‰¡à μâÕßÕ“»—¬
§«“¡‰«â„®„πμ—«ºŸâªÉ«¬·≈– Ú. „™â Visual analog scale (VAS)
«‘∏’π’È¡’®ÿ¥‡¥àπ∑’Ë∑”°“√ª√–‡¡‘π‰¥âßà“¬·≈–√«¥‡√Á« “¡“√∂∫—π
∑÷°º≈°“√ª√–‡¡‘π‰«â„π OPD card ‰¥â ·μà Visual analog scale (VAS) ‡ªìπ‡§√◊ËÕß¡◊Õ∑’Ë¡’§«“¡ÕàÕπ‰À«μâÕßÕ“»—¬°“√
∑”§«“¡‡¢â“„®√–À«à“ßμ—«ºŸâª√–‡¡‘π·≈–ºŸâ∂Ÿ°ª√–‡¡‘π ´÷Ëß°“√
®–‡≈◊Õ°„™â«‘∏’°“√ª√–‡¡‘π°“√√—∫ª√–∑“π¬“Õ¬à“ßμàÕ‡π◊ËÕß·≈–
¡Ë”‡ ¡Õ (Adherence) «‘∏’„¥π—Èπ ∂“π∫√‘°“√®–¡’°“√
ª√—∫„Àâ‡À¡“– ¡°—∫∫√‘∫∑¢Õßæ◊Èπ∑’Ë·≈–®”π«πºŸâ∑’Ë¡“√—∫
∫√‘°“√¬“μâ“π‰«√—
º≈®“°°“√»÷°…“π’Èæ∫«à“ ‚√ß欓∫“≈™ÿ¡™π¡’‚Õ°“ ∑’Ë
®–æ∫ºŸâ∑’Ë¡’ Adherence Ÿß°«à“√âÕ¬≈– ˘ı ¡“°°«à“„π‚√ß æ¬“∫“≈»Ÿπ¬å/∑—Ë«‰ª ‡¡◊ËÕª√–‡¡‘π¥â«¬∑—Èß Ú «‘∏’ §◊Õ°“√π—∫‡¡Á¥¬“
(pill count) ·≈–°“√√“¬ß“πμπ‡Õß (self report) ‚¥¬„™â Vi- sual analog scale (VAS) ·≈– “¡“√∂¬◊π¬—πº≈°“√«‘®—¬
‡∫◊ÈÕßμâπ ®“°°“√«‘‡§√“–Àå Binary logistic regression ·∫∫
univariate ´÷Ëß Õ¥§≈âÕß°—∫°“√»÷°…“√–¥—∫ CD4 ¢ÕߺŸâªÉ«¬
∑’ˇæ‘Ë¡¢÷Èπ „πºŸâ∑’Ë¡“√—∫¬“μâ“π‰«√— „π ∂“π∫√‘°“√√–¥—∫‚√ß æ¬“∫“≈™ÿ¡™π ¡“°°«à“‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫ºŸâ∑’Ë¡“√—∫¬“®“°
‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª(ÒÚ) ´÷ËßÕ“®‡π◊ËÕß¡“®“°¡’§«“¡μàÕ‡π◊ËÕß
·≈– ¡Ë”‡ ¡Õ¢Õß°“√√—∫ª√–∑“𬓂√ß欓∫“≈™ÿ¡™π ¡’º≈
μàÕº≈≈—æ∏å¥â“π ÿ¢¿“æ¢Õß‚√§¥—ß°≈à“«
∂÷ß·¡â«à“°“√®—¥∫√‘°“√¬“μâ“π‰«√— ‡Õ¥ å®–‡ªìπ°“√
∫√‘°“√¿“¬„μâ ‘∑∏‘À≈—°ª√–°—π ÿ¢¿“æ‡À¡◊Õπ°—π‰¡à«à“®–‡ªìπ
‚√ß欓∫“≈¢π“¥„¥ ·μ৫“¡·μ°μà“ß°—π¢Õß°“√√–∫∫∫√‘°“√
Õ“® àߺ≈∑”„À⧫“¡μàÕ‡π◊ËÕß„π°“√√—∫ª√–∑“π¬“μâ“π‰«√—
‡Õ¥ å·μ°μà“ß°—πÕÕ°‰ª ‡æ√“–¢âÕ®”°—¥¢Õß‚√ß欓∫“≈»Ÿπ¬å/
∑—Ë«‰ªÕ“®Õ¬Ÿà∑’Ë °“√¡’®”π«πºŸâ∑’Ë¡“√—∫¬“μâ“π‰«√— ‡Õ¥ 凪ìπ
®”π«π¡“°„π·μà≈–«—π ·≈–§«“¡·ÕÕ—¥¢Õß ∂“π∑’Ë Õ“®∑”„Àâ
‡°‘π»—°¬¿“æ¢Õß‚√ß欓∫“≈∑’Ë®– “¡“√∂„Àâ∫√‘°“√‰¥âÕ¬à“ß¡’
ª√– ‘∑∏‘¿“æ ¥—ßπ—Èπ°“√ π—∫ πÿπ‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª ∑—Èß
¥â“πß∫ª√–¡“≥·≈–°”≈—ߧπ‡ªìπª√–‡¥Á𠔧—≠ ·≈–√«¡∂÷ß
°“√®—¥æ◊Èπ∑’Ë„π°“√„Àâ∫√‘°“√¬“μâ“π‰«√— ‡Õ¥ åÕÕ°‡ªìπ —¥ à«π πÕ°®“°π—Èπ°“√ π—∫ πÿπ„Àâ‚√ß欓∫“≈»Ÿπ¬å/∑—Ë«‰ª¡’¡“μ√°“√
„π°“√°√–μÿâπ„À⺟âªÉ«¬/ºŸâμ‘¥‡™◊ÈÕ‡Õ™‰Õ«’ ¡’§«“¡ π„®„π‡√◊ËÕß
°“√√—∫ª√–∑“π¬“Õ¬à“ßμàÕ‡π◊ËÕß ¡Ë”‡ ¡Õ ·≈–μ√߇«≈“„π∑ÿ°
«‘∂’∑“ß ¬—߇ªìπ ‘Ëß∑’Ë®”‡ªìπ·≈– ”§—≠ ‡æ√“–πÕ°®“°®–‡æ‘Ë¡√–¥—∫
Adherence ·≈â« ¬—ß àߺ≈μàÕº≈≈—æ∏å∑“ß ÿ¢¿“æ∑’Ë¥’¢÷Èπ„π
¿“æ√«¡¥â«¬
πÕ°®“°π’Ȭ—ß¡’ ‘Ëß∑’Ëæ∫‡ÀÁπ®“°°“√«‘®—¬∑’Ëπà“ π„®§◊Õ
‚√ß欓∫“≈∑ÿ°·Àà߉¥â¡’°≈ÿࡇ§√◊Õ¢à“¬ºŸâμ‘¥‡™◊ÈÕ‡¢â“¡“™à«¬‡®â“
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Ò. ”π—°‚√§‡Õ¥ å «—≥‚√§·≈–‚√§μ‘¥μàÕ∑“ß‡æ» —¡æ—π∏å: ∞“π¢âÕ¡Ÿ≈ ◊ËÕ:
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http://www.aidsstithai.org/uploads/media/file/Pic_Aids.pdf Ú. 09 AIDS epidemic update : November 2009, WHO/UNAIDS [cited
Ú æƒ…¿“§¡ ÚııÙ]; Available from: http://www.unaids.org/en/
media/unaids/contentassets/dataimport/pub/report/ 2009/
jc1700_epi_update_2009_en.pdf
Û. ”π—°‚√§‡Õ¥ å«—≥‚√§·≈–‚√§μ‘¥μàÕ∑“ß‡æ» —¡æ—π∏å. √“¬ß“π ∂“π°“√≥废âªÉ«¬‡Õ¥ å·≈–ºŸâμ‘¥‡™◊ÈÕ∑’Ë¡’Õ“°“√„πª√–‡∑»‰∑¬≈à“ ÿ¥
(ÛÒ ¡’π“§¡ ÚııÙ) ”π—°√–∫“¥«‘∑¬“ °√¡§«∫§ÿ¡‚√§
°√–∑√«ß “∏“√≥ ÿ¢; ÚııÙ [cited Ú °√°Æ“§¡ ÚııÙ];
Available from: http://epid.moph.go.th.
Ù. ÿ«—≤πå ®√‘¬“‡≈‘»»—°¥‘Ï, ‡æ≥≥‘π“∑å ‚Õ‡∫Õ√å¥Õ√å‡øÕ√å, ®‘√“æ√ ÿ
«√√≥∏’√“ß°Ÿ√, ¥“√“«√√≥ μä–ªíπμ“, øî≈≈‘ª ‡° å. √–∫∫∫√‘°“√§≈‘
𑬓μâ“π‰«√— ‡Õ™‰Õ«’¢Õß‚√ß欓∫“≈™ÿ¡™π: °√≥’»÷°…“„π Ù
®—ßÀ«—¥¿“§‡Àπ◊ÕμÕπ∫π. «“√ “√«‘®—¬√–∫∫ “∏“√≥ ÿ¢ Úıı;
Ò:ÒÛÚ-ÒÙÙ.
ı. David L. Paterson, Susan Swindells, Jeffrey Mohr, Michelle Brester, Emanuel N. Vergis, Cheryl Squier, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.
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ÒÒ. æ’√–¡π π‘ß “ππ∑å. °“√μ‘¥μ“¡·≈–°“√ à߇ √‘¡°“√√—∫ª√–∑“π¬“
μâ“π‰«√— Õ¬à“ß ¡Ë”‡ ¡Õ·≈–μàÕ‡π◊ËÕß„π°“√„À⬓μâ“π‰«√— „πºŸâ∑’Ë μ‘¥‡™◊ÈÕ‡Õ™‰Õ«’·≈–ºŸâªÉ«¬‚√§‡Õ¥ å√–¥—∫ª√–‡∑». ·π«∑“ß °“√
μ‘¥μ“¡·≈– à߇ √‘¡°“√√—∫ª√–∑“π¬“μâ“π‰«√— Õ¬à“ß ¡Ë”‡ ¡Õ·≈–
μàÕ‡π◊ËÕß. °√ÿ߇∑æ¡À“π§√: ”π—°‚√§‡Õ¥ å «—≥‚√§ ·≈–‚√§μ‘¥μàÕ
∑“ß‡æ» —¡æ—π∏å °√¡§«∫§ÿ¡‚√§ °√–∑√«ß “∏“√≥ ÿ¢; Úıı.
ÒÚ. Sukhum J, Sukhontha K, Kanoksak W, et al. Health outcome of PLWA on ART and Service system in hospitals with different size under universal coverage in Thailand: Does size matter?. Abstract Book Volume 2, 18th International AIDS Conference çRight Here, Right Nowé; July 18-23 2010, Vienna, Austria; 2010.