Y HQC VigT NAM T H A N G 4 - s6 2/2013 trong viem till mat cap do sdi", Y hoc thanh phd
Ho Chi Minh, 7(1), tr. 43 - 47.
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qua ciia c3t tiii mat ndi soi trong viem tiii mat cap do SOl", Yhgc thinh phS Ho Chi Minh, 9(2),tr. 109-114.
Nguyin Dinh Hoi, NguySn Hoang BSC vd cs (2001), "C3t tui mat bSng phau thuat npi soi';
HOI nghi ngoai khoa Viit Nam, 1, tr7-14.
Nguyen Van NghTa ( 2 0 1 0 ) , Danh gl^ kit qua phSu thu$t ngi soi dieu tn viem tui mat cap do sol t?l benh viin da khoa TP CSn Thd, Luan van tot nghidp bac si chuyen khoa cap 2, Dai hpc Y H^ Noi.
Hii VAn Quyet, Hoang Vi^t Dung (2007),
"Nghien cifu dSc diem benh li va ket qua dieu tri phlu thuat viem tui mat d ngu'di cao tuoi", Ngoai khoa, 4, tr. 40 - 44.
KHAO SAT KIEN THOC, THUC HANH VE OIEU TRj ARV VA TUAN THU DIEU TRI CUA BENH NHAN HIV/AIDS TAI PHONG KHAM QUAN NGO QUYEN, HAI PHONG. NAM 2012
T 6 M TAT
Muc tieu: Xac dinh kien thirc va thuc hanh dieu trj ARV CLia benh nhan HIV/AIDS lien quan vdi tuan thil dieu tn. Phudng phap. nghien ciru md ta cat ngang ket hdp hoi dfu. F'hdng van 247 benh nhan HIV/AIDS dang dieu tti ARV tCr 1 thang trd len ve kien thirc, thUc hanh dieu tri. Phan tich so lieu sir dung phan mem SPSS. Kit qua: tuan thu dieu tri cua benh nhan qua bao cao, kiem tra uong thuoc tai moi ian tai kham tuan thil tot chiem (68,4%). Ti le benh nhan tuan thii dieu trj tot, kien thu'c tot chiem (75,9%), cao hdn so vdl nhom tuan thii trung binh va kem (24,1%), khac biet CO y nghia thong ke vdi p<0,05. Moi lien quan co y nghia thong ke giiJa kien thirc va tuan thii dieu tri vdl p<0,05 OR=1,940 ; 95% CI [1,117-3,371]. Nhom benh nhan tuan thii dieu trj tot cd ty le thiTc hanh diing vdi viec sir dung dyng cy nhac thuoc, thUc hanh uong khi phat hien quen thudc va thi/c hanh khi gap tac dung phu (69,6%, 70,8% va 71,1%) cao hdn nhdm tuan thii trung binh (23,9%, 23,4% va 25,4%) va tuan thii han che (6,5%, 5,7% va 3,5%), tuy nhien sU khac biet khong cd y nghia thong ke vdi p>0,05.
Kit lu$rr. Duy tri kien thiTc va thUc hanh uong thudc diing each la ho trd quan trong cho viec tuan thu tot dieu tri ARV ciia benh nhan HIV/AIDS.
fd khoar. Tuan thii, dieu tn ARV, kien thirc, thai do, benh nhan HIV/AIDS
SUMMARY
SURVEY OF KNOWLEDGE, PRACTICE ON ARV TREATMENT AND ADHERENCE IN H!V/AIDS PATIENTS
AT NGO QUYEN DISTRICT, HAI PHONG, 2012 Objectives: Determine the knowledge and
* Dai hgc Y Hai Phong
Phan bien khoa hoc: GS.TS. Phgm Van Thi>c
122
Du'&ng Thj Hu'tfng practice on ARV treatment of HIV/AIDS patients associated with adherence. Method, cross-sedjonat descriptive study combined retrosp)ective. Interviewed 247 HIV/AIDS patients on antiretrovlral treatment last at least one month in knowledge and treatment practices. Data analysis using SPSS software. Result mesure patent's adherence tiy checking the medication file at each follow-up time, the rate of good adhernce is 68.4%. The rate of patients with good adherence, good knowledge of ART (75.9%), higher than the group average and poor adherence (24.1%), p <0,05. Statisticaily significant correlation between knowledge and adherence with p<0.05 OR=1.940;
95% a [1.117 to 3.371]. Group of patients with good adherence rate in correct practices with the use of instruments mentioned drugs, taking of miss dosage or side effects (69.6%, 70.8% and 71.1%) higher than the average adhrence (23.9%, 23.4% and 25.4%) and the average adhrence (6.5%, 5.7% and 3.5%), however the difference was not statistically significant with p> 0.05. Conclusion: Maintain knowledge and proper practice of medicine is an important support for good adherence in antiretroviral treatment for HIV/AIDS patients.
Key workds: Adherence, ART, knowledge, attitude, HIV/AIDS pabent
I.
OAT VANoi
Tuan thu dieu trj ARV la yeu to quyet dinh trong thanh cdng dieu trj ARV eho benh nhan HIV/ADIS tuy nhien viec tuan thir dieu tri phu thupc vao rat nhieu yeu t d trong dd kien thiVc va thai do ciia benh nhan ddng vai trd quan trpng
Y HOC VigT NAM THANG 4 • s6 2/2013
trong viee thi/c hien va duy tri dieu tri. Chiing tdi
tien hanh nghien ciru ve kien thirc va thu'c hanh dieu tri ARV ciia benh nhan HIV/AIDS dang dieu trj nham hieu biet hdn ve kien thirc dieu trj ARV ciia benh nhan va cai thien tu'van ho trd dieu trj.
Muc tigu: Xae djnh kien thire va thu'c hanh dieu tri ARV cua benti nhan HIV/AIDS lien quan vdi tuan thii dieu tri.
II. oo'l TI/ONG VA PHUONG PHAP NGHIEN CCfU 2.1. Dot tddng: gom 247 benh nhan HIV/AIDS dang dieu tri ARV du'dc 1 thang trd len ti'nh den 9/2011.
2.2. Oia diem va thai'glan nghien eiru: tai
phdng kham quan Ngd quyen, Hal phdng, tir 9/2011-9/2012
Thiit ke nghien c&u md ta cat ngang ket hdp hoi ciru
Thu thap thong tin bang phieu phdng van vdi cae eau hdi ve cac bien lien quan kien thiTc, thai dp va thirc hanh ciia benh nhan HIV/AIDS ve benh va dieu tri ARV
2.3. Phan tich sd lieu: Sir dyng phan mem SPSS, ti'nh toan ty te, xem xet sir khac biet ve kien thii'c va thi/c hanh giiJ^a nhdm tuan thii tdt va tuan thii han che dira tren ti'nh toan chl suat chenh, ngu'dng gla tri tin cay, mire y nghia thong ke95%p<0,05.
III. KET QuA
Bang 1. Kien thu'c ciia benh nhan ve benh
N9i dungl.Cach uong thuoc 2.Tac dung phu hay gap 3. Lay truyen HIV
Dunq Sal + Khong biet Dunq Han che Dunq Sai+ khonq biet
Nam 197 (99,0%)
02 (1,0%) 24 (12,1%) 175 (87,9%
175 (87,9%) 24 (12,1%)
Nff 47 (97,9%)
01 (2,1%) 08 (16,6%) 40 (83,4%) 42 (87,5%) 06(12,5%)
Tong (n=247) 244 (98,9%)
03 (1,2%) 32 (13,0%) 215 (87,0%) 217 (87,9%) 30 (12,1%)
Nhanxet:T\ le benh nhan cd kien thirc ve benh cao nhu"each udng thudc diing (98,9%), hieu filing du'dng lay truyen HIV (87,9%). Tuy nhien tl le benh nhan ed kien thirc dung ve tac dung phu cua thuoc cdn thap (13,0%).
Bang 2. Kien thu'c cua benh nhan ve dieu tn ARV N$i dung
l.l^uc di'ch dieu tri
2.Khi nao bat dau d^u trj 3.Hau qua khong tuan thiJ dieu tn 4.Ldi ich Clja dieu tri
Dijnq Han che Sal + Khonq biet Dunq Han che Sai + Khonq biet Dunq Sal + Khonq biet Dljnq Han che
Nam 140 (70,4%) 55 (27,6%)
04 (2%) 136 (68,3%) 47 (23,6%) 16 (8,1%) 116 (58,3%)
83 (41,7%) 195 (98,0%) 4 (2,0%)
Nu' 32 (66,7%) 14 (29.1%) 02 (4,2%) 35 (72,9%) 11 (22,9%) 02 (4,2%) 33 (68,7%1 IS (31,3%) 47 (98,0%) 01 (2,0%)
Tong (n=247) 172 (69,7%)
69 (27,9%) 06 (2,42%) 171 (69,2%) 58 (23,5%) 18 (7,3%) 149 (60,3%) 98 (39,7%) 242 (98,0%) 05 (2,0%) Nhan xet: ti le benh ntian co kien thu'c ve dieu tri ARV cao nhu' hieu biet dijng ve mijc dich dieu trj (69,7%), thcfl di^m bat dau dieu tri ARV (69,2%), va I d ich cua dieu tri (98,0%)
Bangs. Mo ta thiTc hanh uonq thuoc cua benh nhan theo qidi.
Dac diem l.Siy dung dijng cij nhac uonq tliuoc 2.Thu'c hanh uong khi pliat hien quen thuoc S-Thilc hanh khi gap tac dunq phu
Co it nhat 1 fan Khonq Dunq Khonq Dunq Khonq
Nam(l)
146(73,4%) 53 (26,6%) 173(86,9%) 26(13,1%) 137(68,8%) 62(31,3%)Nu-tai 38(79,2%) 10(20,8%) 36(75,0%) 12(25,0%) 36(75,0%) 12(25,0%)
Tonq 184(74j5_%l_
63(25,5%) 209(84,6%) 38(15,4%) 173(70,0%) 74(30,0%)
P Pi,2>0,05 Pi,z<0,05 Pi,2>0,05
Y HQC VIET NAM THANG 4 - s6 2/2013
Nhan xet:J\ le benh nhan silT dung it nhat mot dijng CM nhac uong thuoc chiem (74,5%), trong do benh'nhan nam sir dung dung cij n h k uong thuoc chiem (73,4%) ni? (79,2%), sir khac biet khong CO y nghia thong ke vdi (p >6,05). Ti le benh nhan thi/c hanh diJng khi phat hien quen uong thuoc (84,6%), trong do nam thu'c hanh diJng (86,9%) cao hdn nS (75,0%), su' khac biet co y nghTa thSrig ke vdi (p<0,05). Ti le benh nhan thi/c hanh dung khl gSp tac di^ng phu (70,0%), khong co su' khac biet giuci nam (68,8%) v^ nu' (75,0%) vdl (p>0,05).
Bang 4. Danh gia ti le tuan thil dieu trj theo bao cao uong thuoc cua benh nhan, kiem tra uong thuoc tai moi ian tai kham.
Nam (1) So bgnh nhan Nii'(2)
Tuan thil tot 135 (67,8%) 34 (70,8%)
Tuan thu trung binh, k6m 64 (32,2%) 14 (29,2%)
Chunq 169 (68,4%)
p,j>0,05
78 (31,5%)
Nhan xet: Ket qua cho thay tuan thiJ dieu trj cija benh nhan qua bao cao, kiem tra uong thuoc tai moi iSn tai kham tuan thiJ tot chiem (68,4%) nam (67,8%) nff (70,8%). Khong co si/ khac biet ve tuan thiJ tot giu'a nam va nu' vdi p>0,05.
Bang 5. Lien quan giu'a kien thilTc va tuan thu dieu tri.
Kien thCrc Kien thu'c tot
Kien thu'c trung binh, han che Tonq
Tuan t h u tot 88 (75.9%) 81 (61,8%)
169 (68,4%)
Tuan thil trunq binh, Icem 28(24,1%) 50 (38,2%)
78 (31,5%)
D,OR p<0,05 0R= 1,940
9 5 % a [1,117-3,3711
247 Nhan xet: ti le benh nhan tuan thii dieu trj tot, kien thu'c tot chiem (75,9%), cao hdn so viSi nhom tuan thii trung binh va kem (24,1%), khac biet c6 y nghTa thong ke vdi p<0,05. Moi lien quan CO y nghTa thong ke giii'a kien thirc va tuan thii dieu tri vdi p<0,05 0R= 1,940 ; 95% a [1,117-3,371].
Thu'c hanh l.Sir dung dyng cu nhac uong thuoc.
2.ThUc hanh uong khi phat hien quen uong thuoc
a.ThUc hanh khi gSp tac dung phu
Co it nhat 1 lan Khdng Oiinq Khdng on djnh
Diinq Khdng on djnh
Tuan thu tot ( 1 1 128 (69,6%)
41 (65,1%) 148 (70,8%) 21 (55,3%) 123 (71,1%) 46 (62,2%)
Tuan thu trung binh ( 2 )
44 (23,9%) 20 (31,7%) 49 (23,4%) 15 (39,5%) 44 (25,4%) 20 (27,0%)
Tuan thu kem ( 3 ) 12 (6,5%) 02 (3,2%) 12 (5,7%) 02 (5,3%) 06 (3,5%) 08(10,8%)
P Pi,i>0,05;
Pi^3>0,05;
P J \ > 0 , 0 5 ; Pi.2>0,05;
Pi,3>0,05;
p2'3>0,05;
Pl z>0,05;
Pi,3>0,05;
pj i>0,05 Nhan xet: Nhdm benh nhan tuan thii dieu
trj tot cd ty le thiTc hanh diing vdl viec sir dung dung cu nhac thuoe, thiTc hanh udng khi phat hien quen thude va thu'c hanh khi gap tae dung phu (69,6%, 70,8% va 71,1%) cao hdn nhdm tuan thil tnjng binh (23,9%, 23,4% va 25,4%) va tuan thu han che (6,5%, 5,7% va 3,5%), tuy nhien su"
khac biet khdng cd y nghia thdng ke vdl p>0,05.
IV. BAN LUAN
Dieu tri ART nham keo dai va tang chat lu'dng cude song ciia benh nhan cd HIV va gdp
phan lam giam lay truyen HIV trong cpng dong.
Tuy nhien thanh cong vdi dieu trj ART phu thupc vao rat nhleu yeu to va quan trong nhat la viec tuan thil dieu tri. Nhieu yeu to la rao can doi vdi tuan thli dieu tri. Nghien ciTu cua Nachega tai Nam Phi eho thay phan Idn benh nhan hieu ve tam quan trpng cua tuan thii dieu trj, thi/e te ty le benh nhan khong hieu viec thieu lieu thuoc cd the dan tdi tien trien benh (35%) hoac tang ty le mac (44%) [4].
Ket qua nghien ciiu ciia chung toi cho thay ty le benh nhan co kien thirc ve benh nhu* each udng thuoe dung (98,9%), hieu dung du'dng lay
Y HOC V l | T NAM THANG 4 - S 6 2/2013 truyen HIV (87,9%). Tuy nhien ti le benh nhan
CO kien thirc diing ve tac dung phu eiia thuoe edn thap (13,0%).
Ti le benh nhan co kien thu'c ve dieu t n ARV nhu" hieu biet dung ve muc dfch dieu trj (69,7%), thdi diem bat dau dieu trj ARV (69,2%), va ldi fch ciia dieu tn (98,0%). Benh nhan cd kien thifc ve dieu tri ARV tot co ddng gdp quan trpng eua tu"
van vien va bae sT dieu t n , giup cho ho tin tu'dng vao dieu trj va thiTc hanh tuan thii dieu trj tdt hdn. Nghien ciru ve hieu biet ciia benh nhan ve phac do dieu trj va tuan thii tai phdng kham ngoai tru cho thay ty Ie trung binh tuan thii du'di milt mong ddi nhat la 7 1 % , tuy nhien hieu biet ve thuoc va lieu lam cai thien tuan thii, cir tang 0,10 ve hieu biet phae do va lieu diing ciia benh nhan ket hdp vdi tang tuan thit khoang 2 % [ 3 ] .
Kien thirc eiia benh nhan ve benh va thu'c hanh dieu trj ARV cd lien quan thuan, ty le benh nhan sir dung it nhat mdt dung cu nhac udng thuoe chiem (74,5%); thi/e hanh diing khl phat hien quen udng thuoc (84,6%); thu'c hanh dung khl gap tac dung phu (70,0%).^
I^dt dieu tra ngang, tai An dp, nam 2004, tai 6 phdng kham edng lap va tu" nhan md ta dac diem KAP ciia benh nhan dieu tri ARV. Trong sd 1667 ngu'di phdng van, 609 (36%) da nghe ndi ve ART va 19% trong so nhu'ng ngu'di nay eho rang ARV cd the dieu tri khdi HIV. Can t r d chfnh cho a\eu t n ARV la gia (33%) thieu hieu biet ve ARV (41%). Nhin chung hieu biet ve ART thap, ty le benh nhan tiep can dieu tri ARV tai cd sd cdng lap thap [5]. Nghien cii'u ciia Vd thi Nam, ty le benh nhan cho rang ARV khdng chu'a khoi HIV/AIDS la 9 4 , 1 % va kien thu'c dung ve tuan thil dieu tn la 55,4%.
Ket qua nghien ciru ty le tuan thii danh gia qua bao cao, kiem tra uong thuoe tai mol ian tai kham tuan thii tdt chiem (68,4%) nam (67,8%) nO" (70,8%). Khdng cd sir khae biet ve tuan thii tot giu:a nam va nu' vdi p>0,05, t i le benh nhan tuan thil dieu trj tot, kien thirc tot chiem (75,9%), eao hdn so vdi nhdm tuan thu trung binh va kem (24,1%), khac biet cd y nghTa thdng ke vdi p<0,05. Mdi lien quan cd y nghta thong ke
giij'a kien thirc va tuan thii dieu tri vdi p<0,05 OR=1,940 ; 9 5 % Q [1,117-3,371]. Khdng cd ket hdp giCTa khdng tuan thii vdi tudi, gidi, trinh do van hda, thdi gian dieu tri ARV, khdng sir dyng dung cu nhac thudc, bdc Id HIV, benh nhan cd kha nang trao doi vdi nhan vien y te, khoang each tir nha den phdng kham [ 2 ] . Benh nhan thu'dng bao cao tuan thii cao hdn so vdi thu'c te vi sd bi dirng dieu tri tir chu'dng trinh ART. Nhan vien y te danh gia tuan thii ciia benh nhan cao hpn vi hp sd phan anh chat lu'dng cdng viec.
Nghien eiru eiia Vu thj Nam eho thay ty le danh gia tuan thii tot la 92,9%, ed lien quan giij'a tuan thil dieu tri va kien thirc ve dieu t n ARV [ 1 ] .
V. KET LUAN
Duy tri kien thiTc va thifc hanh udng thudc diing each la ho trp quan trpng eho viee tuan thu tot dieu tri ARV ciia benh nhan HIV/AIDS.
TAI LIEU THAM K H A O
1. Vo Thj Nam (2010). Xac dinh ty le va yeu to lien quan tdi viec tuan thii dieu tri ARV & benh nhan HIV/AIDS tai thanh pho Cin Thd, nam 2009. Bao cac hoi nghi quoc gia phong chong HIV/AIDS lan thir IV, chuyen de 9. Ha noi, thang 12/2010. http://www.vaac, gov.vn/
2. D6 Mai Hoa. (2011). Antiretroviral therapy (ART) adherence among people living with HIV/AIDS (PLHIV) in the north of Vietnam: a multi method approach. PhD thesis, Queensland University of Technology.
3 Miller LG et al. (2003). Knowledge of antiretroviral regimen dosing and adherence: a longitudinal study. Clinical Infectious Diseases 36 -t. Nachega JB. (2005). HIV/AIDS and
antiretroviral treatment knowledge, attitudes, beliefs, and practices in HIV-infected adults in Soweto, South Africa. J Acquir Immune Defic Syndr: 38:196-201.
5. Sunei R Ramchandani, Shruti H. Mehta, Dattatray G. Saple et al (2007). Knowledge, Attitudes, And Practices of Antiretroviral Therapy among HIV-infected Adults Attending Private And Public Clinics m India. AIDS Patient Care and STDs. February 2007, 21 (2); 129-142.
