— • TAP CHI NGHIEN CU'U Y HOC
TRAM CAM (y THANH VIEN GIA DJNH
CUA NAM TIEM C H I C H MA TUY NHIEM HIV TAI HA NQI NAM 2016
Dao Thi Dieu T h u y \ T r l n Minh Hoang^
Dinh Thanh Thuy^, Pham Phipcng Mai^ Le Minh Giang^'^
'Bac sin&i tru Y hqc Dw phdng khda 40, Trw&ng Dai hqc YHa Nqi,
^Trung tim Nghidn ciru vi Dio tqq HIV/AIDS, Trw&ng Bai hqc Y Ha N&i.
^Bd mdn Sire khde Toan ciu, Trw&ng Dai hqc Y Ha Ndi Da so ngu&i tiem chich ma tuy a Viet Nam dang song cung gia dinh va diiu nay tqo ra ganh nang khdng nho trqng vide cham soc Muc tieu nghidn cwu li md ti dac diem trim cam a thanh vien gia dinh cua nam tiem chich ma tuy nhidm HiV va mdt sd yeu Id iidn quan Si lieu nghien cuu cit ngang thu thap tw 138 ngw&i la thanh vien gia dinh cua nam ti&m chich ma tuy nhiem HIV tai Ha Noi Kit qua nghien cuu cho thiy cd xip xi 20% miu nghien ciru co diu hieu trim cam & muc do tu nhe din rit nang Ganh ning cham sdc vi mdi quan he gia dinh cd lien quan v&i trim cam & thanh vien gia dinh Nghien cuu cho thiy nhu ciu can thidp de cai thien mdi quan he gia dinh. giam b&t ganh nang chim sdc nhim nang cao sire khoe hnh than a thanh vien gia dinh nguai tiem chich ma tuy nhiem HiV
lip khoa: tram cam, tiem chich ma tuy n h i l m HIV, ngu'di cham soc
I. OAT
VANBt
Cf Viet Nam, luu hgnh su dung ma tOy cd lich su lau dai [1]. Den nam 2013, ca nude cd hgn 180 nghin ngudi nghidn ma tiiy, tang hgn 3 lln so vdl nam 1994 vdi mue tang x l p xi 6 nghin ngudi nghien mdi nam [2] Tiem chich ma tiiy ia nguygn nhgn chinh gay biing phgt dich HIV tai Viet Nam [3]. Ket qua giam sat trong dilm HIV nam 2015 chg thly ty le nhilm HIV trong nhom tigm chich ma tiiy v l n la eao nhlt trong cac nhdm nguy eg cao [4],
Nhigu nghign ciru tren t h i gidi chi ra ring nghien c h i t la mdt v l n d l ciia gia dinh do dd moi quan tam duac md rdng sang gia dinh ngudi su dung nghign ehlt Mdt nghign cuu tai Nhat Ban cho thly quan he trgng gia dinh cd lign quan chat che tdi kha nang eai nghign Dia chi lien he Dao Di§u Thuy Sdc sT nqi tru Y hoc Dw phong. Truung Dai hoc Y Ha Ndi
Email' [email protected] Ngay nhin- 06/01/2017 Ngay duac chap thuan 26/2/2017
eua ngudi sO' dung ma tuy [5] Hd trg tmh thin tir gia dinh cung tae ddng tieh cue d i n su tuan thu d i l u tn HIV a nhung ngudi tigm chich ma tiiy nhiim HiV [6] Mdt s l dac diem cua ngudi cham-see cd m i l lien quan vdi kha nang kilm soat tai luang virus d bgnh nhgn HIV/AIDS ed tiem ehleh ma tdy [7] Cac nghien cuu cung ghi nhan mire do ky thi va t r i m cam d ngudi tiem chich ma tiiy cd hdn quan tieu cue d i n sue khde tam thin ciia thanh vign gia dinh [8]
Trong bdi canh Viet Nam, gia dinh co vai trd quan trong ddi vdi ngudi tiem chieh ma tuy va ngudi nhilm HIV [9] Nghign cdu cho thly khoang 60 - 80% ngudi tigm chich ma tiiy nhilm HIV bao eao ho dang song ciing bd me hoae ban ddi [10, 11] Trong gia dinh cd ngudi nhigm HIV lam tang nguy ca tram cam d nhtrng ngudi chgm sdc, Viee su dung ma tOy d ngudi benh HIV/AIDS cung duae chung minh la yeu t l nguy eg cOa hdi chirng trim cam d thanh vien gia dinh [12] Tuy nhien, v l n
TCNCYH 106(1)-2017
;U Y HOC - cdn it nghign cuu trong nude ve sire khde tgm than ndi chung va t r i m cam ndi ndng trong nhdm thanh vign gia dinh eua nam tiem chich ma tOy nhilm HiV Vi vgy, nghidn eiru nay dugc thuc hign vdi muc tigu md ta dgc diem trim cam d thanh vien gia dinh eua nam tidm chich ma tiiy nhilm HIV vg cac y l u t l lign quan
II. D 6 I TU'gNG VA PHU'aNG PHAP
1. D6I tu'ang
Thanh vign gia dinh la ngudi cham sdc chinh ciia nam fiem chich ma tiiy nhigm HIV tai Ha Ndi
, Tieu chi lu-a chon: Tuoi tii' 18 trd len. ed hd khau d Ha Ngi, cd kha nang hieu ban thda thuan nghien cdu va ddng y tham gia
2. PhU'O'ng phap
Nghien cuu s u dung thiet kg md ta c i t ngang, thu thgp s l ligu b l n g phdng van true tilp d l i tuang trgng thai gian tir thgng 1/2016 den thang 10/2016.
Camiu
C d m l u tinh theg cdng thirc udc tinh mdt ty le trong q u l n the.
, P (1 -P) 0,479 (1 -0,479)
n-Z",i-a/2) =1,96^ =105 (E P ) '
Trong do, p = 0,479 la ty le t r i m cam g thanh vien gia dinh nam tigm chieh ma tiiy nhilm HIV lly tir mdt nghien eiru tai Trung Quoc ngm 2013 [13], sai lech tuang d l i giua tham s l m l u vg tham s l quln t h i chen z = 0,2, mdc <j nghla thing ke chgn a - 0,05 ngn Z(i-a(3) = 1,96, Tinh ra cd m i u la 105 ngudi.
Du phdng tir c h i i tham gia nghien ciru la 15%, vay cd mau c l n thilt Id 120 ngudi Thuc te, nghien cuu tuyin chon duae 138 ngudi
Cdng cu va phwang phap thu thap thong tin
Thu thap thdng tin v l dae d i l m nhan khIu hoc eua nhdm d l i tuang.
Do ludng tram cam sir dung cau p h l n T r i m cam trong thang do riit ggn T r i m cam - Lo a u - S t r e s s (DASS-21) [14]. Cdng cu gdm 7 cau hdi md ta d l u hieu/ cam xue cua ngudi tra Idi trong vdng 1 t u i n trudc thdi d i l m phong v l n Ivloi cau cd 4 phuang an lua chon tuang irng 4 mire dd d i l m tir "0 - Khdng dung chilt nag" d i n "3 - Hgan tgan dung", tong
(0,2 0,479)'^
d i l m t u 0 - 21 diem, chia thgnh 5 mire dO trim cam t u "Rat nhe" den "Rlt nang",
Danh gia mdi quan he gia dinh sir dung Thang do quan hg gia dinh (Family Function Scale) [15] Cdng cu gdm 15 eau, chia d l u trong 3 c l u p h l n : (1) Su dogn kit, (2) Su mgu thuin, (3) M i l quan he xa hdi cua gia dinh M i l eau ed 4 phuang an tuang irng 4 mire do diem tir "1 - Khdng dimg chiit ngo" d i n "4 - R l t dung". Mdi quan hg gia dinh duac dgnh gia b l n g tdng d i l m e l u p h l n "Su dogn kit" va
"Mdi quan he xa hdi", sau dd trir di diem eau phln "Su mau thuin". Diem cang eao the hien m l i quan hg trong gia dinh cang tich cue
Do ludng ganh nang chgm sdc su dung Bd cgu hoi sang loc ganh nang chgm sdc phat trien t u Thang do ganh ngng cham sdc (a = 0,82). Cdng cu gdm 19 eau hdi, ehia thanh 3 c l u phln: (1) Ganh nang tai chinh, (2) Ganh nang sire khde, (3) Ganh ngng cam xiic Moi cau cd 5 phuang an tuang irng 5 muc dO digm tir "1 - Hoan toan khdng" den "5 - Hoan
TCNCYH 106(1)-2017
• TAP CHl NGHIEN CU'U Y HOC toan ddng y". Ganh nang cham sdc duac
danh gia b l n g tong diem cua ca ba c l u phln, diem cang cao cgng t h i hidn muc dd cua ganh ngng.
Phan tich sd lieu
Du lieu duac nhgp b l n g phln m l m Epi Info 7 va phgn tich blng phan m l m Stata 14, Sd dung trung binh va ty lg 6e md ta cgc biln dmh lugng, dmh tinh Su dung t test hoac Hflann-Whitney de tim su khgc biet trung binh giua hai nhdm; khi binh phugng hgae Fisher
de tim s u khac bigt ty le giua hai nhdm. Su dyng tugng quan tuyin tinh d l tim m l i tugng quan giCra tdng cap cgc bien lign tgc: tram cam, moi quan he gia dinh, ggnh ngng chSm sde, H l i quy da biln dugc su dung d l xgc dmh mpt s l y l u td hen quan d i n trim cam.
3. Dao du'c nghien cii'u
Nghien ciru dugc Hgi d i n g Dao dire trong nghign cuu Y sinh hoc cua trudng Dai hoc Y Ha Ndi xem xgt va phe duyet (giay chip thuan so: 144/HDDDDHYHN) ngay 18/7/2014.
I.
KET QUA1. Dac d i l m ddi tu'ang nghien CLPU
Bang 1. Dac d i l m chung cua ddi tu'ang nghien c i f u
Sd lu'gng/ Trung binh %/ SD Tuoi
<29 3 0 - 3 9 4 0 - 4 9
44,6 17 48
14,6 12,3%
34,8%
18,1%
Hpc van Mil ehu'/Tilu hoc Trung hoc eg sd
16 51
11,6%
37%
Nghe nghiep
dn d|nh (nhg nude, vgn phdng, ) it I n dmh (ndng dan, l u do, )
5,8%
89,1%
Mo; quan he gia dinh (0 • 100) Doan k i t
Mgu thuin
43,2 65,7 37,4
16,4 12,6 11,5
Ganh nang cham soc (0 -100) Kmh t l
Sue khde
50,2 65,6 45,7
14,7 18,6 17,3
TJBIP CHl NGHIEN CU'U Y HOC — ^ SD (Standard Deviation)- Dp lech chuin
Bang 1 cho thay tuoi trung binh ciia thgnh vign gia dinh nam tidm chich ma tuy nhilm HIV la 44,6 tuoi (±14.6) Hai nhdm tudi chilm da sd la nhdm tir 30 - 39 va trgn 50 tuoi Ch! cd 51,4%
trong tong s l thanh vien gia dinh tham gia nghign cuu cd hoc v l n tix trung hoc pho thdng trd len Da s l nghi nghiep khdng cd thu nhap I n dmh nhu lam ndng, xe cm, t u dg
Diem trung binh danh gig moi quan he gia dinh t h l p han mire trung binh (43,2 diem trgn thang 100 dilm) Ganh nang cham sdc co gig tri trung binh 50,2 tren thang diem 100, tuy nhien elu phln ganh nang v l kinh t l chilm uu t h i han so vdi hai e l u phan ganh nang sire khoe va ganh ngng cam xiie
2. Dac diem t r i m cam cua ddi tipgng nghien cu'u
Bang 2. Ty le t r i m cam cua thanh vien gia dinh nam tiem chich ma tuy n h i l m HIV _ Ty le t r i m cam theo cac mii'c do
X ± S D '• : Binh thu'dng Nhe VOa Nang Rat nang Tram cam 2,7 ±3,7 111 (80,4%) 8 (5,8%) '12 (8,7%) 4 (2,9%) 3 (2,2%)
rCMT Ti^m chich ma tiiy
Bang 2 cho thay diem trung binh t r i m cam eua thanh vign gia dinh khdng cao (2,7 diem).
Tuy nhien cd 19,6% trong tong s l ngudi tham gia nghign cuu cd d l u hieu t r i m cam tu nhe din rlt nang, 13,8% e d d l u higu trim cam vira, ngng hoac rlt nang,
3. Mpt s6 y l u t l lien quan t r i m cam ciia ddi tu'ang nghien cu'u
Bang 3. Tifang quan t u y i n tinh giti'a cac b i l n djnh lu'gng nghien cieu T r i m cam Mdi quan he gia dinh Ganh nang cham soc Trim cam 1
M i l quan he gia dinh Ganh nang cham sde
-0,337' 0,586"
1
-0,384" 1
p < 0.001
M i l quan he gia dinh cd tuang quan nghich vdi t r i m cam cOa thanh vien gia dinh nam tiem chich ma tiiy nhilm HIV (r = -0,337, p < 0,001), Ganh nang cham sdc cd tuang quan thuan vdi tram cam d thanh vign gia dinh (r = 0,586; p < 0,001). Bgn canh do ggnh nang cham sdc cung cd tuang quan nghich vdi mdi quan hg trong gia dinh (r = -0,384, p < 0,001).
TCNCYH 106(1)-2017
- TAP CHi NGHIEN CU'U Y HOC Bang 4. Yeu t6 lien quan d i n trim cam o- doi tu-g-ng nghien cii'u
Thanh p (95%CI)
vien gia dinh P Tram cam^
Mdi quan he gia dinh Ganh nang cham soc ThSng so m6 hinh
-0,029 (-0,056; .0,001) 0,137(0,095,0,18) R ' = 3 6 , 4 % , R M S E = 3
<0,05
< 0,001
< 0,001
^ Hdi quy da biin phwang phSp OLS (ordinary least squares), chi tieu VIP cho thiy hiSn twang da cong tuyin trong mo hinh khong nghiam trong, kiSm dmh White kiim tra phwang sai thay d6i sau do dOng sai s6 chuin robust khSc phuc, do vay cac h§ s6 w&c Iwang cua mo hinh vin c6 thi sir dung 'RMSE Root mean squared error; TCMT. Tiem chich ma tuy.
Kit qua hli quy tuyen tinh da biln duac trinh bay d bang 3 Md hinh ed y nghTa thing ke vdi p
< 0,001, giai thich cho 36,4% su biln thign cua tram cam a thgnh vign gia dinh K i t qua chi ra mli quan he gia dinh va ganh nang cham sde ed m l i lign quan vgi t r i m cam (|3 = ,0,029" p < 0,05 va p = 0,137, p < 0,001).
IV. BAN LUAN
Nghign eiru da t i l n hanh tren 138 ngudi tham gia la thanh vien gia dinh ed vai trd ho trg chinh eho nam tigm chich ma tiiy nhilm HIV tai Ha Ndi
Tuang d i n g vdi eae nghien eiru khac, t u l i trung binh cua thgnh vien gia dinh nam tiem chieh ma tuy nhilm HIV d l u Idn han 40 [12, 13] Hoc v l n tie trung hoc pho thdng trd len va ty le cd n g h i nghigp eao hgn nghign cuu khae [13] Ganh nang chgm soc eCia thanh vign gia dinh g mire trung binh (50,2 ± 14,7), dilu ngy phii hgp vdi k i t qua mdt nghien eiru g Phu Thg nam 2013 [12] Mdi quan hg gia dinh dao ddng quanh mire trung binh (43,2 ± 16,4), cao hgn k i t qua nghidn cuu khgc [12].
Ty le thanh vign gia dinh cd dau hieu t r i m cam g mire t u nhe d i n r l t ngng la 19,6%, thlp hgn nhilu so vdi nghien euu cua Claire nam 2013 [13] Cd s u khac nhau nay lg do
nghign cuu eua Claire sir dung thang do t r i m cam va lo au bgnh vien (HADS), thue hien d i l u tra tu nam 2011, d i l u tra vien chi tiep can thanh vign gia dinh eiia nhung ngudi tiem chich ma tiiy nhiem HIV dang dieu tri tai mdt phdng kham d i l u tri HIV va phuc hoi, cae benh nhan HIV/AIDS nay thudng nang hen nhung ngudi benh trong edng dong.
K i t qua nghien ciru cho thly ganh nang cham sdc lign quan thugn chilu ed y nghla thing ke vdi t r i m cam d thanh vien gia dinh Dieu ngy phii hap vdi k i t qua eua cac nghign cuu trudc dd chung mmh rang ggnh nang cham sdc lam tang mue dd trim cam d thanh vien gia dinh [12, 16], Ben canh dd, ggnh nang cham sdc ciing la y l u t l ed tuong quan vdl m i l quan he trong gia dinh (r= -0,384, p <
0,001), k i t qua eung tuang d i n g nghidn cuu khac [12]
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TAP CHI NGHIEN CU'U Y HOC •
Cd su hen quan giua dSc d i l m m l i quan he gia dinh vg kha nang tram cam d thanh vien gia dinh Mdi quan h# gia dinh do thgnh vien gia dinh bao ego ed moi lien quan nguge chilu vdi t r i m cam d nhdm thanh vien gia dinh, chi ra rang khi cam thly m i l quan hg gia dinh cgng tieh cue thi kha nang t r i m cam d thanh vien gia dinh cam t h l p Cac m i l lien quan deu cd y nghTa thong kg va phO hop vdi nghien cuu khac [5, 12].
Nghien cuu cung cd mdt s l han che c l n luu y Thu nhlt, nghien ciru tiln hgnh tren nhtrng ddi tuang ta thanh vien gia dinh eua nam tigm chich ma tuy nhilm HIV smh s i n g va cd hd khau tai Ha Ndi Vi vay, viee ngoai suy ra quln t h i tnanh vign gia dinh ciia nam tidm chich ma tiiy nhilm HIV c l n duac thgn trgng Thir hai, thilt ke nghign ciru e l t ngang nen khdng the diing d l k i t luan m l i quan hg nhan qua
V. K^T LUAN
Nghien eiru nay eho thly ty Id gap d l u hieu trim cam d thdnh vidn gia dinh cua nam tiem chich ma tiiy nhilm HIV cung tuong d l i cag (xlp xi 20%) Mdi quan he trgng gia dinh va ggnh nang cham sdc ed lign quan ed y nghTa thing kg den tram cam cua thgnh vign gia dinh, Nghign cuu eho thly can ed eae bien phap cai thien m i l quan he gia dinh va giam bdt ganh nang cham sdc n h l m giiip cac gia dinh cd ngudi sir dung ma tiiy nhigm HIV doi phd vdl v l n d l tram cam ndi ndng vg sdc khde tam thin ndi chung cOng nhu ngng cao chit lugng chgm sdc ngudi than cd nghien ehich ma tiiy,
Lo'i cam en
Nghien cuu nay duac thuc hien bdi Trung tam Nghign cuu va Dgo tao HIV/AIDS trudng
Dai hoe Y Ha Ngi nam 2016 Tac gia xm cam an sy hd trg ciJa Cue phdng chdng HIV/AIDS, Bd Y t l , cae can bd phdng kham SHP, Trudng Dai hoc Y Ha Ndi, ciing 138 ngudi da tham gia vao nghien ciru
T A I L I E U THAIVI K H A O 1. Vu Doan Trang (2001) Harm Reduction for Injecting Drug Users m Vietnam' A Situa- tion Assessment, Report for Macfarlane Bur- net Centre, Victorian Public Health Training Scheme, Hanoi, Vietnam,
2. Bo Lao Dong - Thu'O'ng Binh va Xa Hpi (2014) Doi mdi edng tac cai nghien ma tuy g Vigt Nam d i n nam 2020, Hg Ndi.
3. PHI 360, Bo Y t l (2014) Danh gia hieu qua eua chuang trinh thi d i l m d i l u tn nghien eac ehlt thulc phien bang Methadone,
4. Cue phdng chdng HIV/AIDS (2016) Bgg cao Cdng tae phdng, chlng HIV/AIDS nam 2015 va eae nhigm vy trong tam nam 2016.
5. Nobuaki Morita, Nobuya Naruse, et al (2011) Mental health and emotional relationships of family members w/hose relatives have drug problems, Japanese Journal of Alcohol Studies & Drug Dependence, 46(6), 525 - 541
6. Matthevi/ J.MImiaga, Steven A.Safren, et al (2010) We fear the police, and the police fear us' structural and individual barriers and facilitators to HIV medication adherence among injection drug users in Kiev, Ukraine AIDS Care, 22(11), 1305-1313
7. Marry M. Mitchell, Allysha C.Robinson (2015) Informal Caregiver Characteristics Associated with Viral Load Suppression Among Current nr Former Injection Drug Users Living with HIV/AIDS AIDS & Behavior, 19(1), 2117-2122
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8. Yunfei Lv, Qun Zhao (2010) Depression symptoms among caregivers of children in HIV-affected families in rural China AIDS Care, 22(6), 669 - 676,
9. Nguyen NTT, Rasch V, Bygbjerg IC, Mogensen HO (2012) Pursuing Treatment and Moral Worth. HIV-infected Women in a Northern Province of Vietnam Living With Antiretrovirai Therapy. Journal of the Association of Nurses in AIDS Care, 23(4), 339 - 349.
10. Tran BX, Ohinmaa A, Duong AT, Do NT et al (2011) Changes in drug use are associated with health-related quality of life improvements among methadone maintenance patients with HIV/AIDS. Quality of Life Research. 21(4), 613 - 623
11. Go VF, Frangakis C, Nam LV, Sripaipan T et al (2011) Characteristics of High-Risk HIV-Positive IDUs in Vietnam Implications for Future Interventions Substance Use and Misure, 46(4), 381 - 389,
12. Li Li, Nguyen Anh Tuan, Martin Flore
TAP CHl NGHIEN CU'U Y HOC
(2013) Mental health and family relations among people who inject drugs and their family members m Vietnam International Journal of Drug Policy, 24, 545 - 549,
13. M. Claire Greene, Trace Kershaw (2013) Mental Health and Social Support among HIV-positive injection drug users and their caregivers in China. AIDS & Behavior, 17, 1775-1784
14. P.F.Lovibond, S.H.Lovibond (1995) The structure of negative emotional states Comparison of the Depression Anxiety Stress Scales (DASS) with the beck Depression and Anxiety inventories Behaviour Research and Therapy, 33(3), 335 - 343
15. Bernard L. Bloom (1985) A Factor Analysis of Self-Report Measures of Family Functioning Fam Proc, 24, 225 - 239
16. Ramesh C.Chauhan, Sanjay K.Ral (2016) Burden Among Caregivers of Children Living with Human Immunodeficiency Virus in North India North American Journal of Medical Sciences. 8(3), 129 -133
Summary
DEPRESSION AMONG CAREGIVERS OF HIV - POSITIVE INJECTION DRUG USERS IN HANOI, 2016
Most of people who inject drugs in Vietnam live in their family homes and these living have formed the burden on caring This study aimed at exploring the charaeteristie of depression of caregivers of HIV - positive injection drug users and relative factors Cross - sectional assessment data were gathered from 138 caregivers recruited from Hanoi city About 20% of the study sample had a depressed condition from mild to extremely severe Caregiver burden and family function were significantly associated with depression of caregivers This study addressed the needs of intervention to improve family function and to decrease caregiver burden aimed at raising mental health of caregivers of HIV - positive injection drug users
Keyw/ords: depression, HIV-positive injection drug user, caregiver
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