TUAN THU Dl^U TRj ARV VA MOT S6 Y^U T 6 LIEN QUAN Diroug Th} Hirvng, Nguyen Thj Tu
Dpi hpcy Hdi phdng;
Trung tdm y ti Ngd Quyin, Hdi Phdng
Mi^c b&u: xac djnh ty 1$ tufin thu diiu trj ARV vi mOt s i ylu tb inh hirdng din tuSn thO. Phi/cng phdp:
Thiit k i nghidn ci>ij mO t i cit ngang, g6m 124 b$nh nhfin HIV/AIDS du tidu chuin vfi duvc diiu trf ARV tai qu$n Ngfl quy^n tfnh ti> 9/2005 - 12/2007. Xdc djnh mCrc 30 tufin thO qua dfinh gii cOa thiy thuic, b$nh nhfin ti/ dfinh gifi vfi nhOng kh6 khfin g^p phfil khi tufin thO thOng qua phliu phdng vin. Kit qui: Tj 19 tufin &1U diiu t i t i t 87,9%; si/ khfic bl$t giO nhim khOng si> dgng ma tu;? v i b nhdm sir dgng ma tuy (90.6% vfi 83.6%) khflng c6 y nghTa thing kd [p > 0.05; OR = 1,898; Cl 95% (1,308 - 4^262)]. Cfic yiu t i finh hirdng tit din tufin thu nhir cb vi$c lfim An djnh, tham gia cfiu l^c bfl ding ding, thfl'i gian khflng cd binh nhiim tKing ccr hfli. Kit luin: Tuin thiH diiu tri tit l i 67,9%, cin phii dirgFc cii thi$n d i cd dirgv hl$u qui diiu trt vfi di/ ph6ng khfing thuic. B^nh nhfin c6 vl$c Ifim i n djnh vfi tham gia cfiu lac bfl ding ding, ngudi nhfi h i tn? uing thuic, giiip cho vi$c duy tri tit tufin thu. B$nh nhfin dang c6 b$nh nhiim Inlng ccr hfli cin dirgrc tfing cird'ng h6 trg'.
Tit kh6a: ART, tufin thCi diiu tr|, b$nh nhfin HIV/AIDS
•ART: antiretroviral therapy, ARV:antiretrovinjs I. DAT VAN DE
Tuan thu diSu tri dong vai tio quan tiipng tiong thinh cong dieu trj ARV eho b§nh nhan HIV/AIDS va du phfing khang tiiuoc. T^^ 1$
tuin thu phii d?t toi thieu tren 95% vi duy tri tn dinh dlSu tri su6t doi [I], [2]. Nhieu nghien cuu trade day cho thay benh nhin b6 tii khim ngay sau Idu bit diu dieu tri gis tang nguy co tt^ vong sdm v i mat theo doi.Tuan thu dieu tri kem lam tang nguy eo khing voi thuoc ARV.
Nhieu ylu t6 inh huang den tuan thil ci^ b^nh nhin nhu hieu biet vk b$nh, thoi gian dilu tq, d$c diem nhan khau hpc ci^ b^nh nhan, eh4t
lupng djch vy y te [3]. Tuy nhlSn vi?c dinh gii tuan thu t^i cie co s6 dilu tri ARV t^ii cic nude e6 nguon l\re h ^ chi con rat ngh^o nan vi khic biet giiia cic vung. Phong khim quin Ngo Quyln triln khai dilu trj ARV tii nim 2005. Viec quin 1^, dinh gii tuan thii bfnh nhan c6n nhieu h ^ che do thay thuoc thieu Irinh nghidm, dich vy cham s6c phoi hpp giua cic nh6m h ^ che, lim vi^c kiSm nhi$m eung nhu nhihig khd khan tii phia b^nh nhan nhiem HIV/AIDS dang ki dilu tri. Chung toi nghidn cihi nhim xie dinh ty 1? tuin thii dieu tri v<5i ARV eua bfnh nhan HIV/AIDS vi mpt so yeu t6 inh hudng.
Tic gii: Duong Thj Huong Dia chi: D^i hpc Y Hii Ph6ng Difn tiio^ii: 0912 759 743 Email: [email protected] Ngiy nhan bii: 16/12/2012 Ngiydangbai: 20/4/2012
Phin bifn 1: P G S . T S . P h ^ V i n H i n D^i hpc Y Hii Ph6ng.
Phin bifn 2: TS. Ph^m Mmh Khue D^i hpc Y Hii Ph6ng.
Tap chi Y hpc dii phbng, T&p XXU, s6 2 (128)
II. PHlTONG PHAP NGHlfiN CtTU Thilt kk nghign cuu md tk cSt ngang.
124 b^nh nhfin dil tigu chu4n dang theo ddi vi dieu tri ARV tfti phdng I c h ^ qu§n Ng6 QuySn tinh tir 9/2005-12/2007 duiyc chpn vio nghiSn curu. SCr d ^ g bing kilm dl thu th§p thdng tin d&nh gii tuin thd ti^ b^nh in, vi bing ciu hdi b^nh nhin t\r dinh gii tuin thu vi cic ylu t l liSn quan tdi tuin thd. Ti£u chuin dinh gii tuin thd dilu trj tit >95%, dvra theo hudng dSa quic
gia [1]. Phin tich xir 1^ s l li$u sit dvng phin mim SPSS 10.0 vi test chi-binh phuong.
III. KfeT QUA
3.1. Tinh trf Dg luin thil dilu trj v i theo d51 tfti phdng khim
Ty 1$ b$nh nhin duy tri theo ddi dupe trSn 12 thing sau dilu tri chilm 79,8%. Ty 1$
mit theo ddi t^p trung d nhihig thing d ^ dilu tri, djc bi$t trong 3 Uiing diu chilm 48% sl Hnh tibia mit Uieo ddi (bing 1).
Bing 1. T$ 1$ b^nh nhin mit tlieo ddi diiu tr|
Tbeo ddi ai/grc
Mit theo dSI tlch IQy
0 - <3 thing sau diiu tr|
112 (90,4%)
12 (9,6%)
3 - <6 thing tau diiu trj
101 (81,5%)
23 (18,5%)
e-<12 thing dliutrl
99 (79.8%)
25 (20.2%)
sau 212 thing sau dliutrl
99 (79,8%)
25 (20.2%)
Dinh gii tinh trftng tuin thd dilu tri theo chd quan cda thay thulc tai cic lin tii khim ART cho thiy ty If tuan thd dilu tri tit cda benh nhan nhin chung dftt d miic 87,9%. Muc dd tuin thu tot tfti cic thiri dilm dinh gii sau
dilu tri 6, 12 vi 18 ttiing 14 83,6%, 87,1% vi 92,9%. Ty 1? tuin Uid tit theo dinh gii oia ttiay thulc vi bfnh nhin t\r dinh gii 87,9%
vi 85,9% khdng cd s\r khic bift vdi p>0,05.
(Bing 2,3).
Bing 2. Dinh gii mirc d$ tuin thu cila bfnh nhin theo chu quan cila thiy thudc
Mi>c dd tuin thu
Tdt (S 95%) TB (85 - < 95%) Kim (< 86%)
T6 (n»67)
%
83.6 11,9 4.5
T12 (n = 31)
T i
87,1 9,7 3.2
T18 (n = 14)
%
92.9 7.1
Chung (%)
87,9 9.6 2,5
• Ihai diem ttinh gii sau dieu Iri ARV 6,12 IS thing (T6, T12, TIS): TB: tmng binh
136 Tap chi Y hpc dvr phdng, TSp XXH, s62 (128)
Bing 3. So sinh dinh gli TTBT khich quan v i phdng vin tr^c tiip
Dinh gli khich quan Dinh gli chi3 quan {%) (%) 1. Tot ( a 95%)
2. TB (85-< 95%) 3. K«m (< 85%)
87.9 10,0 3.1
85,9 14,1 0
p,^ >0,05 Pij ^O-i^S p,j >0.05
* 77B7> tudn thti diiu trf
3.2. Ly do chu yeu b^nh nhSn quen u6ng thu6c
Bing 4. L^ do b$nh nhin tuin thu kim trong 1 thing qua L]^do
Khdng nhd d§ u6ng Oi xa nhi Cdng vi$c qui bin KhSo Tdng(n=99)
Sd b$nh nhin 15 7 6 3 31
T* !«(•/.) 48,3 22,6 19,4 9,7 31,2
T>' I | b^nh nhin udng diuoe khong day dli vi uong thuoc khong dung gifr Ii 31,2% so b$iih nhin dugc phdng vin. L^ do phan I6n Ii do khong nhd de uong thuoc chiem 48,3%. DI xa nhi kh6ng mang thuoc theo Ii 22,6%. Cong vi^c qui b|n khong c6 thdi gian uong thuoc li 19,4%. L^ do khic khong ro ring li 9,7%
33. Tinh trang tuin thu dilu tti ^^ '^9^ ^^
ylu t6 liSn quan
Thih tr^ng tuin thii tot l i 85,9% v i Uiin tini kim li 14,1%. Tuan Uni t6t {> 95%) d nQ gi(5i (92,3%), eao hon so vdi nam gidi (84,9%).
Nhom b§nh nhin c6 trinh d? vin hoi cao tuin thii tot hem nhdm hpc het tieu hpc (PTHT frd
len 89,2%, THCS 87,3%, tiiu hpc 57,1%);
TIBT >95% CO su khic bi^t giua nh6m gan phdng khim vi nh6m xa ph6ng khim (khoing cich t£r nhi den ph6ng khim < 5 km:88,4%, >
5 km:69,2%). Bfnh nhan c6 vi?c lim on dinh tuan thii t6t han sa vdi khong ed viec lira va khdng kn djnh (vifC 1 ^ 6n dinh:96,3%, nhdm khdng cd vi§c lim hoje ed vi§c lim nhung khdng on d{nh:8I,9%). Bfnh nhan khdng cd nhiem tning co hpi khi dilu ti\ ARV tuan thii t6t cao hon b§nh nhin ed NTCH (nhdm khdng ed NTCH:94,1%, nhdm bfnh nhan cd NTCH:67,7%). (p<0,05) (bing 5).
T?5) chi Y hgc duphdng, TSp XXH, sg 2 (128)
Bing 5. L i i n quan g\Ora TTDT v6l nhdm tuii Y i u t d
Nhdm ludi
Gidi
Trinh dd vin hda
Khoing cich ddn phdng khim Tinh trgng vi$c lim Ciu lac bd ddng ding
B^nh NTCH
DOng matuy
Cd ngudi hS irc
Hinh IhCrc hd ttv
1 2 0 - 2 9 tudi 2 30- 39 tudi 3. 2 40 tudi Ni>
Nam 1 . : : Tliu hoc
2. THCS 3. THCS 4. 2 THPT S5km
> 5 k m 6n djnh Khdng dn dinh Tham gia Khdng tham gia Khdng Cd
Khdng Sd dgng 1. Gia dlnh 2. edng ding 3. Khic 1. s i p ijch udng 2. Ghi thdi gian 3. DOng didn thoai 4. Nhd ngudi hd irc 5. Khic Chung(n = 99)
TTDT i 95%
36(81,8%) 42 (89,4%) 7 (87,5%) 12 (92,3%) 73 (84,9%) 4 (57.1%) 48 (87.3%) 48 (87.3%) 33 (89,2%) 76 (88,4%) 9 (69,2%) 26 (96,3%) 59(81,9%) 11 (100%) 74(84,1%) 64(94,1%) 21 (67,7%) 29 (90.6%) 56 (83.6 %) 70 (86,4%)
2 (100%) 11 (78.6%) 2 (66,7%) 3 (75,0%) 35(92,1%) 30 (83,3%) 15(83.3%) 65 (85,9%)
TTDT < 95%
6(18,2%) 5(10,6%) 1 (12,5%) 1 (7,7%) 12(15.1%) 3(42,9%) 7 (12,7%) 7 (12.7%) 4(10.8%) 10(11.6%) 4 (30.8%) 1 (3,7%) 13(18.1%)
0 14 (15,9%)
4 (5,9%) 10(32.3%)
3 (9.4%) 11 (16.4%) 11 (13.6%)
3(21.4%) 1 (33,3%) 1 (25,0%) 3 (7,9%) 6 (16.7%) 3 (16.7%) 14(14,1%)
P, OR Pu>0,05 p.j>0,05 p,,>0,05 p < 0.05: 0R= 1,97 (95%CI 1,352-2.588)
p,j>0.05 P„>0.05 p„>0.05 p.,>0.05 p < 0.05; OR = 3,38 (95%CI:2,876-8,027) p < 0,05; OR = 5.7 (95%CI:3,712-9.115) p < 0,05; OR =1,73 (95%CI:1.087-6,725)
p<0.05;OR = 7,6 (95%CI:3.547-11.653)
p>0.05; OR = 1.698 (95%CI:1.308-4,282)
P,j>0,05 p„>0,05 P,,>0,05 p,j>0,05 p„>0.05 P,,>0.05 P„>0,05
138 Tap chi Y hpc dv phdng, T9p XXH, s«2 (128)
Tham gia cau l^c bp dong ding vi cd ngudi ho trp vi sii dyng dvmg cy nhic thu6c giip b?nh nhan tuin thii tot hon. Nhdm bfnh nhan cd ngudi ho trp dilu tti li ngudi song ttong ciing gia dhih tibi miic TIBT tot; 86,4%, cdn nhdm khic: 78,6%. Thy nhiSn sy khic bift giua cic nhdm khdng c6 f nghia thong ke (p
>0,05). Tuan thii dieu trj t6t d nhdm sii dyng matuy vi khdng sit dyng ma tiiy khdng c6 s\r khic bift. Thin thii dilu tri tot khdng khic bift giiia cic nhdm tuoi (nhdm tudi 20 - 29; 30 - 39 vi > 40 hi6i l i 81,8%, 89,4% vi 87,5%).
IV. BAN LU4.N 4.1. Ihin thii dilu trj
Tiiin thii dilu tri d miic dp eao ed lien quan chat ehe vdi dip ung dieu tri ARV t6t.
Miic ttiin thu dilu tri t6t phii djit tit 95%.
Nhimg bfnh nhan tuan thu k6m (<80%) cd nguy C0 tur vong eao hon cd y nghia thong ke so vdi cic miic dp tuin thii khic [2]. Nhilu nghien ciiu trudc cho thay bfnh nhan tuan thii kim vdi phic d6 dilu tri vi Ididng den khim theo lich hfn tii khim ngay sau khi bit dau dieu hi cd the giim hif u qui dieu tri ARV. Ty If bfnh nhan tuin thii tot cung rat khie nhau giua eic C0 sd dilu tri. Ty If niy li 76,8% theo dinh gii ciia Vo Thj Nim [4]. Trong nghien ciiu ciia chiing tdi ty If tuan thii dieu frj tot tai thdi diem dinh gii sau 6-11 thing v i tten 12 thing sau ART la 87,9% vi 79,8% .
4.2. M§t so yen to hen quan tdl tuin thu dilu trj ARV
Mdt so nghiSn cttu danh gia tuan thii vi cic rio ein d6i vdi tuan thii dilu ttj nhu chin nin, g^p cac tic dyng phy, tin tudng vio v ^ may ve sue khde, uong nhilu nigu ttong thing vita qua (aOR=2.49; 95% Cl-1.50-4.15) Sii dyng ma tiiy thing ttudc (aOR=1.99; 95%
C1=I.15-3.45)- USn quan din giim su dyng ma tiiy, ting tuan tini dilu tti ARV, glim ndng dd virus v i tang CD4— giim hinh vi tiem chlch
T&p chi Y hoc dv phdng, Tgp XXH, s5 2 (128)
ma tuy vi ting tufin thii dilu tri ARV - Giim thdi quen sii dyng ma tiiy vi cd cudc sdng dn dinh hcTi, diy m&nh tuin tini dilu tti ARV [5].
Tuy nhien ket qui nghien ciiu ciia chiing tdi SV khic bift c6 f nghia vl tuan thii gifia nhdm c6 tiem chich vi khdng tiem chich khdng ed f nghia thong ki; so lifu ehua dii eho cic dinh gii li€n quan tuin thii vi mttc giim vl tii lupng virut; nhung kit qui tuin thii cd sy khic bi§t cd f nghia gida nhdm khdng cd nhilm triing eo hdi vi vl^c lim dn dpih cd tf If tuin thii cao horn so vdi nhdm khie vdi p < 0,05; OR = 7,6;
CI 95% (3,547 - 11,653). Dilu niy eho thay ddi vdi b$nh nhin dang cd bfnh nhilm triing co hdi, e4n ting cudng hd frp tuin thii, ciing cd ldng tin eiia bpnh nhan vdi kit qui dilu tr;.
Khoing cich di chuyen tii nhi den ca sd dieu tri cung inh hudng ed y nghia doi vdi tuan thu. Ket qui nghien ciiu cho thay nhdm bfnh nhan nhi gan phdng khim tuin thii tdt hem so vdi nhdm bfnh nhin d xa phdng kham vdi p
< 0,05; OR = 3,38; Cl 95% (2,876 - 8,027).
Nghien ciiu eua Cadanee M de c§p chi phi van chuyen bfnh nhan tir nhi tdi phdng kham, ciing nhu di chuyen co sd y te khac la mpt ttong nhung rio cin ddi vdi vipc tuan thu dieu tri v i tii khim theo lich [6]. Tie gii ciing dl cap tdi vifc ho ttp chi phi di lgi cho bfnh nhin hoac lap ke ho^h dieu trj, cap thudc dii ban 1 thing nhu dinh Id [3],[7]. Vifc quSn bd udng thudc ciing cd rat nhieu I^ do vi bi inh hudng bdi cudc sdng vi thdi quen sinh ho^t ciia bfnh nhan. Nghien cttu eiia chiing tdl eho thay ty If bfnh nhin udng thudc khdng day dil vi uong thudc khdng diing gid Ii 31,2% so bfnh nhan dupe phdng van. hf do p h ^ ldn li do khdng nhd de udng thude ehiem 48,3%. Di xa nhi khdng mang thudc theo li 22,6%. Vai ttd ciia thiy thude dilu duSng, tu van vi ngudi nhi ho ttp giiip bfnh nhin tyf lip ke hogch udng thudc phu hpp vdi ei nhin li quan ttpng nhit. Tu vin tuan thu phii de cgp den d mpi lan til khim.
139
V. KET LUAN
Tuan tini dieu trj tdt li 87,9%, cin phii dupe cii thifn de ed dupe hi^u qui dieu tri vi dy phdng khing thudc. Bfnh nhfin cd vifc lim dn djnh vi tham gia cfiu lgc bd ddng ding, ngudi nhi hd ttp udng thudc, giiip cho vifc duy tti tdt tuin tiiii. Bfnh nhfin dang cd bfnh nhiem triing CO h$i cin dupe ting cudng hd ttp. Bfnh nhin tiem chich ma tiiy khdng inh hudmg din vife tufin thii.
TAI LIEU THAM KHAO
1. BdYTe(2005,2009).HudngdSnchamsdc vi dilu tti HIV/AIDS.
2. Brennan et al (2010). The importance of clmic attencdance in the first six months on antirefroviral tteatment: a rettospective analysis at a large pubhc sector HIV clinic in South AMca. Journal of the International AIDS Society, 13:49. Benjamm H Chi, Ronald A Canttell, Isaac Zulu et al (2009).
Adherence to first-line antirefroviral therapy affected non virologic outcomes among patients on freatment for more than 12 months in Lusaka, Zambia. International Joumal of Epidemiology 2009;38:746-756.
3. GareiaR,Badaro'R,NettoEM,etall(2006).
Cross-sectional study to evaluate factors associated with adherence to anthefrovhal therapy by Brazilian HIV-infected patients.
AIDS Res Hum Resttovmises; 22(12);
1248-52.
4. va tfli Nim (2010). Xic dinh ty If vi cic ylu td lifin quan tdi tuin thu d ^-u tti ARV d bfnh nhfin HIV/AIDS tgi tiiinh phd Can Tho, nim 2009. Tuyen tgp bio cio Hfi nghi ^oa hpc Qudc gia phdng, chdng HIV/
AIDS lin thtt 4.
5. Masaya Kato (2010). NhOng ylu td inh hudng din duy tri vi tuin thii dieu trj khing refrovirus - Nhihig ggi f ddi vdi ViftNam.
Tuyln t$p bio cio Hpi nghi khoa hpe Qudc gia phdng, chdng HIV/AIDS lan tiitt 4.
6. Candace M. Miller, Mpefe Ketlhapile, Heather Rybasack-Smith and Sydney Rosen (2010), Why are antttefroviral treatment patients lost to follow-up? A quaUtative study from South Africa. Tropical Medicine and International Health, Volume 15 suppl.
1 pp 48-54
7. Ncama BP, Melnemey PA, Bhengu BR, et all (2008). Social support and medication adherence in HIV disease in KwaZuIu- Natal. Soutii Africa, hit J Nurs Stiid.
Tap chi Y hQC dvphdng, T^ipXXn, stf 2 (128)
THE ADHERENCE IN HIV/AIDS PATIENTS ON ART AT NGOQUYEN, HAIPHONG
Duong Thi Huong, Nguyen Thi lii*
Haiphong Medical University Ngo Quyen Health Center, Hai Phong Objectives: identify the rate of adherence in HTV/AIDS patients on ART and the associated factors
Method: Design cross-sectional descriptive shidy, 124 HIV/AIDS patients on ART enrolled from 9/2005-12/2007 at NgoQuyen OPC. Identify the adherence and the associated factors through physician assessment and self-assessment questionnahe.
Results: The rate of good adherence is 87.9%.
No difference of the rate of good adherence between no-IDU and IDU - Injected Drug Users (90.6% and 83.6%) p> 0.05, OR =
1.898; (95%CI:1.308 to 4.282). The associated factors to the adherence such as: a stable job, join the peers clubs, OIs during tteatment.
Conclusions: Good adherence is 87.9%, needs to be improved in order to get effective freatment and prevention of drug resistance.
Patients with stable jobs and join the club peers, family support, will mantain good ahdrenee.
Patients with opportunities Infections should be enhanced support. Injected drugs users do not affect to ahrence.
Keywords: ART", adherence, HIV/AIDS patients
Tap chi Y hpc du ph6ng, Tfip XXU, so 2 (128)