[Study of the promosud cohort. Predictors of adherence to treatment plans by French patients living with HIV].
The aim of this study was to identify factors associated with adherence in patients treated by antiretroviral therapy for HIV infection, after 12 months of follow-up, and to identify potential predictive factors of adherence over a one-year period. All patients included in the cohort had an optimal adherence at inclusion, evaluated by the level of viral load and a questionnaire. Among the 133 patients included in the cohort, 115 patients were still followed one year later. Potential risk factors analysed in the study were: side effects, social support, level of stress, stress adaptation, strategies of coping and quality of life. The stress-coping model developed by Lazarus-Folkman (1984) was used to analyse pathways by which variables could influence level of adherence. Results showed that patients who stayed adherent during the follow-up reported less side effects, had a lower level of stress than patient who became non-adherent over time. They used more frequently active strategies of coping (positive reappraisal) and had a higher score of quality of life. Results from logistic regression showed variables associated with adherence at one year were strategies of positive reappraisal (OR = 1.08; 95% CI: 1.02-1.15) and a high score of physical health status (OR = 1.85; 95% CI: 0.99-3.49). The score of mental health status at inclusion was a predictive factor of adherence one year later, a lower score being predictive of a non-optimal level of adherence (OR = 1.05; 95% CI 1.002-1.09). For reinforcing adherent behaviours, interventions focused on the learning of active strategies of coping should be developed. The measure of quality of life should also become a standard measure of patients' surveillance, as biological parameters are.
Delmas
Philippe
P
L'Hôpital Cochin (AP-HP).
Delpierre
Cyrille
C
Côté
José
J
Lauwers-Cancès
Valérie
V
Delon
Simone
S
D000223:Adaptation, Psychological; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007861:Lebanon; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000209:etiology