摘要:

SummaryAdherence to antiretroviral medications is essential for optimal treatment of HIV infection. We investigated nonadherence to antiretroviral medications in an inner-city population by using a confidential interview and a self-administered anonymous questionnaire. We estimated adherence on the day before and the month before the interview and asked reasons for nonadherence. Of 173 people who were taking antiretroviral medications, all participated in the confidential interview and 101 also completed the anonymous questionnaire. Results of the confidential interview and the anonymous questionnaire revealed rates of 6% and 28%, respectively, for nonadherence to any drug on the preceding day and of 11% and 39%, respectively, in the preceding month. The most common reasons for nonadherence in both methods were forgetfulness, inaccessibility of medications, and perceived or actual toxicity. On 12% of the anonymous questionnaires one reason for nonadherence was perceived or actual lack of drug efficacy; this reason was not given in any of the confidential interviews. Responses about the extent of nonadherence and the reasons for it may differ depending on the method of ascertainment. Interventions to improve adherence should focus on making medication dosages easier to remember, ensuring a continued supply of medications, and circumventing toxicities.

ISSN:1525-4135    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryHospitals are significant resources for care of HIV/AIDS patients. Previous studies that have attempted to identify and track the characteristics of these patients and their hospitalizations have been limited in their ability to produce national estimates of patient use of such resources. This study, using data from the Healthcare Cost and Utilization Project (HCUP-3) attempted to characterize and estimate the cost of hospital usage by HIV/AIDS patients. We estimate that in 1994 ∼188,506 admissions of HIV/AIDS patients occurred with an average charge of $19,244 U.S. per admission, for an estimated total cost of $3.63 billion. Compared with non-HIV–infected patients, HIV/AIDS patients tended to be male (75.83% versus 41.49%), a member of a minority group (53.51% versus 20.77%), hospitalized in a private, nonprofit, urban teaching hospital with a longer average length of stay (10.27 versus 5.52 days), and to have a higher in-hospital mortality (11.45% versus 2.58%). Approximately half of the hospital charges (47%) for these admissions were absorbed by Medicaid, and 25% by private insurance. The remainder of the charges were borne by the patients themselves. The results presented here for 1994 predate the widespread use of protease inhibitor/ highly active antiretroviral therapy (HAART), thus making this study an important benchmark for the delineation of the effects of HAART and any other future developments in HIV therapy on the characteristics of HIV/AIDS patient resource use on a national level. This study further demonstrates that HCUP is a powerful tool for the estimation and costing of hospital resource use.

ISSN:1525-4135    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryClear understanding of the natural history of HIV-1 disease is critical for planning and developing appropriate therapeutic strategies for HIV-1–infected populations in the developing world. Present knowledge about Africa is based on very limited data that largely use clinical staging as the prognostic marker; this approach has not been prospectively validated. Our objectives were to compare clinical staging and CD4+T-cell counts as prognostic tools and to describe survival and cause of death in seroprevalent HIV-1–infected Ugandan adults by means of a prospective cohort study. Consecutive HIV-1–infected adults registering with a community HIV/AIDS clinic in Entebbe, Uganda were enrolled between October 1994 to January 1995 and observed during follow-up until the end of December 1997. Baseline CD4+T-cell count distribution showed clear and appropriate associations with clinical stage in the 201 participants. Both provided equivalent prognostic information: median survival with CD4+T-cell count <200 cells/&mgr;l was 9 months (95% confidence interval [CI], 7–15 months) compared with 19 and 7 months (95% CI, 10–28 and 0–8 months, respectively) in clinical stages 3 and 4, respectively; survival at 3 years with CD4+T-cell count ≥200 cells/&mgr;l was 68% and for clinical stage 1 and 2, 80% and 60%, respectively. Clinical stage 3 and 4 were 76% sensitive and 65% specific for predicting a CD4+T-cell count <200 cells/&mgr;l, positive predictive value of 56%, negative predictive value 78%. In all, 82 participants died (41%; mortality rate 216 of 1000 person-years) and was strongly associated with low CD4+T-cell counts. In conclusion, clinical staging is valid and comparable with staging by CD4 T-cell counts for epidemiologic measurements. Mortality with early disease in Entebbe appears equivalent to that found in the developed world but there is poor survival with advanced disease.

ISSN:1525-4135    

出版商:OVID    

年代:1999

数据来源: OVID