病人對愛滋病個案管理計畫之依循度與生物指標及性行為之相關性

Correlation between Patient's Compliance to the HIV Case Management Program and Biological Indices and Sexual Behaviors

以個案生物性指標與性行為評估愛滋病個案管理計畫的成效。本研究採回溯性設計，依個案就診依循度分成規律就醫者及未規律就醫者兩群組，分析收案期間生物指標CD4 改變值；且依性別、感染年齡分佈、感染因素、性行為認知、保險套使用情形等個案行為分析。追蹤2008 年1 月至2010 年4 月間的199 位病患，男性個案有187 位，女性個案有12 位；發現規律就醫者，CD4 的改變值在6 個月、12個月、18 個月與24 個月均比未規律就醫者有較佳地提升（p＜0.05）；分析個案前六個月有持續性行為者共89 位（44.7%），每次性行為皆有使用保險套者只佔一至二成。依循醫師之就醫規律性返診，CD4 有較佳的改變值，提供更多醫院在推行愛滋病個案管理工作參考，希望病患依循醫師所提之規範就診及服藥。在感染者性行為的態度上應再透過個案管理師諮商，對持續有性行為者，建議作好事前防範措施如戴保險套，以杜絕愛滋病的傳播。

This study evaluates the influence of patients' adherence to medical treatment recommendations on his/her health outcome, including CD4 cell count and sexual behavioral awareness. The source patients were those who have participated in "HIV case management program" at our hospital. By reviewing medical records and according to the regularity of hospital visits, patients were categorized into two groups: the one with regular visits and the other with irregular visits. The norm for blood tests was determined by CD4 cell count that was compared between these two groups. Sexual behavioral awareness was investigated for patients who had sexual activity within prior six months. From January 2008 to April 2010, there are 187 male and 12 female patients enrolled in the study. The patients in the group with regular visits experienced more rapid recovery in CD4 cell counts over time (6 months、12 months、18 months、24 months, respectively) than those in the group with irregular visits(p value＜0.05). Within prior six months, 89 patients (44.7%) have had consistent sexual activity. Only 10 to 20 percents of those patients used condoms each and every time when they had sexual activities. HIV-infected patients who kept regular follow-up visits had significantly better outcomes. These results provide information for hospitals in carrying out HIV case management program. HIV-infected patients should follow physician's recommendation to keep regular follow-up visits and to take antiretroviral agents regularly. Case managers must persuade those patients who have consistent sexual activities to take precautions, such as using condoms, to prevent the spread of HIV.