預測愛滋感染者決定服藥之服藥準備度的最佳臨床切點

Ideal Medication-Readiness Cutoff Score for Initiating Antiviral Therapy in HIV Patients

背景：2016年起愛滋感染者的服藥時機為診斷後立即服藥，選擇合適臨床評估工具，客觀地評估感染者服藥準備度對服藥的決定十分重要。目的：（1）比較開始服藥與未曾服藥的準備度差異，（2）比較開始服藥與未曾服藥二組其服藥準備度隨時間變化情形，（3）鑑別決定服藥之服藥準備度最佳臨床切點。方法：採多中心世代研究法，共297位2014年後新診斷愛滋感染尚未開始服藥者，共追蹤4個時程：基準值、用藥後一個月、3–6個月及9–12個月。資料收集包括人口學、服藥準備度中文量表（HIV Medication Readiness Scale, HMRS）及兩題簡易自評量尺（自覺服藥準備度、自覺信心程度）。結果：224位感染者（75.4%）決定開始服用抗病毒藥物。開始服藥者服藥準備度平均分數隨追蹤時程逐漸增加，且平均分數皆顯著高於未曾服藥者（p<.001）。簡易自評量尺之平均分數，開始服藥者皆顯著高於未曾服藥者（p<.001）。各工具最佳切點分別為：HMRS23.5分；自覺服藥準備度5.5分；自覺信心程度6.5分。結論：實務應用本研究顯示中文版HMRS23.5分可做為評估愛滋感染者服藥時機的最佳切點。愛滋照顧專業人員可以簡易自評量尺做為評估感染者的服藥準備度是否決定開始服藥的工具。

Background: There has been a global consensus since 2016 that antiretroviral therapy (ART) should be initiated following HIV diagnosis regardless of CD4-count test results. Identifying an instrument that is able to accurately assess the readiness of HIV-infected persons for treatment initiation is thus critical. Purpose: (1) To evaluate the comparative readiness of patients receiving ART and those who are not yet on ART; (2) to evaluate the respective readiness variation within these 2 groups over a one-year period; and (3) to identify the cutoff value for medication readiness that indicates the ideal time to initiate ART. Method: A multicenter cohort study design was conducted and 297 newly diagnosed patients with HIV were enrolled at four time points, including: baseline and at 1, 3-6, and 9-12 months after ART initiation. Data collection included a demographics datasheet, the Chinese version of the HIV Medication Readiness Scale (HMRS), and 2 items, readiness to take ART for a long period of time and confidence in adhering to ART, which were scored using a 10-point Likert scale. Results: Overall, 224 (75.4%) of the participants had initiated ART. Over time, the medication readiness of participants with ART initiation had increased significantly over that of non-ART user (p < .001). The mean scores of the 2-item self-rated readiness scale for patients with ART initiation were significantly greater than those without (p < .001). The cutoff values for HMRS, self-rating readiness for ART, and confidence in adherence to ART were 23.5, 5.5, and 6.5, respectively. Conclusions/Implications for Practice: The optimal cutoff value of the Chinese version HMRS for evaluating HAART initiation among persons with HIV infection was 23.5. HIV healthcare professionals may apply the Chinese version HMRS and the two simple self-rated items as a clinical tool for quickly assessing the initiation of ART in people living with HIV.