2022至2023年花東地區愛滋個案就醫可近性及服藥順從性之關聯性探討

Investigation of the Relationship Between Accessibility to HIV Medical Care and Medication Adherence in Eastern Taiwan, 2022–2023

近年來，臺灣經由多面向的愛滋防治策略，包含與民間團體合作辦理友善服務及衛教、多元化愛滋病毒檢驗及諮詢服務管道、免費提供高效能抗愛滋病毒治療、推動暴露愛滋病毒前預防性投藥(Pre-exposure prophylaxis, PrEP)等計畫共同執行之下，愛滋病的防治成效已取得了國際認可的成效。然而，花東地區愛滋個案病毒量測不到率為88.8%，低於全國平均92.9%。為探討治療順從性不佳的原因，本研究利用衛生福利部疾病管制署「愛滋追蹤管理系統」資料，進行定性及質性研究，檢視系統之統計數據及訪視紀錄並訪問愛滋指定醫院個案管理師及地方衛生所個管人員，以瞭解原因。
分析顯示，花東地區愛滋相關之醫療資源明顯不足，就醫的可近性影響了偏鄉地區的服藥順從性。因此，建議以視訊或遠距醫療來服務偏鄉地區及其他不易透過傳統方式獲得醫療照護的人，避免病毒持續散播、減少伺機感染後的醫療負荷及產生抗藥性，讓預防及治療達最大效益化。

In recent years, Taiwan has achieved internationally recognized results in the prevention and control of HIV through multi-faceted strategies, including collaborating with non-governmental organizations to provide friendly services and health education, diversifying HIV testing and counseling services, offering free antiretroviral therapy, and promoting pre-exposure prophylaxis (PrEP). However, in Eastern Taiwan (Hualien and Taitung counties), the rate of viral suppression among People Living with HIV (PLWH) was 88.8%, below the national average of 92.9%. To explore the reasons for poor treatment adherence, in this study we analyzed data from the HIV/AIDS Management System of the Taiwan Centers for Disease Control to conduct quantitative and qualitative analyses. Statistical data and visitation records in the system were examined, and HIV case managers in designated HIV/AIDS hospitals and local health centers were interviewed.
Analyses revealed that there was a clear insufficiency of HIV-related medical resources in Eastern Taiwan, and inaccessibility to medical services negatively affected medication adherence among patients living in rural and mountainous areas. Using telehealth to provide medical services to patients living in remote areas and those who have difficulty accessing care through traditional means is recommended to prevent the continued spread of viruses, decrease the healthcare burden following opportunistic infections, and minimize the development of drug resistance, thereby maximizing the effectiveness of prevention and treatment.