Influencing factors for compliance with antiviral therapy with nucleos(t)ide analogues in patients with chronic hepatitis B / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the current status of compliance with antiviral therapy with nucleos(t)ide analogues (NAs) among chronic hepatitis B (CHB) patients treated in General Hospital of Ningxia Medical University. MethodsThe CHB patients who received antiviral therapy with NAs at the outpatient and inpatient services of Department of Infectious Diseases, General Hospital of Ningxia Medical University, from May to December, 2017 were enrolled. A questionnaire survey was performed for demographics, family history of CHB, detailed doctor’s advice, daily routines, physical exercise, compliance, awareness of the knowledge about hepatitis B, health belief, and social support, and the influence of various factors on compliance with NAs treatment was analyzed. The Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was used to investigate the influencing factors for compliance with antiviral therapy with NAs among CHB patients. ResultsA total of 612 questionnaires were distributed, among which 600 were collected, with a questionnaire recovery rate of 98% and a valid rate of 100%. Among the 600 CHB patients, 334 (55.67%) had good compliance with the antiviral therapy with NAs and 266 (44.33%) had poor compliance. Among the 266 CHB patients with poor compliance, 56 (21.05%) did not follow the doctor’s advice and took other drugs, 206 (77.44%) sometimes forgot medication, 187 (7030%) sometimes did not pay attention to medication (time, dose, and frequency), 135 (50.75%) reduced or stopped drugs after symptoms were improved, and 100 (37.59%) stopped the drugs due to symptom aggravation or appearance of other symptoms. The univariate analysis showed that 13 indices were the influencing factors for compliance with NAs treatment among CHB patients (all P＜0.05). A multivariate analysis was performed for these 13 indices and the results showed that race (odds ratio ［OR］=0.218, 95% confidence interval ［CI］ 0.076-0.996, P=0.007), mode of medical payment (OR=0.772, 95%CI 0.445-0.919, P＜0.001), physical exercise (OR=2.55, 95%CI 1.472-6.545, P=0.020), level of social support (OR=0.836, 95%CI 0.649-0.947, P＜0.001), awareness of the outcome of incompliance (OR=0.577, 95%CI 0.393-0.886, P＜0.001), and self-efficacy (OR=0.094, 95%CI 0074-0.328, P＜0.001) were independent influencing factors for compliance with NAs treatment among CHB patients. ConclusionCompliance with antiviral therapy among CHB patients is closely associated with the mode of medical payment, psychological state, and self-management ability. Related measures, such as improvement of patients’ ability to pay medical expenses, education on disease risk for patients, and reduction of social discrimination, can help to improve treatment compliance.