Monitoring self-reported adherence to antiretroviral therapy in public HIV care facilities in Brazil: A national cross-sectional study.
Monitoring self-reported adherence to antiretroviral therapy in public HIV care facilities in Brazil: A national cross-sectional study.
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DOI：
10.1097/md.0000000000009015
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发表时间：
2018-05
期刊：
影响因子：
1.6
通讯作者：
Nemes MIB
中科院分区：
文献类型：
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作者：
Santos MA;Guimarães MDC;Helena ETS;Basso CR;Vale FC;Carvalho WMDES;Alves AM;Rocha GM;Acurcio FA;Ceccato MDGB;do Prado RR;Menezes PR;Nemes MIB
患者坚持抗逆转录病毒治疗（ART）是艾滋病毒治疗成功的关键。在ART普遍可用的巴西，监测公共艾滋病毒门诊护理机构的依从性可以改善结果。我们在2010年进行了一项关于ART依从性的全国横断面调查。参与者是使用多阶段概率抽样选择的。首先，根据7个组织质量分类（OQC）组和地区对艾滋病门诊护理设施进行分层。其次，每个地区为每个OQC组选择1或2个设施。最后，在每个机构随机选择患者。在第一部分中，邀请患者回答基于网络的问卷（WebAd-Q），这是一种经验证的自我报告工具，包括关于过去7天内对ART的依从性的3个问题（时间-时间、药物方案-药物和药丸计数-剂量），本文称为潜在不依从性指标（IPN）。此外，对参与者的子样本进行了访谈，以获得有关社会人口统计学和临床特征的进一步数据（第二部分）。使用加权数据估计每个IPN的比例，以解释具有95%置信区间（CI）的抽样设计，并进行描述性分析。选择了55个设施，2424名患者在研究的第一部分完成了WebAd-Q，而598名患者接受了第二部分的采访。时间、药物和剂量的IPN加权比例分别为50.9%、31.8%和19.5%，而11.7%的患者具有所有3项指标，东南地区为5.9%，东北地区为21.9%。总体而言，61.1%的患者至少有1例IPN（95% CI：58.5-63.7%）。报告抑郁症状、非法药物使用和错过医疗预约的患者的不依从结局更差。总体而言，有一个高比例的所有指标IPN和时间是与低依从性的主要组成部分。虽然这些指标不一定表明个人不遵守，但它们代表了巴西公共艾滋病毒护理设施中令人担忧的情况。在常规的基础上，这些设施可以找出差距，提供咨询和抗逆转录病毒疗法的方向，他们的客户和开发创新的战略，以防止不遵守。
Patient adherence to antiretroviral therapy (ART) is critical for HIV treatment success. Monitoring rates of adherence in public HIV outpatient care facilities can improve outcomes in Brazil where ART is universally available. We conducted a national cross-sectional survey of ART adherence in 2010. Participants were selected using a multistage probability sample. First, HIV outpatient care facilities were stratified according to 7 Organizational Quality Classification (OQC) groups and regions. Second, 1 or 2 facilities were selected per region for each OQC group. Finally, patients were randomly selected at each facility. In a first component, patients were invited to answer to a web-based questionnaire (WebAd-Q), a validated self-reported tool that includes 3 questions on adherence to ART in the past 7 days (time scheduling—timing, drug regimen—medication, and pill counts—dose), herein named indicators of potential nonadherence (IPN). In addition, a subsample of participants were interviewed in order to obtain further data on sociodemographic and clinical characteristics (second component). The proportion of each IPN was estimated using weighted data to account for the sampling design with 95% confidence interval (CI) and descriptive analysis was carried out. Fifty-five facilities were chosen and 2424 patients completed the WebAd-Q in the first component of the study, while 598 patients were interviewed for the second component. The weighted proportions of the IPN were 50.9%, 31.8%, and 19.5%, for timing, medication, and dose, respectively, while11.7% had all 3 indicators, varying from 5.9% in the Southeast and 21.9% in the Northeast regions. Overall, 61.1% of the patients had at least 1 IPN (95% CI: 58.5–63.7%). Patients reporting depression symptoms, illicit drug use and those who missed medical appointments had worse nonadherence outcomes. Overall, there was a high proportion of all indicators IPN and timing was the main component associated with low adherence. Although these indicators may not necessarily indicate individual nonadherence, they represent a worrisome scenario in the public Brazilian HIV care facilities. On a routine basis, these facilities can identify gaps in providing counseling and ART orientation to their clientele and develop innovative strategies to prevent nonadherence.