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Perazzo H, Gonçalves JL, Cardoso SW, Grinsztejn B, Veloso VG, Luz PM. Pathways to Poor Adherence to Antiretroviral Therapy Among People Living with HIV: The Role of Food Insecurity and Alcohol Misuse. AIDS Behav 2024; 28:1173-1185. [PMID: 37523050 DOI: 10.1007/s10461-023-04141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
Daily adherence to antiretroviral therapy (ART) increases the length and quality of life of people living with HIV (PLHIV). We explored whether socioeconomic status directly impacts ART adherence and whether part of the effect is mediated by pathways through alcohol misuse or food insecurity. A cross-sectional study was conducted in Rio de Janeiro/Brazil (November/2019 to March/2020) with PLHIV aged ≥ 18 years. Validated instruments were used to measure alcohol use, food insecurity, and ART adherence. Using structural equation modeling we assessed the direct and indirect effects of variables on ART adherence. Participants reported significant challenges: hunger: 12%, alcohol use: 64%, and missing ART doses: 24%. Results showed that lower socioeconomic status increased poor adherence and that this effect was mediated through higher food insecurity. Alcohol misuse also increased poor adherence through a strong direct effect. Providing socio-economic support coupled with interventions to mitigate alcohol's harmful impact can aid HIV care.
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Affiliation(s)
- Hugo Perazzo
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Juliana L Gonçalves
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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2
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Schaab BL, Remor E. Development, feasibility testing and perceived benefits of a new app to help with adherence to antiretroviral therapy in people living with HIV in Brazil. Pilot Feasibility Stud 2023; 9:130. [PMID: 37496084 PMCID: PMC10369752 DOI: 10.1186/s40814-023-01370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Despite the availability of antiretroviral therapy (ART) in many countries, people living with HIV still experience difficulties with treatment. We propose a new smartphone mobile application to assist in adherence to ART. This study aimed to describe this new mobile application's development (content construction and usability), feasibility testing (recruitment, retention rates [attendance], satisfaction) and primary perceived benefits. METHODS Two consecutive studies were conducted. First, people living with HIV, health care workers and experts in information technology provided feedback to improve the content and usability of the app. After changes in the app were implemented according to the feedback, a second study was performed to assess the feasibility and perceived benefits. Effects on self-reported adherence and perceived well-being were also assessed. RESULTS Scores of participants (N = 11) showed differences in adherence (effect size .43) and well-being (effect size .45) after using the app. However, the differences did not reach statistical significance. Observing scores individually, six out of 11 participants improved their overall adherence scores, and seven out of 11 participants improved their perceived well-being scores. Recruitment was 95%, and attendance at sessions was 62.5%. In general, the participants were satisfied with the intervention and viewed the app as an informative tool. CONCLUSION The results are promising and allow us to recommend further studies with the app.
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Affiliation(s)
- Bruno Luis Schaab
- Institute of Psychology, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2600, Porto Alegre, RS. 90035003, Brazil
| | - Eduardo Remor
- Institute of Psychology, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, 2600, Porto Alegre, RS. 90035003, Brazil.
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3
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dos Santos AP, Cordeiro JFC, Fracarolli IFL, Gomide EBG, de Andrade D. Instruments to assess adherence to medication in people living with HIV: a scoping review. Rev Saude Publica 2022; 56:112. [PMID: 36629703 PMCID: PMC9749734 DOI: 10.11606/s1518-8787.2022056004475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/18/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To compile the instruments validated in Brazil for assessing adherence of people living with HIV to antiretroviral therapy. METHODS Scoping review using the Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL and Lilacs databases. In addition, the Preprints bioRxiv, Google Scholar and OpenGrey servers were checked. There was no language restriction for the search, and it considered articles published from the year 1996 onwards. RESULTS Three publications were included in the qualitative synthesis. Following were the instruments identified "Questionário para Avaliação da Adesão ao Tratamento Antirretroviral" (Questionnaire for Assessment of Adherence to Antiretroviral Treatment) developed in Porto Alegre (RS) and published in 2007; the "Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids" (Self-efficacy Scale for Adherence to Antiretroviral Treatment in Children and Adolescents with HIV/Aids) developed in São Paulo (SP) and published in 2008; and the "WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil" (WebAd-Q, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/Aids services in Brazil) developed in São Bernardo do Campo (SP) and published in 2018. The instruments were validated in Brazil, and presented statistically acceptable values for psychometric qualities. CONCLUSION The instruments to assess adherence of people living with HIV to antiretroviral therapy are validated strategies for the Brazilian context. However, their (re)use in different settings and contexts of the nation should be expanded. The use of these instruments by health professionals can improve the understanding of factors that act negatively and positively on antiretroviral therapy adherence, and the proposition of strategies intended to consolidate good adherence and intervene in the treatment of people with low therapeutic engagement.
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Affiliation(s)
- André Pereira dos Santos
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Grupo de Estudos e Pesquisa em Antropometria, Treinamento e Esporte. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Human Exposome and Infectious Diseases NetworkRibeirão PretoSPBrasilHuman Exposome and Infectious Diseases Network. Ribeirão Preto, SP, Brasil
| | - Jéssica Fernanda Corrêa Cordeiro
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Isabela Fernanda Larios Fracarolli
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Euripedes Barsanulfo Gonçalves Gomide
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Grupo de Estudos e Pesquisa em Antropometria, Treinamento e Esporte. Ribeirão Preto, SP, Brasil,Claretiano – Centro UniversitárioBatataisSPBrasilClaretiano – Centro Universitário. Batatais, SP, Brasil
| | - Denise de Andrade
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Human Exposome and Infectious Diseases NetworkRibeirão PretoSPBrasilHuman Exposome and Infectious Diseases Network. Ribeirão Preto, SP, Brasil
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HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
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Miranda MDMF, Oliveira DRD, Quirino GDS, Oliveira CJD, Pereira MLD, Cavalcante EGR. Adherence to antiretroviral therapy by adults living with HIV/aids: a cross-sectional study. Rev Bras Enferm 2021; 75:e20210019. [PMID: 34669905 DOI: 10.1590/0034-7167-2021-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/13/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To verify the association between adherence to antiretroviral treatment by adults with HIV/AIDS and sociodemographic factors, social and clinical support. METHODS Cross-sectional study, with a quantitative approach. Participation of 230 patients. Questionnaires of sociodemographic characterization, social and clinical support, and assessment of adherence to antiretroviral treatment were used. Descriptive and inferential statistics were performed. RESULTS Adherence was classified as good/adequate. An association with sex, income, employment, and level of education was noted. In social support: having access to health services; communication with health professionals; health education; having support to allow venting/talking about issues; information on HIV/AIDS; and company for leisure. In the clinical profile: non-interruption of the drug treatment due to absence from the service or due to changes in the medical prescription. CONCLUSION Adherence was classified as good/adequate and especially associated with social support factors, which should be enhanced in clinical practice.
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Mendicino CCP, Moodie EEM, Guimarães MDC, Pádua CAMD. Immune recovery after antiretroviral therapy initiation: a challenge for people living with HIV in Brazil. CAD SAUDE PUBLICA 2021; 37:e00143520. [PMID: 34669770 DOI: 10.1590/0102-311x00143520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
Immune recovery reflects health conditions. Our goal was to estimate the time it takes to achieve immune recovery and its associated factors, in people living with HIV (PLHIV), after antiretroviral therapy (ART) initiation. A historical cohort study was performed among PLHIV (> 18 years-old) in Minas Gerais State, Brazil, using data from healthcare databases. Patients initiating ART between 2009-2018, with T-CD4+ lymphocytes and viral load recorded before and after antiretroviral therapy were included. The outcome is achievement of immune recovery, defined as the first T-CD4+ > 500 cells/µL after ART initiation. Explanatory variables were age, gender, place of residence, year of ART initiation, baseline viral load and T-CD4+, viral load status, and adherence to ART at follow-up. Descriptive analysis, cumulative, and person-time incidences of immune recovery were estimated. Median-time to immune recovery was estimated using Kaplan-Meier method. Factors associated with immune recovery were assessed by Cox regression. Among 26,430 PLHIV, 8,014 (30%) were eligible. Most were male (67%), mean age 38.7 years, resided in non-central region, median-baseline T-CD4+ = 228 cells/µL (< 200 cells/µL = 43%) and viral load median-baseline = 4.7 log10 copies/mL (detectable viral load = 99%). Follow-up time = 15,872 person-years. Cumulative and incidence rate were 58% (95%CI: 57-58) (n = 4,678) and 29.47 cases/100 person-years, respectively. Median-time to immune recovery was of 22.8 months (95%CI: 21.9-24.0). Women living with HIV, younger than 38 years of age, with T-CD4+ baseline > 200 cells/µL, detectable viral load (baseline), antiretroviral therapy-adherence and undetectable viral load (follow-up) were independently associated with immune recovery. Time to immune recovery remains long and depends on early treatment and antiretroviral therapy-adherence.
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Affiliation(s)
- Cássia C P Mendicino
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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7
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Gräf T, Bello G, Andrade P, Arantes I, Pereira JM, da Silva ABP, Veiga RV, Mariani D, Boullosa LT, Arruda MB, Fernandez JCC, Dennis AM, Rasmussen DA, Tanuri A. HIV-1 molecular diversity in Brazil unveiled by 10 years of sampling by the national genotyping network. Sci Rep 2021; 11:15842. [PMID: 34349153 PMCID: PMC8338987 DOI: 10.1038/s41598-021-94542-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 12/04/2022] Open
Abstract
HIV-1 has diversified into several subtypes and recombinant forms that are heterogeneously spread around the world. Understanding the distribution of viral variants and their temporal dynamics can help to design vaccines and monitor changes in viral transmission patterns. Brazil has one of the largest HIV-1 epidemics in the western-world and the molecular features of the virus circulating in the country are still not completely known. Over 50,000 partial HIV-1 genomes sampled between 2008 and 2017 by the Brazilian genotyping network (RENAGENO) were analyzed. Sequences were filtered by quality, duplicate sequences per patient were removed and subtyping was performed with online tools and molecular phylogeny. Association between patients’ demographic data and subtypes were performed by calculating the relative risk in a multinomial analysis and trends in subtype prevalence were tested by Pearson correlation. HIV-1B was found to be the most prevalent subtype throughout the country except in the south, where HIV-1C prevails. An increasing trend in the proportion of HIV-1C and F1 was observed in several regions of the country, while HIV-1B tended to decrease. Men and highly educated individuals were more frequently infected by HIV-1B and non-B variants were more prevalent among women with lower education. Our results suggest that socio-demographic factors partially segregate HIV-1 diversity in Brazil while shaping viral transmission networks. Historical events could explain a preferential circulation of HIV-1B among men who have sex with men (MSM) and non-B variants among heterosexual individuals. In view of an increasing male/female ratio of AIDS cases in Brazil in the last 10–15 years, the decrease of HIV-1B prevalence is surprising and suggests a greater penetrance of non-B subtypes in MSM transmission chains.
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Affiliation(s)
- Tiago Gräf
- Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Rua Waldemar Falcão, 121, Salvador, 40296-710, Brazil.
| | - Gonzalo Bello
- Laboratório de AIDS e Imunologia Molecular, Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula Andrade
- Laboratório de AIDS e Imunologia Molecular, Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ighor Arantes
- Laboratório de AIDS e Imunologia Molecular, Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - João Marcos Pereira
- Laboratório de Virologia Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório de Bioinformática and Evolução Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre Bonfim Pinheiro da Silva
- Laboratório de Virologia Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório de Bioinformática and Evolução Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael V Veiga
- Center of Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, Brazil.,Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Diana Mariani
- Laboratório de Virologia Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lídia Theodoro Boullosa
- Laboratório de Virologia Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica B Arruda
- Laboratório de Virologia Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Carlos Couto Fernandez
- Laboratório de AIDS e Imunologia Molecular, Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ann M Dennis
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - David A Rasmussen
- Department of Entomology and Plant Pathology, North Carolina State University, Raleigh, USA.,Bioinformatics Research Center, North Carolina State University, Raleigh, USA
| | - Amilcar Tanuri
- Laboratório de Virologia Molecular, Departamento de Genética-IB, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Population attributable fractions of mortality in people living with HIV: roles of delayed antiretroviral therapy, hepatitis coinfections and social factors. AIDS 2020; 34:1843-1854. [PMID: 32889854 DOI: 10.1097/qad.0000000000002621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Despite free access to antiretroviral therapy (ART) from 1996 onward, and treatment for all people living with HIV (PLWHIV) from 2013, mortality in Brazil has not homogeneously decreased. We investigated to what extent delayed ART, hepatitis coinfections and sociodemographic factors predict all-cause mortality in Brazilian PLWHIV. DESIGN We included PLWHIV at least 18 years, with complete CD4 cell count data, followed up between 2007 and 2015 in Brazil. METHODS After multiple imputation, an extended Cox model helped estimate the effects of fixed and time-varying covariates on mortality. RESULTS The study population (n = 411 028) were mainly male (61%), white (55%), 40 years or less (61%), heterosexually HIV infected (71%), living in the Southeast region (48%) and had basic education (79%). Hepatitis C virus and hepatitis B virus coinfection prevalences were 2.5 and 1.4%, respectively. During a 4-year median follow-up, 61 630 deaths occurred and the mortality rate was 3.45 (95% confidence interval: 3.42-3.47) per 100 person-years. Older age, male sex, non-white ethnicity, illiteracy/basic education and living outside the Southeast and Central-West regions were independently associated with increased mortality. The main modifiable predictors of mortality were delayed ART (i.e. CD4 cell count <200 cells/μl at ART initiation) (adjusted population attributable fraction: 14.20% [95% confidence interval: 13.81-14.59]), being ART-untreated (14.06% [13.54-14.59]) and ART-treated with unrecorded CD4 at ART initiation (5.74% [5.26-6.21]). Hepatitis C virus and hepatitis B virus coinfections accounted for 2.44 [2.26-2.62] and 0.42% [0.31-0.53] of mortality, respectively. CONCLUSION The current study demonstrates that besides early ART and coinfection control, actions targeting males, non-whites and illiterate people and those with basic education are important to reduce avoidable deaths among Brazilian PLWHIV.
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Abstract
Purpose of review To describe how countries in Latin America and the Caribbean are (or are not) meeting 2016 WHO guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, that is, their progress on the adoption of ‘Treat All’ and of preexposure prophylaxis (PrEP) as an additional prevention tool for people at substantial risk of HIV infection. Recent findings The HIV epidemic in the region continues largely concentrated in vulnerable populations with MSM and transgender women (TGW) suffering the highest burden. On treatment, the challenges of late initiation as well as suboptimal adherence persist. On prevention, recent studies on PrEP willingness in key populations show promising results, meanwhile PrEP implementation projects as well as actual PrEP adoption by national health systems is expanding. A glimpse of real-world PrEP uptake is shown through Brazil's first-year experience of offering PrEP in multiple cities in all regions of the country. Summary In conclusion, accomplishments have been made though challenges for fully addressing the HIV epidemic persist. The impact of both treatment and PrEP will be limited by the availability and prompt use of all services, including HIV testing.
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Velame KT, Silva RDSD, Cerutti Junior C. Factors related to adherence to antiretroviral treatment in a specialized care facility. ACTA ACUST UNITED AC 2020; 66:290-295. [PMID: 32520147 DOI: 10.1590/1806-9282.66.3.290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/01/2019] [Indexed: 11/21/2022]
Abstract
The objective of this study was to verify the level of adherence to antiretroviral treatment and its associated factors. This is a descriptive cross-sectional study based on data retrieved from medical records. To achieve this, we used a questionnaire composed of sociodemographic and clinical information recorded from patients aged between thirteen and fifty-nine years who attended a specialized service from 2007 to 2014. The chi-square test was performed to verify the association of the outcome with the categorical variables. Continuous variables were compared through the Student t-test. Thirteen variables were analyzed in the bivariate model, resulting in the selection of the following variables to the multivariate model (p<0.20) age of discovery (p=0.12), age (p=0.14), skin color (p=0.12), level of education (p=0.03), time since HIV diagnosis (p<0.001) and AIDS case (p<0.001). Among the six variables selected for the multivariate model, cases of aids (p<0.001) remained significant. We concluded that having aids decreases the probability of non-adherence to antiretroviral treatment by 92%. These results indicate that symptomatic patients have better adherence to therapy.
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Affiliation(s)
| | | | - Crispim Cerutti Junior
- . Departamento de Medicina Social. Universidade Federal do Espírito Santo, Vitória, ES, Brasil
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11
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Shen Y, Guo B, Wang L, Peng H, Pan J, Zhang Q, Huang L, Zhou F, Yu Q. Significance of Amylase Monitoring in Peritoneal Drainage Fluid after Splenectomy: A Clinical Analysis of Splenectomy in 167 Patients with Hepatolenticular Degeneration. Am Surg 2020. [DOI: 10.1177/000313482008600429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Different kinds of complications after splenectomy in hepatolenticular degeneration patients with hypersplenism have been reported in the past decades, but studies on pancreatic fistula and the corresponding targeted prevention and treatment after splenectomy still remain much unexplored. The present work investigated the pathogenic factors of pancreatic fistula after splenectomy and the variation tendency of amylase in drainage fluid, aiming to verify the significance of monitoring amylase in the abdominal drainage fluid in the early diagnosis of pancreatic fistula after splenectomy. One hundred sixty-seven patients with hepatolenticular degeneration and hypersplenism who underwent splenectomy in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2016 to August 2018 were selected and analyzed. The amylase in the abdominal drainage fluid was monitored routinely after splenectomy. We also conducted the statistics on the incidence of different types of pancreatic fistula and analyzed the influence factors of pancreatic fistula formation. After splenectomy, biochemical fistula occurred in 11 patients (6.6%), grade B fistula in six patients (3.6%), grade C fistula in one patient (0.6%), and the incidence of pancreatic fistula was 4.2 per cent (biochemical fistula excluded). The amylase in the peritoneal drainage fluid was closely concerned with the incidence of pancreatic fistula according to our statistics. Furthermore, by analyzing the different influence factors of pancreatic fistula, Child-Pugh grading of liver function ( P = 0.041), pancreatic texture ( P = 0.029), degree of splenomegaly ( P = 0.003), and operative method ( P = 0.001) were supposed to be closely related to the formation of pancreatic fistula. Monitoring of amylase in peritoneal drainage fluid is regarded as an important physiological parameter in the early diagnosis of pancreatic fistula after splenectomy, which provides effective clinical reference and plays a significant role in preventing the occurrence and development of pancreatic fistula.
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Affiliation(s)
- Yi Shen
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Binbin Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Laiyong Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Hui Peng
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Jinfang Pan
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Qi Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Long Huang
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Fuhai Zhou
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
| | - Qingsheng Yu
- Department of General Surgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China and
- Anhui Provincial Academy of Traditional Chinese Medicine, Institute of Chinese Medicine Surgery, Hefei, China
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12
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Sabino TE, Avelino-Silva VI, Cavalcantte C, Goulart SP, Luiz OC, Fonseca LAM, Casseb JS. Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo, Brazil. AIDS Care 2020; 33:31-38. [PMID: 31906696 DOI: 10.1080/09540121.2019.1710449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study focused on factors associated with antiretroviral therapy (ART) adherence and quality of life among transgenderwomen in Sao Paulo, Brazil, using univariable and adjusted analysis. Adherence was evaluated with a self-report tool and with HIV viral load (VL) measurement. PROQOL-HIV was used to assess quality of life. 106 TGW with median 41 years old were included; most were white (56%) and had >10 years of education (57%). Median time since HIV/AIDS diagnosis was 10 years. Overall, participants had high T CD4+ counts (median 659 cells/mm3) and most (75%) had undetectable HIV VL. 85% were considered adherent using self-report (95%CI 77-91), whereas 72% (95%CI 62-80) were considered adherent when self-report and undetectable HIV VL were analyzed jointly. Older age was associated with higher ART adherence; each year increase in age was associated with 5% higher odds of adherence (p = 0.021). Quality of life ranged from good-excellent in 5 of 8 domains. Younger age, lower education, higher time since HIV diagnosis, comorbidities, illicit drugs use and depression were associated with lower PROQOL scores in specific domains in univariable analysis, while depression was also associated with lower total PROQOL score even after adjustment for age, comorbidities and time since HIV diagnosis (p = 0.048).
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Affiliation(s)
- Thiago E Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Clara Cavalcantte
- School of Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia P Goulart
- HIV/AIDS Reference and Treatment Center in São Paulo, Centro de Referência e Tratamento de DST Aids, São Paulo, Brazil
| | - Olinda C Luiz
- Departament of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz A M Fonseca
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Jorge S Casseb
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
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