Adherence to antiretroviral therapy among women living with HIV/AIDS in the interior of the Brazilian state of Pará: cross-sectional study

Case-control study on challenges in loss of follow-up care and the limitations in the reach of HIV policies for women

INTRODUCTION

HIV has transitioned from a devastating 1980s epidemic to a manageable chronic condition with antiretroviral therapy. In Brazil, challenges persist, including high detection rates and loss of medical follow-up among people living with HIV/AIDS (PLHIV). Adherence, engagement, and avoiding loss to follow-up are critical for effective HIV/AIDS prevention and care.

OBJECTIVES

This case-control study within longitudinal research on PLHIV linkage and retention in Porto Alegre aims to analyze factors associated with treatment abandonment.

METHODS

The study, based on patients from the Therapeutic Care Service for HIV and AIDS at Sanatorio Partenon Hospital, involved 360 PLHIV in a retention and linkage outpatient clinic.

RESULTS

Risk factors for loss to follow-up include cisgender women, diagnosis between 1991 and 2005, and non-adherence to antiretroviral treatment (ART). Conversely, cisgender men, diagnosis between 2015 and 2023, and good ART adherence were protective factors.

CONCLUSION

Gender disparities and ART non-adherence pose significant challenges in comprehensive PLHIV care. Cisgender women diagnosed before 2005 face higher risk, while cisgender men diagnosed after 2015 with good ART adherence are more protected, influencing care and prevention strategies for PLHIV.

Effectiveness of educational intervention among seropositive women about knowledge about HIV sexual transmission

OBJECTIVES

to assess the effectiveness of a group and telephone educational intervention with seropositive women about knowledge about HIV sexual transmission prevention.

METHODS

a quasi-experimental before-and-after study, carried out with 151 women living with HIV in a Specialized Care Service in a Brazilian capital. The educational intervention was carried out in three moments, with the assessment being carried out before the first and after the last moment.

RESULTS

97.4% of study participants were cisgender women aged between 18 and 58 years; 55.6% considered themselves brown; and 32.5% of interviewees had elementary school. Regarding knowledge about HIV sexual transmission, in 78.5% of items, there was an association (p<0.005) with increased participants' knowledge after receiving the intervention.

CONCLUSIONS

the educational intervention helped to increase the knowledge of women living with HIV about the sexual transmission of the infection.

Adherence to antiretroviral therapy and factors associated with non-adherence: a cohort study at two referral services in Brazil

This cohort study evaluated non-adherence to antiretrovirals at referral services in Pernambuco, Brazil, 2016/2017, through self-report. A generalized mixed-effects model for binary outcomewas used. We assessed 542 participants with an adherence rate of 85.50%. A greater chance of non-adherence was associated with:a low/moderate level of nicotine dependence (OR = 2.79, p = 0.00, IC = 1.44-5.41); ≥7 tablets/day (OR = 6.14, p = 0.00, IC = 3.42-11.02); LPV/r (OR = 1.49, p = 0.6, IC = 0.98-2.26), ddI (OR = 3.34, p = 0.03, IC = 1.12-9.97), ABC (OR = 4.02, p = 0.05, IC = 1.01-16.03), RAL (OR = 2.49, p = 0.01, IC = 1.32-4.70) and DTG (OR = 4.65, p = 0.01, IC = 1.42-15.16); 6-10 year seropositive diagnosis (OR = 2.17, p = 0.01, IC = 1.20-3.92) and symptoms of depression (OR = 1.55, p = 0.03, IC = 1.03-2.33). Protective factors for non-adherence weres: ≥50 years (OR = 0.67, p = 0.06, IC = 0.45-1.01), secondary/higher education (OR = 0.48, p = 0.00, IC = 0.34-0.70), embarrassment at health service (OR = 0.49, p = 0.04, IC = 0.24-0.97), good understanding of antiretrovirals (OR = 0.62, p = 0.03, IC = 0.40-0.96), adverse event (OR = 0.74, p = 0,06, IC = 0.54-1.01), use of TDF (OR = 0.62, p = 0.01, IC = 0.43-0.90), NVP (OR = 0.41, p = 0.05, IC = 0.71-1.00) and EFZ (OR = 0.48, p = 0.01, IC = 0.29-0.80) and good knowledge of HIV/AIDS/ART. (OR = 0.67, p = 0.07, IC = 0.43-1.04). Variables with stronger association were those linked to ART. Systematic use of self-report adherence is recommended for priority groups.