Qualidade de vida e adesão à medicação antirretroviral em pessoas com HIV

Quality of life and adherence to antiretroviral therapy in people living with HIV in the Ceará, Brazil

The aim of this study was to investigate the quality of life (QOL) and adherence to antiretroviral therapy (ART) in people living with HIV (PLWH) in Fortaleza, Ceará, Brazil. A cross-sectional study with a sample of 385 patients followed-up on an outpatient basis. Interviews were conducted using the Sociodemographic, Epidemiological and Clinical Form, the World Health Organization's Quality of Life in PLWH Instrument, the Assessment of Adherence to Antiretroviral Treatment Questionnaire and Pittsburgh Sleep Quality Index. Descriptive statistics and univariate and multivariate logistic regression analysis were performed. The odds ratio and confidence interval were calculated, considering P < 0.05 as statistically significant. Of the 385 PLWH, 134 (34.8%) had unsatisfactory QOL which was associated with unemployment (P = 0.0037), monthly income less than the minimum wage (P < 0.0001), sleep disorders (P = 0.0039) and not doing regular exercise (P = 0.0032). Inadequate adherence to ART occurred in 24 patients (6.23%) and was associated with detectable viral load (P = 0.0001) and unsatisfactory QOL (P = 0.0033). QOL was more unsatisfactory for those unemployed and with low income, sleep disorders and sedentary lifestyle. People with detectable viral load and unsatisfactory QOL had more inadequate adherence to ART.

Enhancing quality of life and medication adherence for people living with HIV: the impact of an information system

BACKGROUND

The widespread availability of antiretroviral therapy has led to improvements in life expectancy and thus an increase in the number of people living with HIV/AIDS (PLWHA) worldwide. However, a similar increase in the number of newly-diagnosed patients in Cyprus suggests the need for solutions designed to improve monitoring, planning, and patient communication. In this study, we aimed to determine whether the use of an information system to manage PLWHA might contribute to improved quality of life and critical adherence to prescribed drug regimens and ongoing medical care.

METHODS

A randomized controlled trial study was conducted in Cyprus based on information that we collected using the highly valid and reliable Greek translation of the World Health Organization (WHO) Quality of Life (QOL) HIV-BREF questionnaire to assess sociodemographic variables and patient compliance. We distributed 200 questionnaires before implementing a Health Medical Care (HMC) information system at our clinic. Six months after implementing this system, 68 of the completed questionnaires were selected, including two groups of 34 participants who had been assigned at random to the intervention or the control group. Participants included PLWHA aged ≥ 18 years who had been receiving antiretroviral therapy for more than 12 months between July 15, 2020, and July 15, 2022.

RESULTS

The changes in baseline to six-month scores reported for the intervention group were significantly higher than in the control group in all six subscales assessed with the WHOQOL-HIV-BREF questionnaire, as well as in the assessment of compliance. Furthermore, compliance with treatment was associated with higher scores in the questionnaire subscales, including physical health, psychological health, degree of autonomy, social relationships, life circumstances, and spirituality/religious/personal beliefs. We also identified specific demographic factors and behaviors that were associated with better compliance with scheduled medical care and the prescribed drug regimen. Specifically, men exhibited better compliance than women and younger PLWHA exhibited better compliance than the elderly as did individuals who reported a higher level of educational attainment. Additionally, individuals who did not use addictive substances, consumed less alcohol, and were managed using the monitoring information system all exhibited better compliance compared to those in the control group.

CONCLUSION

The results of this study suggest that management of PLWHA via the use of an information system can contribute to improved QOL and drug compliance.

Association of syndemic conditions and quality of life among people living with HIV/AIDS

The syndemics theory seeks to understand the effect of multiple synergic problems in promoting poor health outcomes. To disentangle which and how syndemic conditions affect the quality of life (QoL) may be important to improve well-being of people living with HIV/AIDS (PLWHA). This study evaluates the association between syndemic conditions and QoL among PLWHA. We performed a secondary analysis using data obtained between 2014 and 2017 among PLWHA under care in Rio de Janeiro, Brazil. The outcomes were the six QoL domains (physical, psychological, level of independence, social relationships, environmental, and spirituality) measured through the World Health Organization Quality of Life in HIV infection scale, abbreviated version (WHOQOL-HIV-BREF). The independent variables were demographic and clinical characteristics, syndemic conditions (binge drinking, compulsive sexual behavior, polysubstance use, intimate partner violence, and depression), and syndemics (two or more syndemic conditions simultaneously). Bivariate analysis (t-test and ANOVA) and linear regressions were performed for each quality-of-life domain. The analytical sample comprised 1530 participants, mostly male at birth (64%) and with median age of 43 years. The syndemic conditions most frequently observed were binge drinking (56%), IPV (13%), and depression (9%). Both individual syndemic conditions and syndemics were associated with worse QoL. In the multivariate analysis, positive screening for depression was associated with worse QoL in all domains. Polysubstance users presented worse QoL at social and environmental domains. Intimate partner violence was associated with worse QoL at environment domain while binge drinking was associated with worse scores in the physical domain. The presence of syndemics increased the likelihood of worse scores in the psychological, social, and environment domains. Our study expands the understanding of QoL in PLWHA, as it considers a holistic/integral, multifactorial, and synergistic approach to the determinants of QoL. Seeking strategies that target syndemics may be important to improve patient-centered outcomes in health.Abbreviations: HIV/AIDS: human immunodeficiency virus/acquired immunodeficiency syndromeWHO: World Health OrganizationQoL: quality of lifeHRQoL: health-related quality of lifePLWHA: people living with HIV/AIDScART: combined antiretroviral therapyIPV: intimate partner violenceINI/FIOCRUZ: Evandro Chagas National Institute of Infectious DiseasesOswaldo Cruz FoundationSRH: self-rated healthVL: viral loadCD4: CD4 cell countNIAAA: National Institute on Alcohol Abuse and AlcoholismCSBcompulsive sexual behaviorWHO-ASSIST: alcoholsmoking and substance involvement screening test developed by the World Health OrganizationPHQ-2: Patient Health Questionnaire-2.

Instruments to assess adherence to medication in people living with HIV: a scoping review

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.

Virologic success under antiretroviral therapy among people living with HIV/AIDS in the state of Paraná, Brazil

Objective:

To characterize the sociodemographic profile of the population undergoing antiretroviral treatment in the state of Paraná, Brazil, to investigate the proportion of people undergoing treatment among all those diagnosed, and to analyze the proportion of patients with suppressed viral load in different regions of the state.

Methods:

Observational descriptive and analytical study carried out with information referring to the period from January 2018 to January 2019. Data were obtained from the Sistema Informatizado de Monitoramento Clínico das Pessoas Vivendo com HIV/AIDS [Computerized System for Clinical Monitoring of People Living with HIV/AIDS] and Sistema de Controle Logístico de Medicamentos[Drug Supply Control System]. The proportion of people on antiretroviral treatment in the state and the proportion of patients with viral load ≤1,000 copies/mL and ≤50 copies/mL were calculated. The results were compared with the corresponding parameters of the World Health Organization goal 90-90-90.

Results:

The state of Paraná managed to reach the second and third parameters of the 90-90-90 goal of the World Health Organization. Among those diagnosed, 93.12% were on antiretroviral treatment, and 90.0% of them had a viral load below 50 copies of viral RNA/mL of blood, indicating virologic success.

Conclusion:

The health policy aimed at the population living with HIV/AIDS, and the health services available in Paraná have been successful in parameters relevant to the control of the epidemic. However, it is necessary to ensure the diagnosis of people infected with HIV in the population.

Effect of lipodystrophy on self-esteem and adherence to antiretroviral therapy in people living with HIV

The aim of this study was to determine the effect of lipodystrophy on self-esteem and adherence to antiretroviral therapy (ART) in people living with HIV (PLHIV). A cross-sectional and comparative study was carried out in an infection clinic, with 125 patients with lipodystrophy and 125 without lipodystrophy. Sociodemographic, clinical and epidemiological data were collected, using the Rosenberg Self-Esteem Scale and Assessment of Adherence to Antiretroviral Treatment Questionnaire (CEAT-VIH). Descriptive statistics and univariate and multivariate logistic regression analysis were used. Of the total sample, 57.2% had unsatisfactory self-esteem and 57.6% adequate adherence to ART. Self-esteem was lower in PLHIV with lipodystrophy (66.4%). PLHIV with monthly income less than or equal to two minimum wages (P < 0.001) and those with lipodystrophy had more unsatisfactory self-esteem (P < 0.001). Catholics had better self-esteem (P = 0.012), when compared to those without religion. Patients with monthly income less than or equal to two minimum wages (P = 0.021) and people with unsatisfactory self-esteem had more inadequate adherence to ART (P = 0.001). Catholics had better adherence to antiretrovirals (P = 0.007). In conclusion, lipodystrophy and low income negatively affect the self-esteem of PLHIV. Low income and unsatisfactory self-esteem make adherence to ART difficult. Religion is a protective factor for satisfactory self-esteem and adherence to antiretrovirals.

[Evaluation of the level of knowledge about Aids and syphilis among the elderly from a city in the interior of the state of Ceará, Brazil]

The scope of this study was to evaluate the knowledge of the elderly about syphilis and AIDS before and after conducting educational activities. Fifty-five individuals participating in a convenience group from territory of Terrenos Novos in Sobral in the State of Ceará were selected. To collect the data, a semi-structured questionnaire about HIV/AIDS and syphilis was used, including general features and information about concept, transmission, prevention, vulnerability and treatment. The questionnaire was applied before and after the implementation of educational workshops about AIDS and syphilis. Among those surveyed, 96.4% were aware about AIDS and 67.3% did not know about syphilis. However, 38.1% believed that a kiss on the mouth and 78.1% that mosquito bites were means of HIV transmission. 70.9% did not know the mode of transmission of syphilis. After the workshops the indexes changed positively. Data analysis revealed gaps in knowledge of this group about the concept, transmission and treatment of these diseases. Educational interventions were effective for knowledge assimilation.

Adherence to antiretroviral therapy and correlation with adverse effects and coinfections in people living with HIV/AIDS in the municipality of Goiás State

INTRODUCTION

Acquired immunodeficiency syndrome is an advanced stage of a human immunodeficiency virus infection. The antiretroviral therapy aims to improve the life quality of HIV patients and a good adherence is essential for a better prognosis. This study aimed to evaluate the adherence of human immunodeficiency virus/acquired immunodeficiency syndrome patients to antiretroviral therapy recommended by the Brazilian health system in Anápolis/Goiás, and correlate the level of adherence with sociodemographic data and clinical-laboratory variables.

METHODS

Adherence to antiretroviral therapy was assessed using the Questionnaire for Evaluation of Adherence to Antiretroviral Therapy. The sociodemographic data were collected using a standardized questionnaire and the clinical-laboratory records were reviewed.

RESULTS

Among 220 patients included, 59% (129/220) were men and the average age was 41 years. Infection was acquired primarily through sexual contact (92%, 202/220), and 69% (152/220) of the patients were heterosexual. Approximately 86% (188/220) of the patients had good or strict adherence to antiretroviral therapy. In our study, the use of illicit drugs was associated with low adherence to antiretroviral therapy (p=0.0004), and no significant association was observed between adherence levels and other sociodemographic data (p>0.05). The logistic regression indicated that adverse effects (p=0.0018) and sexual orientation (p=0.0152) were associated with the level of adherence to antiretroviral therapy. Patients with good or strict adherence had higher CD4+T lymphocyte count (p<0.0001) and undetectable viral load (p<0.0001). Patients with low adherence (14%, 32/220) had higher frequency of adverse events (p=0.0009). The frequency of coinfections was 25% (55/220), with syphilis and tuberculosis being the most common coinfections.

CONCLUSIONS

Adherence was related to use of illicit drugs, adverse effects, and sexual orientation.

Fatores associados à não adesão dos antirretrovirais em portadores de HIV/AIDS

Resumo Objetivo Identificar os fatores associados à não adesão ao tratamento antirretroviral em portadores de HIV/ AIDS em um Hospital de referência em Manaus. Métodos Estudo com abordagem quantitativa, transversal de base hospitalar, desenvolvido com 100 participantes com HIV/AIDS em acompanhamento ambulatorial. Para a coleta de dados foi utilizado o questionário autoaplicável, denominado “Questionário para a avaliação da adesão ao tratamento antirretroviral em pessoas com HIV/AIDS” (CEAT–VIH). Foi realizada análise descritiva, empregado o teste de qui-quadrado de Pearson chi-square para o valor de p. Resultados Predominou o sexo masculino (57%), faixa etária entre 40 a 59 anos (34%) escolaridade de 2º Grau (49%), sem vínculo empregatício (84%), renda mensal de 1 a 3 salários mínimos (54%), solteiros (47%), heterossexuais (76%), com parceiro sexual (56%), sem vida sexual ativa (61%), tempo de diagnóstico entre 6 meses a 5 anos (59%), nenhuma internação hospitalar (59%). O nível de adesão predominante foi a média adesão (85%). As variáveis sociodemográficas que tiveram associação estatisticamente significantes com a adesão TARV foram a orientação sexual (p=0,010) e o tempo de diagnóstico (p=0,035). Conclusão O estudo mostrou que pessoas que convivem com HIV aderem a TARV, porém com média adesão e os principais fatores associados a esse resultado foram a orientação sexual e o tempo de diagnóstico.

Use of the Whatsapp application in health follow-up of people with HIV: a thematic analysis

Abstract Objective: To investigate the statements of people living with HIV during a health follow-up through the WhatsApp® application. Methods: A descriptive study, using a qualitative approach, was conducted with 26 people accompanied by two specialized care services for HIV/AIDS in Fortaleza, Ceará. Data were collected from September 2016 to February 2017, with participants' statements given during the online follow-up and submitted to thematic content analysis. Results: The following categories emerged: difficulties with treatment, antiretroviral dose delayed or missed, side effects, association between antiretroviral drugs and alcohol, use of dietary supplements and medicines, emotional changes, life habits, social rights, physical symptoms, and coping with and committing to with treatment. Conclusion: Follow-up over WhatsApp® improved access to health professionals, by providing an open and immediate communication channel.

Treatment adherence in patients living with HIV/AIDS assisted at a specialized facility in Brazil

INTRODUCTION

In the 1990s, Brazil adopted a public policy that allowed for universal, free access to antiretroviral therapy (ART). Since then, treatment adherence has become a new challenge for administrators of sexually transmitted disease/acquired immunodeficiency syndrome (STD/AIDS) policies. This study quantified adherence to ART and verified whether there is an association between sociodemographic variables and clinical/laboratory data in human immunodeficiency virus (HIV)-infected patients.

METHODS

This was a cross-sectional, exploratory study with a quantitative approach that was conducted over 8 months. The target population contained patients who were assisted at the ambulatory care facility specialized in STD/AIDS of a medium-size city located in Northwest São Paulo. In order to verify the level of adherence to ART, a validated CEAT-VIH (Assessment of Adherence to Antiretroviral Therapy Questionnaire) questionnaire was used. Sociodemographic aspects and clinical/laboratory data were obtained from the medical records. The results were analyzed using the Student's t-test and Pearson's coefficient.

RESULTS

Herein, 109 patients were interviewed, 56% of whom were male. The age of the population ranged 18-74 years (mean 45.67 years). Adherence to ART was classified as insufficient in 80.7% of cases. There was an association between ART adherence and presence of symptoms and/or opportunistic infection (p=0.008) and economic status (p<0.001).

CONCLUSIONS

Adherence to ART among HIV carriers cared for by the public health system is low. Patients who reported a favorable economic status and those without symptoms and/or opportunistic infection demonstrated greater treatment adherence than those who needed to take more than 3 pills a day.

Validação de mensagens telefônicas para promoção da saúde de pessoas com HIV

Resumo Objetivo Avaliar a opinião de experts sobre o conteúdo de mensagens telefônicas para a promoção da saúde de pessoas vivendo com HIV. Métodos Estudo de desenvolvimento metodológico direcionado à validação de dez mensagens telefônicas, com participação de 11 experts que avaliaram sua clareza e grau de relevância. O índice de validade de conteúdo relativo a cada mensagem foi calculado e estabeleceu-se uma concordância mínima de 75%. Resultados Foram consideradas mensagens claras (79,1%) e muito relevantes (98,2%). O índice de validade de conteúdo geral foi 0,98. Principais alterações sugeridas: inclusão de um questionamento sobre o tema no início de cada mensagem; adequação para uma linguagem mais simples e interativa; substituição de termos específicos e exclusão de palavras ou expressões relacionadas ao HIV. Conclusão Os experts consideraram as mensagens claras e relevantes para a promoção da saúde das pessoas vivendo com HIV.

Adherence to antiretroviral therapy by people living with HIV/AIDS in a municipality of São Paulo

Objective

To assess adherence to antiretroviral drugs by people living with HIV/AIDS and identify its association with sociodemographic and clinical variables.

Methods

Cross-sectional analytical study using a sociodemographic instrument and CEAT-HIV, with data collected in the period from 2014-2015.

Results

A 75.0% was identified as having a good/proper adhesion. It was found that individuals between ages 40 and 59 (p = 0.029) and with morethan eight years of formal education (p = 0.043) had a higher level of compliance, as well as those diagnosed with HIV/AIDS for more than 10 years (p = 0.002), CD4 count >350 cells/mm3 (p<0,001) and an undetectable viral load (p=0,025).

Conclusion

In this study, a good adhesion between the subjects was identified and it was observed that individuals of older age, higher level of education, delayed diagnosis, high CD4 cell counts and undetectable viral load were associated with higher treatment adherence.