Understanding the reasons for interruption of outpatient clinical care in HIV-infected individuals, hospitalized in tertiary care center
R.D. Zimmermann1, J.M.A.H. Suleiman1, H.M.M. Lima2
1Emilio Ribas Institute of Infectology, Infectious Diseases, São Paulo, Brazil, 2University of São Paulo, Faculty of Public Health, São Paulo, Brazil
Background: Adherence in HIV care is essential to maximizing patient clinical outcomes and factors associated with hospitalized in tertiary center has not been examined. The purpose of this qualitative study is understand reasons associated to the interruption of outpatient clinical care and clinical issues.
Methods: Practice based, longitudinal, qualitative interview. Participants: hospitalized in Emilio Ribas- Reference in Infectious Diseases- HIV-infected patients aged above 18 years (intentional 9 women and 9 men). Participants were categorized by interruption of outpatient clinical care and treatment adherence.
Results: From the 18 hospitalized patients interviewed, 9 (50%) reported interruption of outpatient clinical care, 5 men and 4 women. Most of the them (6 patients) explained their reasons referring negative experiences they had while patient-provider relationship. Lack of clarification and poor communication about drugs interactions and adverse events were disclosure. Furthermore, the false perception (misunderstanding) about positive medical comments like “nobody dies of aids today” added to patients feeling like “I'm feeling well” were decisive for choosing medical non-adherence. For women, diagnostic revelation in gestation period was reported in 2 (50%) of 4 women that interrupted outpatient clinical care. Those women patients reported disease stigma, fear of side-effects and the well-being feeling in diagnostic revelation period. Additionally, 3 patients experienced difficulties in treatment adherence and drug treatment dropout relationship with illicit drug usage, alcohol abuse and depression symptoms.
Conclusions: A clear explanation about staff is essential for the maintenance of a solid understanding of disease by patient. Information and clarification about the natural history of the disease during free time symptoms and possible secondary adverse events to an antiretroviral therapy are vital to keep a medical adherence. Careful evaluation about vulnerable population segments are an important key about strategies in adherence outpatient clinical care.
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