Dispensation record of antiretrovirals as monitor of
non-adherence to treatment for people followed at a reference service in Belo Horizonte, Brazil
M.D.G.B. Ceccato1, S.C. Oliveira2, W.J. Santos3, J.A.G. Barbosa3, P.F. Bonolo4, M.I.F. Freitas5
1Universidade Federal de Minas Gerais, Faculdade de Farmácia, Belo Horizonte, Brazil, 2UNIMONTES, Belo Horizonte, Brazil, 3Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, Brazil, 4Universidade Federal de Ouro Preto, Ouro Preto, Brazil, 5Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento Materno Infantil e Saúde Pública, Belo Horizonte, Brazil
Background: Adherence to antiretroviral therapy (ART) is a challenge for reference HIV/AIDS services, and promoting it is essential for therapeutic effectiveness and for rationalizing use of therapy. Pharmacy dispensation records are a renowned method for measuring non-adherence that highlights the importance of monitoring antiretroviral pick up at the pharmacy and incorporating this information in the clinical practice.
Objective: To evaluate non-adherence to ART using dispensation records as a tool for monitoring.
Methods: Transversal study with patients followed at the Specialized HIV/AIDS Assistance Service in Belo Horizonte, Brazil. We estimated the mean of time intervals between antiretroviral dispensations given at the service during the twelvemonth of 2006, for the following definitions: ≤ 35 days = adherence; > 35-60 days = non-adherence; > 60 days = abandon.
Results: The population consisted mainly of males aged 31-40, single or separated, with less than eight years of schooling, and monthly earnings below R$350 (approx. USD 190). Delayed ART onset happened in 47.6% of the population. Out of the 531 patients assessed, 60.3% were non-adherent to ART and 25.5% abandoned the treatment in 2006. Among the 5760 dispensations, the regimen of zidovudine + lamivudine + efavirenz was the most frequent (37.9%), followed by zidovudine + lamivudine + atazanavir (11.7%), and by zidovudine + lamivudine + nevirapine (8.3%). Changes of regimen happened in 58.6% of cases, and 63.8% of patients used other medication besides antiretrovirals.
Conclusions: The present study reiterates the difficulty in keeping adherence to ART. Pharmacy dispensation records are a practical and effective instrument for identifying irregular use of ART, and should be systematically used by HIV/AIDS services, with an eye for opportune intervention based on Pharmaceutical Care.
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