Adherence to antiretroviral therapy in patients attending an AIDS clinic in Vitória, Brazil
A. Miranda1, A. Zago2, P. Morelato1, E. Endringer1, K. Page3
1Universidade Federal do Espírito Santo, Medicina Social, Vitoria, Brazil, 2Prefeitura Municipal de Vitoria, Centro de Referencia em DST/AIDS, Vitoria, Brazil, 3University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, United States
Background: Adherence to antiretroviral therapy (ART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. Our goal was to evaluate adherence to ART and investigate risk factors for non-adherence over 24 months follow-up among patients attending the Reference Center for STD/AIDS in Vitória, Brazil.
Methods: We conducted a prospective study of HIV+ patients starting therapy in 2006 and 2007. Participants were queried using a structured questionnaire to assess demographic, behavioral and clinical data every six months over 24 months (July-2007 to June-2009). A blood sample was collected for testing CD4 and viral load testing at each study visit.
Results: A total of 181 patients were included in the study, 75.7% were ART naive, and 24.3% were restarting therapy after abandonment. Adherence rates were 51.9% in the first year and 60.2% in the second year. Sample characteristics: 107 men (59.1%) and 74 women (40.9%), median age was 35, interquartile range 31 to 39 years old, 5 to 8 years of schooling (39.2%). Factors associated to non-adherence in the first year were up to 4 years of education (0.032), lower income (0.046), unemployment (0.008), alcohol abuse (0.001), illicit drugs use (0.041), trying to keep AIDS a secret (0.013), side effects (0.004), and lack of belief in benefits of ART (0.017). Non-adherence in the second year was associated with lower income (0.002), unemployment (0.001), previously stopping ART abandonment (0.023), non-acceptance of disease (0.040) and tries to keep AIDS in secret (0.025).
Conclusions: Social and cultural factors are more difficult to be overcome in order to achieve treatment adherence than those related to taking medication, thus making the role played by the health sector important, supported by clear public social policies. These dimensions must be faced also on social and political levels.
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