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Pakhomova TE, Tam C, Wang L, Salters K, Moore DM, Barath J, Elterman S, Dawydiuk N, Wesseling T, Grieve S, Sereda P, Hogg R, Barrios R. Depressive Symptoms, the Impact on ART Continuation, and Factors Associated with Symptom Improvement Among a Cohort of People Living with HIV in British Columbia, Canada. AIDS Behav 2024; 28:43-58. [PMID: 37632606 DOI: 10.1007/s10461-023-04156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
Depressive symptoms among people living with HIV (PLWH) are associated with poorer overall health outcomes. We characterized depressive symptoms and improvements in symptomology among PLWH (≥ 19 years old) in British Columbia (BC), Canada. We also examined associations between depressive symptomology and antiretroviral therapy (ART) treatment interruptions. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), within a longitudinal cohort study with three surveys administered 18-months apart. We used multivariable logistic regression to model factors associated with improvements in depressive symptoms (CES-D-10 scores from ≥ 10 to < 10). Of the 566 participants eligible for analysis 273 (48.2%) had CES-D scores indicating significant depressive symptoms (score ≥ 10) at enrollment. Improvements in symptoms at first follow-up were associated with greater HIV self-care on the Continuity of Care Scale (adjusted odds ratio: 1.17; 95% CI 1.03-1.32), and not having a previously reported mental health disorder diagnosis (aOR 2.86; 95% CI 1.01-8.13). Those reporting current cocaine use (aOR 0.33; 95% CI 0.12-0.91) and having a high school education, vs. less than, (aOR 0.25; 95% CI 0.08-0.82) had lower odds of improvement in depressive symptomatology. CES-D scores ≥ 10 were not significantly associated with ART treatment interruptions during follow-up (aOR: 1.08; 95% CI:0.65-1.8). Supporting greater self-care and consideration of mental health management strategies in relation to HIV may be useful in promoting the wellbeing of PLWH who experience depressive symptoms.
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Affiliation(s)
- Tatiana E Pakhomova
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada.
| | - Clara Tam
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Kate Salters
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- Simon Fraser University, Burnaby, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- University of British Columbia, Vancouver, Canada
| | - Justin Barath
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Simon Elterman
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Nicole Dawydiuk
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Tim Wesseling
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Sean Grieve
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Paul Sereda
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
| | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- Simon Fraser University, Burnaby, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Y6, Canada
- University of British Columbia, Vancouver, Canada
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Arashiro P, Maciel CG, Freitas FPR, Koch GSR, da Cunha JCP, Stolf AR, Paniago AMM, de Medeiros MJ, Santos-Pinto CDB, de Oliveira EF. Adherence to antiretroviral therapy in people living with HIV with moderate or severe mental disorder. Sci Rep 2023; 13:3569. [PMID: 36864110 PMCID: PMC9980869 DOI: 10.1038/s41598-023-30451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection remains a serious public health concern, with an estimated 38 million people living with HIV (PLHIV). PLHIV are often affected by mental disorders at higher rate than the general population. One challenge in the control and prevention of new HIV infections is adherence to antiretroviral therapy (ART), with PLHIV with mental disorders having seemingly lower adherence than PLHIV without mental disorders. This cross-sectional study assessed adherence to ART in PLHIV with mental disorders who attended the Psychosocial Care Network health facilities in Campo Grande, Mato Grosso do Sul, Brazil, from January 2014 to December 2018. Data from health and medical databases were used to describe clinical-epidemiological profiles and adherence to ART. To assess the associated factors (potential risk or predisposing factors) with ART adherence, we used logistic regression model. Adherence was extremely low (16.4%). Factors associated with poor adherence were lack of clinical follow-up, particularly in middle-aged PLHIV. Other apparently associated factors were living on the streets and having suicidal ideation. Our findings reinforce the need for improvements in the care for PLHIV with mental disorders, especially in the integration between specialized mental health and infectious disease health facilities.
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Affiliation(s)
- Priscilla Arashiro
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Camila Guadeluppe Maciel
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Fernanda Paes Reis Freitas
- Hospital Universitário Maria Aparecida Pedrossiam, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Anderson Ravy Stolf
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Anamaria Mello Miranda Paniago
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.
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Báez P, Tiburcio A, Alba N, Mateo F, Grullon E, Cordero S, Fernández A, Reinoso J, Cruz D, Gómez K, Vargas N, Saint-Hilaire C, Abreu O, Acosta G, Halpern M, Stonbraker S. Medición de adherencia a antirretrovirales con métodos múltiples en La Romana, República Dominicana. Rev Panam Salud Publica 2022; 46:e207. [PMCID: PMC9733707 DOI: 10.26633/rpsp.2022.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/15/2022] [Indexed: 12/13/2022] Open
Abstract
RESUMEN
Objetivo.
El objetivo fue desarrollar una herramienta para medir los niveles de adherencia al tratamiento antirretroviral (la TARV) en un entorno de escasos recursos, a partir de la combinación de cuatro métodos de medición de adherencia.
Métodos.
Revisión retrospectiva de 500 expedientes médicos de personas que viven con VIH, elegidos de manera aleatoria desde octubre del 2017 hasta enero del 2020. Se midió la adherencia a la TARV combinando cuatro métodos de medición (porcentaje de cobertura de la TARV recetada, recogida de la TARV en farmacia, nivel de carga viral y autoinforme de adherencia). Se realizaron pruebas de chi al cuadrado con P <0,05 para diferencias estadísticamente significativas y regresión binaria logística para identificar probabilidades de adherencia óptima y subóptima. Realizamos pruebas de Spearman para correlación de categorías y alfa de Cronbach para medir la consistencia interna de la herramienta.
Resultados.
Obtuvimos 497 calificaciones de adherencia. De estas, 307 (61,8%) usuarios se calificaron como adherentes, 141(28,4%) como semiadherentes y 49 (9,8%) como no adherentes. Se encontró una mayor probabilidad de adherencia óptima en grupos de 60 años o más (odds ratio [OR]: 1,6; IC95%: 0,8-3,5) sin diferencia entre hombres y mujeres (OR: 0,9; IC95%: 0,7-1,4). La prueba de Spearman informó una relación (r = 0,8) entre los niveles de carga viral y la calificación final, y la prueba alfa de Cronbach arrojó una modesta consistencia interna (α = 0,7).
Conclusiones.
Se desarrolló una herramienta para medir adherencia en un entorno de escasos recursos. La herramienta presenta niveles modestos de consistencia interna y una correlación fuerte en la categoría de carga viral y adherencia.
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Affiliation(s)
- Pamela Báez
- Clínica de Familia La Romana, La Romana, República Dominicana. Pamela Báez
| | - Adriana Tiburcio
- Clínica de Familia La Romana, La Romana, República Dominicana. Pamela Báez
| | - Nicole Alba
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Fernando Mateo
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Estefani Grullon
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Sheyla Cordero
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Ana Fernández
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Janetly Reinoso
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Desireé Cruz
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Karina Gómez
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Natacha Vargas
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Camila Saint-Hilaire
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Olga Abreu
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Grace Acosta
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, República Dominicana
| | - Mina Halpern
- Clínica de Familia La Romana, La Romana, República Dominicana. Pamela Báez
| | - Samantha Stonbraker
- Escuela de Enfermería, Universidad de Colorado, Colorado, Estados Unidos de América
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dos Santos AP, Cordeiro JFC, Fracarolli IFL, Gomide EBG, de Andrade D. Instruments to assess adherence to medication in people living with HIV: a scoping review. Rev Saude Publica 2022; 56:112. [PMID: 36629703 PMCID: PMC9749734 DOI: 10.11606/s1518-8787.2022056004475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/18/2022] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- André Pereira dos Santos
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Grupo de Estudos e Pesquisa em Antropometria, Treinamento e Esporte. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Human Exposome and Infectious Diseases NetworkRibeirão PretoSPBrasilHuman Exposome and Infectious Diseases Network. Ribeirão Preto, SP, Brasil
| | - Jéssica Fernanda Corrêa Cordeiro
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Isabela Fernanda Larios Fracarolli
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Euripedes Barsanulfo Gonçalves Gomide
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Universidade de São PauloEscola de Educação Física e Esporte de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Educação Física e Esporte de Ribeirão Preto. Grupo de Estudos e Pesquisa em Antropometria, Treinamento e Esporte. Ribeirão Preto, SP, Brasil,Claretiano – Centro UniversitárioBatataisSPBrasilClaretiano – Centro Universitário. Batatais, SP, Brasil
| | - Denise de Andrade
- Universidade de São PauloEscola de Enfermagem de Ribeirão PretoRibeirão PretoSPBrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil,Human Exposome and Infectious Diseases NetworkRibeirão PretoSPBrasilHuman Exposome and Infectious Diseases Network. Ribeirão Preto, SP, Brasil
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HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8–15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
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Fan X, Ning K, Liu C, Zhong H, Lau JTF, Hao C, Hao Y, Li J, Li L, Gu J. Uptake of an app-based case management service for HIV-positive men who have sex with men in China: a process evaluation study (Preprint). J Med Internet Res 2022; 25:e40176. [PMID: 37099367 PMCID: PMC10173030 DOI: 10.2196/40176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/15/2023] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in China are disproportionately affected by the HIV epidemic, and medication adherence to antiretroviral treatment in this vulnerable population is suboptimal. To address this issue, we developed an app-based case management service with multiple components, informed by the Information Motivation Behavioral skills model. OBJECTIVE We aimed to conduct a process evaluation for the implementation of an innovative app-based intervention guided by the Linnan and Steckler framework. METHODS Process evaluation was performed alongside a randomized controlled trial in the largest HIV clinic in Guangzhou, China. Eligible participants were HIV-positive MSM aged ≥18 years planning to initiate treatment on the day of recruitment. The app-based intervention had 4 components: web-based communication with case managers, educational articles, supportive service information (eg, information on mental health care and rehabilitation service), and hospital visit reminders. Process evaluation indicators of the intervention include dose delivered, dose received, fidelity, and satisfaction. The behavioral outcome was adherence to antiretroviral treatment at month 1, and Information Motivation Behavioral skills model scores were the intermediate outcome. Logistic and linear regression was used to investigate the association between intervention uptake and outcomes, controlling for potential confounders. RESULTS A total of 344 MSM were recruited from March 19, 2019, to January 13, 2020, and 172 were randomized to the intervention group. At month 1 follow-up, there was no significant difference in the proportion of adherent participants between the intervention and control groups (66/144, 45.8% vs 57/134, 42.5%; P=.28). In the intervention group, 120 participants engaged in web-based communication with case managers and 158 accessed at least 1 of the delivered articles. The primary concern captured in the web-based conversation was the side effects of the medication (114/374, 30.5%), which was also one of the most popular educational articles topics. The majority (124/144, 86.1%) of participants that completed the month 1 survey rated the intervention as "very helpful" or "helpful." The number of educational articles accessed was associated with adequate adherence in the intervention group (odds ratio 1.08, 95% CI 1.02-1.15; P=.009). The intervention also improved the motivation score after adjusting for baseline values (β=2.34, 95% CI 0.77-3.91; P=.004). However, the number of web-based conversations, regardless of conversation features, was associated with lower motivation scores in the intervention group. CONCLUSIONS The intervention was well-received. Delivering educational resources of interest may enhance medication adherence. The uptake of the web-based communication component could serve as an indicator of real-life difficulties and could be used by case managers to identify potential inadequate adherence. TRIAL REGISTRATION Clinicaltrial.gov NCT03860116; https://clinicaltrials.gov/ct2/show/NCT03860116. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-020-8171-5.
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Affiliation(s)
- Xiaoyan Fan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ke Ning
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cong Liu
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Haidan Zhong
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Joseph T F Lau
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Centre for Health Information Research, Sun Yat-sen University, Guangzhou, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jinghua Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Centre for Health Information Research, Sun Yat-sen University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Centre, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Centre for Health Information Research, Sun Yat-sen University, Guangzhou, China
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Perez TA, Chagas EFB, Pinheiro OL. Health functional literacy and adherence to antiretroviral therapy in people living with HIV. Rev Gaucha Enferm 2021; 42:e20200012. [PMID: 33566947 DOI: 10.1590/1983-1447.2021.20200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To verify the relationship between adherence to antiretroviral therapy and Functional Health Literacy. METHODS Cross-sectional study, carried out in the Specialized Care Service in 2019, using questionnaires about adherence to treatment and Functional Health literacy people living with human immunodeficiency virus. The LFS questionnaire has questions about numerical and text interpretation skills and the adherence questionnaire addresses how to use antiretrovirals. Viral load was verified by analysis of medical records. Associations between variables were analyzed using the Chi-square test. RESULTS 78 patients were interviewed and a significant association between the variables to treatment adherence and Functional Literacy in Health was observed. The association between adherence to therapy and viral load levels was also significant. CONCLUSIONS The data found show a significant association between the variables, ie, the lower the functional health literacy, the greater the difficulty to adhere to treatment.
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Affiliation(s)
| | - Eduardo Federighi Baisi Chagas
- Faculdade de Medicina de Marília (FAMEMA). Marília, São Paulo, Brasil.,Universidade de Marília (UNIMAR). Marília, São Paulo, Brasil
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Yang X, Wang Z, Harrison S, Lau JTF. Coverage and adherence of antiretroviral therapy among Chinese HIV-positive men who have sex with men with high CD4 counts in the era of 'Treat all'. Trop Med Int Health 2019; 25:308-318. [PMID: 31758830 DOI: 10.1111/tmi.13353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES HIV-positive men who have sex with men (MSM) with CD4 cell counts> 350 cells/mm3 in China recently became eligible for free antiretroviral therapy (ART) due to updated national guidelines. This study aimed to investigate ART coverage and adherence among a large sample of HIV-positive MSM in China. METHODS A cross-sectional survey was conducted in Chengdu and Hangzhou, China, from February to November 2016. Participants were 277 MSM who had received a confirmatory HIV diagnosis and had CD4 levels of> 350 cells/mm3 . Trained staff of collaborating non-governmental organizations contacted all HIV-positive MSM listed in their service records and invited them to join the study. The ART initiation, ART adherence and interactions between healthcare professionals and the patients were assessed. RESULTS ART coverage was 60.3%. Among those who were on ART (n = 167), no participants reported missing any doses in the last four days, but 25.7% reported non-compliance to either ART dosing schedule or dosage instructions. After adjusting for background variables and perceived eligibility for ART, two variables were significant factors of higher ART coverage: (i) receiving a recommendation from healthcare professionals for immediate ART initiation and (ii) perceiving having received an adequate explanation of potential harms of ART. Being prescribed> 3 pills per dose and not having a temporary resident permit were associated with non-compliance. CONCLUSIONS Significant efforts are needed to increase ART coverage among HIV-positive MSM with high CD4 counts in China. Although prevalence of missing doses was low, non-compliance to dosing schedule/instructions should not be neglected. Interactions between healthcare professionals and MSMs play an important role in facilitating ART initiation.
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Affiliation(s)
- Xueying Yang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Sayward Harrison
- Department of Health Promotion, Education, and Behavior, South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Leadebal ODCP, Pereira RR, Nóbrega LMB, Oliveira JAMD, Chaves RB, Medeiros LBD, Monroe AA, Nogueira JDA. Prevalência do alto risco de complicações clínicas associadas ao óbito por Aids. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Investigar a prevalência do alto risco entre casos de óbitos a partir da classificação de risco de complicações clínicas associadas a aids e sua relação com variáveis sociodemográficas e terapêuticas. Métodos: Estudo epidemiológico, retrospectivo, envolvendo 80 casos de óbito por aids ocorridos entre 2007 e 2015 em um Estado do Nordeste brasileiro. A estratificação do risco considerou indicadores de acompanhamento obtidos no diagnóstico da infecção, atribuindo-se valores de 1,2 para carga viral, e 1,2 e 3 aos indicadores de linfócitos T CD4+, quantidade de doenças oportunistas, manifestações clínicas e doenças crónicas, com escore variando entre 5 e 14. Quanto maior esse escore, maior o risco para complicações clínicas. Os dados foram analisados estimando a prevalência e razão de prevalência para o alto risco, seguido do método de Weight of Evidence e estatística D de Somers. Resultados: Dos 80 casos estudados, 51,2% foram alocados no estrato de alto risco. O registro de antecedentes psiquiátricos aumentou em 2 vezes a prevalência para o alto risco e a faixa etária apresentou forte relação com esse estrato. A contagem de linfócitos T-CD4+, doenças oportunistas e manifestações clínicas foram os indicadores que apresentaram maior força de associação com a estratificação de risco. Conclusão: O estudo mostrou a prevalência do alto risco para o desenvolvimento de complicações clínicas, maior força associativa nos indicadores LT-CD4+, doenças oportunistas e manifestações clínicas com escore de risco proposto. Estes resultados sugerem a necessidade de atenção especial dos serviços de atenção especializada aos indivíduos acompanhados em nível ambulatorial.
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Soares RDCA, de Brito AM, Lima K, Lapa TM. Adherence to antiretroviral therapy among people living with HIV/AIDS in northeastern Brazil: a cross-sectional study. SAO PAULO MED J 2019; 137:479-485. [PMID: 32159632 PMCID: PMC9754276 DOI: 10.1590/1516-3180.2019.0212170919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/18/2019] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.
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Affiliation(s)
| | - Ana Maria de Brito
- PhD. Researcher, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ), Recife (PE), Brazil.
| | - Kledoaldo Lima
- PhD. Laboratory Analyst (Biomedicine), Hospital das Clínicas (HC), Universidade Federal de Pernambuco (UFPE), Recife (PE), Brazil.
| | - Tiago Maria Lapa
- PhD. Researcher, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ), Recife (PE), Brazil.
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Edessa D, Sisay M, Asefa F. Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0220159. [PMID: 31356613 PMCID: PMC6663009 DOI: 10.1371/journal.pone.0220159] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Increased second-line antiretroviral therapy (ART) failure rate narrows future options for HIV/AIDS treatment. It has critical implications in resource-limited settings; including sub-Saharan Africa (SSA) where the burden of HIV-infection is immense. Hence, pooled estimate for second-line HIV treatment failure is relevant to suggest valid recommendations that optimize ART outcomes in SSA. METHODS We retrieved literature systematically from PUBMED/MEDLINE, EMBASE, CINAHL, Google Scholar, and AJOL. The retrieved studies were screened and assessed for eligibility. We also assessed the eligible studies for their methodological quality using the Joanna Briggs Institute's appraisal checklist. The pooled estimates for second-line HIV treatment failure and its associated factors were determined using STATA, version 15.0 and MEDCALC, version 18.11.3, respectively. We assessed publication bias using Comprehensive Meta-analysis software, version 3. Detailed study protocol for this review/meta-analysis is registered and found on PROSPERO (ID: CRD42018118959). RESULTS A total of 33 studies with the overall 18,550 participants and 19,988.45 person-years (PYs) of follow-up were included in the review. The pooled second-line HIV treatment failure rate was 15.0 per 100 PYs (95% CI: 13.0-18.0). It was slightly higher at 12-18 months of follow-up (19.0/100 PYs; 95% CI: 15.0-22.0), in children (19.0/100 PYs; 95% CI: 14.0-23.0) and in southern SSA (18.0/100 PYs; 95% CI: 14.0-23.0). Baseline values (high viral load (OR: 5.67; 95% CI: 13.40-9.45); advanced clinical stage (OR: 3.27; 95% CI: 2.07-5.19); and low CD4 counts (OR: 2.80; 95% CI: 1.83-4.29)) and suboptimal adherence to therapy (OR: 1.92; 95% CI: 1.28-2.86) were the factors associated with increased failure rates. CONCLUSION Second-line HIV treatment failure has become highly prevalent in SSA with alarming rates during the 12-18 month period of treatment start; in children; and southern SSA. Therefore, the second-line HIV treatment approach in SSA should critically consider excellent adherence to therapy, aggressive viral load suppression, and rapid immune recovery.
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Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
- * E-mail:
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
| | - Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
- Center for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, NSW, Australia
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12
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Costa JDM, Torres TS, Coelho LE, Luz PM. Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta-analysis. J Int AIDS Soc 2019; 21. [PMID: 29356390 PMCID: PMC5810329 DOI: 10.1002/jia2.25066] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Optimal adherence to antiretroviral therapy is closely related with suppression of the HIV viral load in plasma, slowing disease progression and decreasing HIV transmission rates. Despite its importance, the estimated proportion of people living with HIV in Latin America and the Caribbean with optimal adherence has not yet been reported in a meta-analysis. Moreover, little is known of the factors leading to poor adherence which may be setting-specific. We present a pooled estimate of adherence to antiretroviral therapy (ART) of people living with HIV in Latin America and Caribbean, report the methods used to measure adherence and describe the factors associated with poor adherence among the selected studies. METHODS We electronically searched published studies up to July 2016 on the PubMed, Web of Science and Virtual Health Library (Latin America and the Caribbean Regional Portal); considering the following databases: MEDLINE, LILACS, PAHO and IBECS. Two independent reviewers selected and extracted data on ART adherence and study characteristics. Pooled estimate of adherence was derived using a random-effects model. Risk of bias in individual studies was assessed independently by two investigators using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). RESULTS AND DISCUSSION The meta-analysis included 53 studies published between 2005 and 2016, which analysed 22,603 people living with HIV in 25 Latin America and Caribbean countries. Overall adherence in Latin America and Caribbean was 70% (95% CI: 63-76; I2 = 98%), similar to levels identified by studies conducted in high-income regions. Self-report was the most frequently used method to measure adherence. Subgroup analysis showed that adherence was higher for the shortest recall time frame used, as well as in countries with lower income level, Gross National Income (GNI) per capita and Human Development Index (HDI). Studies reported diverse adherence barriers, such as alcohol and substance misuse, depression, unemployment and pill burden. CONCLUSIONS Our study suggests that adherence to ART in Latin America and Caribbean may be below the sufficient levels required for a successful long-term viral load suppression.
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Affiliation(s)
- Jessica de Mattos Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Santos MA, Guimarães MDC, Helena ETS, Basso CR, Vale FC, Carvalho WMDES, Alves AM, Rocha GM, Acurcio FDA, Ceccato MDGB, do Prado RR, Menezes PR, Nemes MIB. Monitoring self-reported adherence to antiretroviral therapy in public HIV care facilities in Brazil: A national cross-sectional study. Medicine (Baltimore) 2018; 97:S38-S45. [PMID: 29912815 PMCID: PMC5991539 DOI: 10.1097/md.0000000000009015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient adherence to antiretroviral therapy (ART) is critical for HIV treatment success. Monitoring rates of adherence in public HIV outpatient care facilities can improve outcomes in Brazil where ART is universally available. METHODS We conducted a national cross-sectional survey of ART adherence in 2010. Participants were selected using a multistage probability sample. First, HIV outpatient care facilities were stratified according to 7 Organizational Quality Classification (OQC) groups and regions. Second, 1 or 2 facilities were selected per region for each OQC group. Finally, patients were randomly selected at each facility. In a first component, patients were invited to answer to a web-based questionnaire (WebAd-Q), a validated self-reported tool that includes 3 questions on adherence to ART in the past 7 days (time scheduling-timing, drug regimen-medication, and pill counts-dose), herein named indicators of potential nonadherence (IPN). In addition, a subsample of participants were interviewed in order to obtain further data on sociodemographic and clinical characteristics (second component). The proportion of each IPN was estimated using weighted data to account for the sampling design with 95% confidence interval (CI) and descriptive analysis was carried out. RESULTS Fifty-five facilities were chosen and 2424 patients completed the WebAd-Q in the first component of the study, while 598 patients were interviewed for the second component. The weighted proportions of the IPN were 50.9%, 31.8%, and 19.5%, for timing, medication, and dose, respectively, while11.7% had all 3 indicators, varying from 5.9% in the Southeast and 21.9% in the Northeast regions. Overall, 61.1% of the patients had at least 1 IPN (95% CI: 58.5-63.7%). Patients reporting depression symptoms, illicit drug use and those who missed medical appointments had worse nonadherence outcomes. CONCLUSIONS Overall, there was a high proportion of all indicators IPN and timing was the main component associated with low adherence. Although these indicators may not necessarily indicate individual nonadherence, they represent a worrisome scenario in the public Brazilian HIV care facilities. On a routine basis, these facilities can identify gaps in providing counseling and ART orientation to their clientele and develop innovative strategies to prevent nonadherence.
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Affiliation(s)
- Maria Altenfelder Santos
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | - Cáritas Relva Basso
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | - Felipe Campos Vale
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | - Ana Maroso Alves
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
| | | | | | | | | | - Paulo Rossi Menezes
- Faculty of Medicine of University of Sao Paulo, Department of Preventive Medicine, São Paulo, São Paulo
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Souza Neto VLD, Silva RARD, Rocha CCT, Costa RTDS, Nóbrega MMLD. Diagnósticos de enfermagem da CIPE® para pessoas com Síndrome da Imunodeficiência Adquirida. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Resumo Objetivo: Identificar diagnósticos de enfermagem da CIPE®, a partir dos fenômenos da prática de enfermagem evidenciados na avaliação da saúde de pessoas vivendo com a Síndrome da Imunodeficiência adquirida. Métodos: Estudo transversal com 120 pessoas vivendo com Aids em um hospital de doenças infectocontagiosas. Para a coleta de dados empregaram-se um roteiro de entrevista e exame físico. A elaboração dos diagnósticos foi realizada utilizando-se a CIPE®. Os dados foram analisados por meio da estatística descritiva e inferencial. Resultados: Identificaram-se 72 fenômenos da prática de enfermagem, sendo possível a elaboração de 37 diagnósticos. Destes, apenas 11 obtiveram o índice de Concordância e índice de validação de conteúdo > 0.80, sendo considerados validados; dos quais sete foram classificados dentro das necessidades psicobiologicas e quatro nas psicossociais. Conclusão: A identificação dos fenômenos da prática de enfermagem corrobora na elaboração dos diagnósticos, resultados e intervenções direcionados às necessidades prioritárias de pessoas vivendo com Aids.
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Effects of depression and anxiety on antiretroviral therapy adherence among newly diagnosed HIV-infected Chinese MSM. AIDS 2017; 31:401-406. [PMID: 27677168 DOI: 10.1097/qad.0000000000001287] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Our objective was to explore the effect of depression and anxiety on adherence to antiretroviral therapy (ART) among MSM with newly diagnosed HIV infections. DESIGN We conducted a prospective study of Chinese MSM with newly diagnosed HIV infections. METHODS The Hospital Anxiety and Depression Scale was used to measure depression and anxiety at baseline, 6 and 12 months, separately. ART adherence was self-reported once every 3 months ('perfect' or no missing dose in the past 3 months vs. 'imperfect' adherence or at least one missing dose in the past 3 months). We utilized a priori substantial knowledge guided by causal models to identify confounding covariates, and performed mixed-effect logistic regression to assess the effects of depression and anxiety on ART adherence. RESULTS We included 228 participants who initiated ART after HIV diagnosis and before the end of study. A one-unit increase in the depression and anxiety score was associated with a 16% increase [adjusted odds ratio (aOR), 1.16; 95% confidence interval (CI), 1.02-1.32] and a 17% increase (aOR, 1.17; 95% CI, 1.03-1.33) in the odds of reporting imperfect ART adherence, respectively. When depression and anxiety were categorized (normal, borderline, and likely), only likely anxiety had a significant association with imperfect ART adherence (aOR, 4.79; 95% CI, 1.12-20.50). CONCLUSION Depression and anxiety are risk factors for imperfect ART adherence among Chinese MSM with newly diagnosed HIV infections. Intensive intervention on depression and/or anxiety beyond regular post-HIV-testing counseling may increase adherence to ART, and improve HIV treatment outcomes.
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Reis RK, Castrighini CDC, Melo ES, Jesus GJD, Queiroz AAFL, Gir E. Avaliação dos sintomas depressivos somáticos e afetivo-cognitivos de pessoas vivendo com HIV/AIDS. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Resumo Objetivo Analisar os sintomas somáticos e afetivo-cognitivos de depressão segundo o sexo de pessoas que vivem com HIV/AIDS. Métodos Estudo analítico realizado em serviços de atendimento especializado em Ribeirão Preto-SP, com amostra de 331 participantes. Para coleta de dados foram utilizados instrumento de caracterização sociodemográfica e o Inventário de Depressão de Beck (BDI). Resultados Dos entrevistados, 50,4% eram do sexo masculino e destes, 52,1% estavam na faixa etária de 20 a 35 anos. As mulheres apresentaram maior escolaridade (p=0,001) e menor renda (<0,001), e os homens apresentaram mais comorbidades (p=0,004). Identificou-se que as mulheres apresentaram maiores médias de escores de depressão, tanto no domínio somático (p<0,001) quanto no afetivo/cognitivo (p<0,001). Conclusão Os resultados deste estudo apontam que as mulheres apresentam maiores escores de sintomatologia depressiva do que os homens, tanto no domínio somático quanto no afetivo/cognitivo das subescalas do IDB.
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