Adherence to antiretroviral therapy and factors associated with non-adherence: a cohort study at two referral services in Brazil

This cohort study evaluated non-adherence to antiretrovirals at referral services in Pernambuco, Brazil, 2016/2017, through self-report. A generalized mixed-effects model for binary outcomewas used. We assessed 542 participants with an adherence rate of 85.50%. A greater chance of non-adherence was associated with:a low/moderate level of nicotine dependence (OR = 2.79, p = 0.00, IC = 1.44-5.41); ≥7 tablets/day (OR = 6.14, p = 0.00, IC = 3.42-11.02); LPV/r (OR = 1.49, p = 0.6, IC = 0.98-2.26), ddI (OR = 3.34, p = 0.03, IC = 1.12-9.97), ABC (OR = 4.02, p = 0.05, IC = 1.01-16.03), RAL (OR = 2.49, p = 0.01, IC = 1.32-4.70) and DTG (OR = 4.65, p = 0.01, IC = 1.42-15.16); 6-10 year seropositive diagnosis (OR = 2.17, p = 0.01, IC = 1.20-3.92) and symptoms of depression (OR = 1.55, p = 0.03, IC = 1.03-2.33). Protective factors for non-adherence weres: ≥50 years (OR = 0.67, p = 0.06, IC = 0.45-1.01), secondary/higher education (OR = 0.48, p = 0.00, IC = 0.34-0.70), embarrassment at health service (OR = 0.49, p = 0.04, IC = 0.24-0.97), good understanding of antiretrovirals (OR = 0.62, p = 0.03, IC = 0.40-0.96), adverse event (OR = 0.74, p = 0,06, IC = 0.54-1.01), use of TDF (OR = 0.62, p = 0.01, IC = 0.43-0.90), NVP (OR = 0.41, p = 0.05, IC = 0.71-1.00) and EFZ (OR = 0.48, p = 0.01, IC = 0.29-0.80) and good knowledge of HIV/AIDS/ART. (OR = 0.67, p = 0.07, IC = 0.43-1.04). Variables with stronger association were those linked to ART. Systematic use of self-report adherence is recommended for priority groups.

GRAVIDEZ NA ADOLESCÊNCIA E CONDIÇÃO DE VIDA: DIFERENCIAIS NA DISTRIBUIÇÃO ESPACIAL

Com o objetivo de analisar os diferenciais da gravidez na adolescência e algumas de suas consequências a partir da condição de vida, em Recife, realizou-se um estudo ecológico, incluindo duas unidades de análise: bairro e estrato da condição de vida. Utilizou-se o Indicador Composto de Condição de Vida, obtido por meio de análise fatorial, e os indicadores referentes à gravidez na adolescência. Com base no indicador composto, os bairros foram agrupados em três estratos, pela técnica de cluster. Para as variáveis dependentes, foram calculadas as razões entre os indicadores dos estratos e a correlação com o Indicador Composto de Condição de Vida dos bairros. Para aqueles com correlação significativa, aplicou-se regressão linear simples. A razão entre o estrato de pior e melhor condição de vida foi em torno de 2,00 para a proporção de mães adolescentes e taxa de fertilidade específica, em todos os grupos etários. As correlações reforçaram a relação entre a gravidez na adolescência e a condição de vida (r entre 0,32 e 0,88). Nos modelos de regressão, a condição de vida desempenhou um papel importante na predição da gravidez na adolescência. No geral, observou-se um gradiente crescente da gravidez na adolescência com a piora da condição de vida.     

Structure of the herb stratum under different light regimes in the Submontane Atlantic Rain Forest

This study aimed to characterize the structure of the herb stratum in relation to light availability in the Submontane Atlantic Rain Forest at the Carlos Botelho State Park, SP, Brazil. Fortyone 10 x10 m plots were established under the closed canopy (18 plots), small and medium canopy gaps (11) and large canopy gaps dominated by Guadua tagoara (Ness) Kunth (12). Inside each plot, the line intercept method was applied to assess soil coverage as an estimate of density of herb stratum vegetation. Hemispherical photographs were taken at the centre of the plots to evaluate the annual light regime. Overall, Calathea communis Wanderley and S. Vieira had the greater mean coverage, followed by woody seedlings, ground ferns and other herbs (mainly, Araceae, Acanthaceae, Amaranthaceae and Cyperaceae). There were strong correlations among several groups of the herb stratum, such as the negative correlations between woody seedlings with the coverage of C. communis and with rocks. The analysis of the hemispherical photographs confirmed the difference among environments that led to significant differences in the soil coverage of the herb stratum vegetation but woody seedlings. For instance, C. communis showed great coverage in large gaps while ferns were more abundant in small and medium gaps and in the understorey. Other herbs, in turn, demonstrated bigger soil coverage in small and medium gaps. Although this study represents a rough assessment of the structure and composition of the herb stratum, the results found here illustrated the evident relation between herb species density and the environmental variation promoted by changes on canopy structure and topography.