Avaliação da adesão à terapia antirretroviral em indivíduos que vivem com HIV/AIDS
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2017-02-22
Autores
Camargo, Caio Cavassan de [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A Organização Mundial da Saúde divulgou no final de 2015, através da Joint United Nations Programme on HIV/AIDS, que existem no mundo cerca de 36,7 (34,0 – 39,8) mi-lhões de pessoas infectadas com o vírus da imunodeficiência humana. A partir da escolha do esquema medicamentoso podem surgir potenciais implicações relacionadas à variação da durabilidade da atividade antirretroviral, restauração do sistema imune, dificuldades de ade-são ao regime terapêutico, bem como as possibilidades de aparecimento de resistência às drogas. A compreensão dos aspectos dificultadores da adesão é um passo essencial à melho-ria do manejo terapêutico e para superação das adversidades causadas pela infecção pelo HIV. Os objetivos desse estudo foram caracterizar a adesão à terapia medicamentosa antirre-troviral em indivíduos que vivem com HIV/Aids de um serviço público de ambulatórios do estado de São Paulo/Brasil e avaliar os fatores associados no processo terapêutico, como aspectos socioeconômicos, sintomas depressivos e enfrentamento da doença. Esta tese foi dividida em dois estudo sendo um transversal, que responde questões relacionadas à mensu-ração de adesão à TARV, quais fatores se relacionam à não adesão, presença de sinais de depressão e uso de estratégias de enfrentamento perante o diagnóstico de infecção pelo HIV/aids; o segundo estudo trata-se de estudo do tipo coorte não concorrente, que avaliou o tempo de uso de TARV em função do tempo, associada à mensuração da adesão à TARV. Em ambos os dados foram obtidos por meio de entrevista, recentemente realizada pelo pró-prio pesquisador, com duração de aproximadamente 40 minutos, cujos dados foram estima-dos para todo o período de uso da medicação. Além disso, foi realizada consulta a prontuá-rios médicos e ao sistema de controle logístico de medicamentos (SICLOM). Para avaliar a adesão foi utilizada a adaptação brasileira do "Cuestionario para la Evaluación de la Adhe-sión al Tratamiento Antiretroviral". Os sinais de depressão foram investigados pela escala Beck Depression Index - BDI-II e o enfrentamento por meio do inventário de estratégias de coping de Folkman & Lazarus, adaptado para o português. Foram entrevistados 112 pacien-tes do Serviço de Ambulatórios Especializados de Infectologia “Domingos Alves Meira”, com média de idade de 42±10 anos, sendo predominantes, sexo masculino, baixa escolarida-de e renda, não ter parceiros sexuais fixos, contagem de linfócitos T CD4+ > 500 célu-las/mm3 e carga viral indetectável. Quase 30% dos indivíduos referiram consumos de tabaco e álcool. Dois terços da casuística apresentaram níveis de adesão abaixo do ideal e algum sinal de depressão. Dentre as estratégias de enfrentamento, autocontrole, suporte social, reso-lução de problemas e reavaliação positiva, influenciaram para a melhora da adesão.
At the end of 2015, the World Health Organization (WHO) announced, through the Joint United Nations Program on HIV / AIDS, that there are around 36.7 (34.0 - 39.8) million people infected with the Immunodeficiency. From the choice of the drug regimen, potential implications can arise regarding the variation of the durability of the antiretroviral activity, restoration of the immune system, difficulties of adherence to the therapeutic regimen, as well as the possibilities of drug resistance. Understanding the difficult aspects of adherence is an essential step towards improving therapeutic management and overcoming adversities caused by HIV infection. The aims of this study were to characterize adherence to antiretro-viral drug therapy in individuals living with HIV / AIDS at a public outpatient clinic in the state of São Paulo / Brazil and to evaluate the associated factors in the therapeutic process, such as socioeconomic aspects, depressive symptoms And coping with the disease. This the-sis was divided into two studies, a cross-sectional study that answers questions related to the measurement of adherence to ART, which factors are related to non-adherence, the presence of signs of depression and the use of coping strategies in the diagnosis of HIV infection / Aids; The second study is a noncompetitive cohort study, which evaluated the survival of each therapeutic regimen used, as a function of time, associated to the measurement of ART adherence. Both data were obtained through an interview, recently conducted by the resear-cher himself, with a duration of approximately 40 minutes, whose data were estimated for the entire period of medication use. In addition, the medical records and the medical logistic control system (SICLOM) were consulted. To assess adherence, the Brazilian adaptation of the "Questionnaire for the Evaluation of Adherence to Antiretroviral Treatment" was used. Signs of depression were investigated by the Beck Depression Index - BDI-II scale and co-ping with Folkman & Lazarus's inventory of coping strategies adapted to Portuguese. We interviewed 112 patients from the "Domingos Alves Meira" Specialized Clinic of Infectolo-gy, with a mean age of 42 ± 10 years, being predominant, male, low schooling and income, having no fixed sex partners, T lymphocyte count CD4 +> 500 cells / mm3 and undetectable viral load. Almost 30% of the individuals reported consuming tobacco and alcohol. Two-thirds of the sample had below-optimal levels of adhesion and some signs of depression. Among the coping strategies, self-control, social support, problem solving and positive re-evaluation, influenced the improvement of adherence.
At the end of 2015, the World Health Organization (WHO) announced, through the Joint United Nations Program on HIV / AIDS, that there are around 36.7 (34.0 - 39.8) million people infected with the Immunodeficiency. From the choice of the drug regimen, potential implications can arise regarding the variation of the durability of the antiretroviral activity, restoration of the immune system, difficulties of adherence to the therapeutic regimen, as well as the possibilities of drug resistance. Understanding the difficult aspects of adherence is an essential step towards improving therapeutic management and overcoming adversities caused by HIV infection. The aims of this study were to characterize adherence to antiretro-viral drug therapy in individuals living with HIV / AIDS at a public outpatient clinic in the state of São Paulo / Brazil and to evaluate the associated factors in the therapeutic process, such as socioeconomic aspects, depressive symptoms And coping with the disease. This the-sis was divided into two studies, a cross-sectional study that answers questions related to the measurement of adherence to ART, which factors are related to non-adherence, the presence of signs of depression and the use of coping strategies in the diagnosis of HIV infection / Aids; The second study is a noncompetitive cohort study, which evaluated the survival of each therapeutic regimen used, as a function of time, associated to the measurement of ART adherence. Both data were obtained through an interview, recently conducted by the resear-cher himself, with a duration of approximately 40 minutes, whose data were estimated for the entire period of medication use. In addition, the medical records and the medical logistic control system (SICLOM) were consulted. To assess adherence, the Brazilian adaptation of the "Questionnaire for the Evaluation of Adherence to Antiretroviral Treatment" was used. Signs of depression were investigated by the Beck Depression Index - BDI-II scale and co-ping with Folkman & Lazarus's inventory of coping strategies adapted to Portuguese. We interviewed 112 patients from the "Domingos Alves Meira" Specialized Clinic of Infectolo-gy, with a mean age of 42 ± 10 years, being predominant, male, low schooling and income, having no fixed sex partners, T lymphocyte count CD4 +> 500 cells / mm3 and undetectable viral load. Almost 30% of the individuals reported consuming tobacco and alcohol. Two-thirds of the sample had below-optimal levels of adhesion and some signs of depression. Among the coping strategies, self-control, social support, problem solving and positive re-evaluation, influenced the improvement of adherence.
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Palavras-chave
HIV, Adesão à medicação, Depressão, Enfrentamento, Fatores socioeconômicos