Adhesión a la terapia antirretroviral de adultos viviendo con VIH/sida: un estudio transversal

Miranda, Mariana de Morais Fortunato; Oliveira, Dayanne Rakelly de; Quirino, Glauberto da Silva; Oliveira, Célida Juliana de; Pereira, Maria Lúcia Duarte; Cavalcante, Edilma Gomes Rocha

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (2) • 2022 • https://doi.org/10.1590/0034-7167-2021-0019 copiar

Adhesión a la terapia antirretroviral de adultos viviendo con VIH/sida: un estudio transversal

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Verificar la relación entre la adhesión al tratamiento antirretroviral de adultos con VIH/SIDA y los factores sociodemográficos, apoyo social y clínico.

Método:

Estudio transversal, con abordaje cuantitativo. Participaron 230 pacientes. Utilizaron encuestas de caracterización sociodemográfica, apoyo social, clínico y evaluación de la adhesión al tratamiento antirretroviral. Realizó estadística descriptiva e inferencial.

Resultados:

La adhesión fue clasificada como buena/adecuada. Percibió relación con el sexo, renta, empleo y nivel de instrucción. En el apoyo social: ter acceso al servicio de salud; comunicación con los profesionales de salud; educación en salud; recibir apoyo para desahogar/conversar; información sobre VIH/SIDA; y compañía para el ocio. En el perfil clínico: no dejar de tomar los medicamentos por ausencia en el servicio o por alteración en la prescripción médica.

Conclusión:

La adhesión fue clasificada como buena/adecuada y relacionada, especialmente, a los factores de apoyo social, los cuales deben ser potencializados en la práctica clínica.

Descriptores:
Terapia Antirretroviral Altamente Activa; Cumplimiento de la Medicación; VIH; Síndrome de Inmunodeficiencia Adquirida; Apoyo Social

Adherence	n	Average	Standard deviation	95% confidence interval for mean		Minimum	Maximum
Adherence	n	Average	Standard deviation	Inferior limit	Superior limit	Minimum	Maximum
1 - Low/insufficient (Gross score up to 76)	97	71.20	4.261	70.34	72.05	56	76
2 - Good/adequate (Gross score from 77 to 82)	102	79.13	1.645	78.80	79.45	77	82
3 - Strict (Gross score of 83 or higher)	31	84.52	1.610	83.93	85.11	83	88
Total	230	76.51	5.730	75.76	77.25	56	88

Variables	n	%	Adherence						P
Variables	n	%	Low/ Insufficient		Good/ Adequate		Strict		P
Sex
Male	134	58.3	48	35.8	64	47.8	22	16.4	0.005^* * Chi-squared test
Female	96	41.7	49	51.0	38	39.6	9	9.4
Color/ethnicity									0.715
White	62	27.0	29	46.8	25	40.3	8	12.9
Black	10	4.3	3	30.0	4	40.0	3	30.0
Yellow	5	2.2	1	20.0	3	60.0	1	20.0
Brown	152	66.1	64	42.1	69	45.4	19	12.5
Indigenous	1	0.4	0	0.0	1	100.0	0	0.0
Age									0.890
18 to 39 years	114	49.6	50	43.8	46	40.3	18	15.9
40 to 59 years	94	40.8	39	41.5	43	45.7	12	12.8
≥ 60 years	22	9.6	8	36.3	6	27.4	8	36.3
Marital Status
Married	95	41.3	36	37.9	41	43.1	18	19.0	0.354
Divorced	84	36.5	35	41.7	40	47.6	9	10.7
Widowed	51	22.1	23	45.1	24	47.1	4	7.8
Sexual Orientation									0.569
Heterosexual	168	73.1	69	41.1	79	47.0	20	11.9
Homosexual	47	20.5	20	42.5	18	38.3	9	19.2
Bisexual	15	6.4	7	46.6	5	33.3	3	20.1
Income									0.034^* * Chi-squared test
Without income	9	3.9	6	66.7	3	33.3	0	0.00
Less than 1 minimum wage salary	110	47.8	58	52.7	39	35.5	13	11.8
From 1 to 2 salaries	56	24.3	21	37.5	28	50.0	7	12.5
2 to 3 salaries	29	12.6	6	20.7	19	65.5	4	13.8
3 to 5 salaries	19	8.3	4	21.1	10	52.6	5	26.3
5 to 10 salaries	5	2.2	2	40.0	2	40.0	1	20.0
10 to 20 salaries	2	0.9	0	0.0	1	50.0	1	50.0
Employed
No	154	67.2	77	50.0	62	40.3	15	9.7	0.007^* * Chi-squared test
Yes, registered	23	10.0	5	21.7	14	60.9	4	17.4
Yes, unregistered	53	22.7	15	28.4	25	47.1	13	24.5
If employed, does anyone in the workplace know of your diagnosis?
Yes	13	17.1	3	23.1	6	46.2	4	30.7	0.058
No	63	82.9	19	30.2	34	54.0	10	15.8	0.058
Use some type of drugs?									0.058
Yes	14	6.1	9	64.3	4	21.4	1	8.3
No	216	93.9	87	40.3	99	45.8	30	13.9
Drink alcohol?
Yes	85	37.0	39	45.9	35	41.2	11	12.9	0.679
No	145	63.0	58	40.0	67	46.2	20	13.8	0.679
Level of education
Incomplete elementary school	72	31.3	36	50.0	25	34.7	11	15.3	0.010^* * Chi-squared test
Elementary school	28	12.2	9	32.1	16	57.2	3	10.7
Incomplete high school	24	10.4	13	54.2	8	33.3	3	12.5
High school	53	23.1	21	39.6	27	50.9	5	9.5
Incomplete higher education	16	7.0	3	18.8	11	68.8	12	12.4
Higher education	15	6.5	5	33.3	5	33.3	5	33.3
Master's degree	1	0.4	0	0.0	0	0.0	1	100.0
Doctorate degree	1	0.4	0	0.0	0	0.0	1	100.0
Undetermined	20	8.7	9	45.0	10	50.0	1	5.0

Variables	n	%	Adherence						p
Variables	n	%	Low/ Insufficient		Good/ Adequate		Strict		p
Obtaining health monitoring in the specialized HIV/AIDS care service
Difficult	12	5.2	7	58.3	3	25.0	2	16.7	0.223
More or less	42	18.4	21	50.0	19	45.2	2	4.8
Easy	176	76.5	69	39.2	80	45.5	27	15.3
Access to the monitoring service									0.005^* * Chi-squared test.
Difficult	29	12.6	19	65.5	7	4.2	3	10.3
More or less	46	20.0	21	45.7	21	45.7	4	8.6
Easy	155	67.4	57	36.8	74	47.7	24	15.5
Communication between health professionals
Difficult	4	1.7	4	100.0	0	0.0	0	0.0	0.024^* * Chi-squared test.
More or less	24	10.5	9	37.5	15	62.5	0	0.0
Easy	202	87.8	84	41.6	87	43.0	31	15.4
Participation in some HIV/AIDS treatment group within the service
Yes	22	9.6	14	63.6	7	31.8	1	4.5	0.079
No	208	90.4	82	39.4	96	46.1	30	14.5	0.079
Do you receive support from someone, facilitating health care (e.g., taking care of the children on consultation days, taking care of the house or other situation)?
Never	52	22.6	27	51.9	20	38.5	5	9.6	0.352
Rarely	2	0.9	1	50.0	1	50.0	0	50.0
Sometimes	27	11.7	14	51.9	11	40.7	2	7.4
Often	11	4.8	4	36.4	7	63.6	0	0.0
Always	138	60.0	51	37.0	63	45.6	24	17.4
Do you get financial support from someone, such as splitting household expenses, money received or borrowed?
Never	135	58.7	62	46.0	55	40.7	18	13.3	0.678
Rarely	7	3.0	3	42.8	2	28.6	2	28.6
Sometimes	15	6.5	5	33.4	8	53.3	2	13.3
Often	7	3.0	1	14.3	5	71.4	1	14.3
Always	66	28.8	26	39.4	32	48.5	8	12.1
Do you get support from someone who helps you cope with your health problems?
Never	53	23.1	28	52.8	19	35.8	6	11.4	0.328
Rarely	3	1.3	2	66.7	0	0.0	1	33.3
Sometimes	26	11.3	13	50.0	11	42.3	2	7.7
Often	6	2.6	1	16.7	4	66.7	1	16.7
Always	142	61.7	53	37.3	68	47.9	21	14.8
Does the service that tracks your progress offer all the medications you need for treatment?
Never	0	0.0	0	0.0	0	0.0	0	0.0	0. 216
Rarely	1	0.4	0	0.0	0	0.0	1	100.0
Sometimes	1	0.4	0	0.0	1	100.0	0	0.0
Often	7	3.0	2	28.6	4	57.1	1	14.3
Always	221	96.2	95	43.0	97	43.9	29	13.1
Does the service provide all the required exams free of charge?
Never	0	0.0	0	0.0	0	0.0	0	0.0	0.592
Rarely	1	0.4	1	100.0	0	0.0	0	0.0
Sometimes	18	7.8	5	27.8	10	55.5	3	16.7
Often	6	2.6	1	16.7	3	50.0	2	33.3
Always	205	89.2	90	43.9	89	43.4	26	12.7
Does the service offer medical consultations for monitoring the treatment?
Never	1	0.4	0	0.0	1	100.0	0	0.0	0.592
Rarely	0	0.0	0	0.0	0	0.0	0	0.0
Sometimes	0	0.0	0	0.0	0	0.0	0	0.0
Often	7	3.1	2	28.6	3	42.8	2	28.6
Always	222	96.5	95	42.8	98	44.1	29	13.1
Does the service offer other types of professional follow-up (e.g., psychologist, social worker, others)?
Never	112	48.7	52	46.4	46	41.1	14	12.5	0. 197
Rarely	13	5.7	4	30.8	8	61.5	1	7.7
Sometimes	69	30.0	30	43.5	33	47.8	6	8.7
Often	6	2.6	1	16.7	3	50.0	2	33.3
Always	30	13.0	10	33.3	12	40.0	8	26.7
Does the service carry out health education actions encouraging the continuity of treatment (e.g., lectures, conversation circles, etc.)?
Never	141	61.3	62	44.0	67	47.5	12	8.5	0.013^* * Chi-squared test.
Rarely	17	7.4	6	35.3	8	47.1	3	17.6
Sometimes	36	15.7	19	52.8	11	30.5	6	16.7
Often	18	7.8	4	22.2	11	61.1	3	16.7
Always	18	7.8	6	33.3	5	27.8	7	38.9
Do you receive support from someone who makes you feel valued and helps improve your self-esteem?
Never	31	13.5	14	45.2	16	51.6	1	3.2	0. 542
Rarely	4	1.7	3	75.0	1	25.0	0	0.0
Sometimes	32	13.9	17	53.1	13	40.6	2	6.3
Often	5	2.2	2	40.0	2	40.0	1	20.0
Always	158	68.7	62	39.2	72	45.6	24	15.2
Do you receive support from someone with whom you can vent or talk about issues related to your illness?
Never	55	24.0	32	58.2	21	38.2	2	3.6	0.002
Rarely	8	3.4	3	37.5	4	50.0	1	12.5
Sometimes	32	14.0	15	46.9	16	50.0	1	3.1
Often	5	2.1	1	20.0	1	20.0	3	60.0
Always	130	56.5	46	35.4	60	46.2	24	18.5
Do you receive support from someone who makes you feel socially integrated?
Never	53	23.1	30	56.6	20	37.7	3	5.7	0.165
Rarely	4	1.7	2	50.0	1	25.0	1	25.0
Sometimes	31	13.5	15	48.4	12	38.7	4	12.9
Often	6	2.6	1	16.7	3	50.0	2	33.3
Always	136	59.1	49	36.0	66	48.5	21	15.5
Do you receive information that helps you to improve your level of knowledge about HIV/AIDS?
Never	18	7.9	13	72.2	4	22.2	1	5.6	0.039^* * Chi-squared test.
Rarely	14	6.1	9	64.3	3	21.4	2	14.3
Sometimes	75	32.6	35	46.7	32	42.7	8	10.6
Often	28	12.1	8	28.6	15	53.5	5	17.9
Always	95	41.3	31	32.6	49	51.6	15	15.8
Do you receive support from someone when you need some company to have fun or do leisure activities?
Never	65	28.3	35	53.8	28	43.1	2	3.1	0.001
Rarely	9	3.9	8	88.9	0	0.0	1	11.1
Sometimes	34	14.8	22	64.7	10	29.4	2	5.9
Often	7	3.0	2	28.6	3	42.9	2	28.5
Always	115	50.0	30	26.1	61	53.0	24	20.9

Variables	n	%	Adherence						p
Variables	n	%	Low/ Insufficient		Good/ Adequate		Strict		p
Time since diagnosis
Up to 5 years	124	53.9	49	39.5	54	43.5	21	17.0	0.502
6 to 10 years	59	25.7	27	45.8	25	42.4	7	11.8
11 years or more	47	20.4	20	42.6	24	51.1	3	6.3
Time in treatment
Up to 5 years	141	61.3	60	42.5	59	41.8	22	15.7	0.293
6 to 10 years	50	21.7	24	48.0	20	40.0	6	12.0
11 years or more	39	17.0	13	33.3	23	59.0	3	7.7
T-CD4 Value
Up to 500 cell./mm³	116	51.8	53	45.7	50	43.1	13	11.2	0.354
500 cell./mm³ or higher	108	48.2	40	37.0	51	47.2	17	15.7
Viral Load Value									0.888
Up to 50 copies/mL	168	73.0	64	38.1	81	48.2	23	13.7
From 50 to 100 thousand copies/mL	53	23.1	25	47.2	21	39.6	7	13.2
> 100 thousand copies/mL	9	3.9	4	4.44	21	4.44	1	11.2
Line of Treatment									0.062
First line	165	71.7	71	43.0	67	40.6	27	16.4
Second line	65	28.3	26	40.0	35	53.8	4	6.2
Stopped taking the drugs because did not get them (were not available in the service)
Yes	70	30.4	38	54.3	26	37.1	6	8.6	0.039^* * Chi-squared test and Fisher's exact test.
No	160	69.6	59	36.9	76	7.5	25	15.6
Stopped taking the medication due to a change in prescription
Yes	29	12.6	19	65.5	9	31.0	1	3.5	0.018^* * Chi-squared test and Fisher's exact test.
No	201	87.4	78	38.8	93	46.3	30	14.9
Form of transmission									0.628
Maternal transmission	4	1.7	1	25.0	2	50.0	1	25.0
Blood transmission	2	0.9	1	50.0	1	50.0	0	0
Injectable drugs	1	0.4	1	1000	0	0.0	0	0
Sexual transmission	164	71.3	70	42.7	75	45.7	17	11.6
Unknown	59	25.7	24	40.7	23	39.0	12	20.3
Did you have an opportunistic infection?									0.335
Yes	85	37.0	40	47.1	36	42.4	9	10.5
No	145	63.0	54	37.2	69	47.6	22	15.2
Number of pills taken daily									0.584
1 pill	86	37.4	40	46.5	34	39.5	12	14.0
2 to 4 pills	93	40.4	33	35.5	45	48.4	15	16.1
5 to 7 pills	48	20.9	22	45.8	22	45.8	4	8.4
8 to 10 pills	3	1.3	2	66.7	1	33.3	0	0.0
Had a change in lifestyle due to treatment
Yes	151	65.7	65	43.0	69	45.7	17	11.3	0.393
No	79	34.3	32	40.5	33	41.8	14	17.7

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[1] Corresponding author: Edilma Gomes Rocha Cavalcante. E-mail: edilma.rocha@yahoo.com.br