[Assessment of factors associated with patients' comprehension of treatment at the start of antiretroviral therapy]. / Evaluación de factores asociados a la comprensión del tratamiento en pacientes que inician la terapia antirretroviral.

OBJECTIVE: The aim of this study was to evaluate factors associated with patients' comprehension of antiretroviral therapy (ART). METHOD: Cross-sectional analysis in which patients at 2 HIV/AIDS public referral centers (Belo Horizonte, Brazil) were interviewed after initiating ART. Information was recorded on variables related to the patient's characteristics, the treatment prescribed, and the healthcare professional involved. A score indicating the patients' level of comprehension regarding the medications prescribed was obtained using a latent trait model estimated by the item response theory. RESULTS: A total of 406 patients were interviewed. Mean (SD) age was 35 (10) years, 227 were men (56%), 302 of Afro-American ethnicity (77%), and 213 had <8 years of education (53%). The regression model determined that 52.25% of the variability of comprehension was explained by the individual's characteristics. Variables associated (P<0.05) with poorest understanding about ART were lower education (<8 years), lack of knowledge about treatment duration and clinical severity, inadequate information provided by physicians, inability to understand pharmaceutical information, daily number of tablets, and the ART regimen prescribed. CONCLUSION: Comprehension of information about the ART regimen prescribed varies considerably between individuals. Nonetheless, several factors were found to be associated with the level of understanding: characteristics of the patient (education, clinical severity), characteristics of treatment (daily number of tablets, ART regimen prescribed), and contribution of healthcare professionals (information from physicians and pharmacists). Strategies to reinforce information about ART should be a priority for patients with a low level of understanding.

[Cost-effectiveness of initial adherence to antiretroviral therapy among HIV infected patients in Belo Horizonte, Brazil]. / Análisis coste-efectividad de la adhesión inicial a la terapia antirretroviral entre individuos infectados por el VIH en Belo Horizonte, Brasil.

BACKGROUND: In Brazil, there is free antiretroviral (ARV) distribution to patients with HIV disease by the National Health System. Adherence to the treatment is one of the main factors that health services can manage to increase the effectiveness of the ARV medication. The aim of this study is to evaluate the cost-effectiveness of initial adherence to the ARV therapy and to identify factors that influence patient's costs and global evolution. METHODS: Prospective study of HIV infected patients receiving their first ARV prescription in two public referral centers to HIV/Aids, Brazil. The non-adherence was defined as the intake of <95% of the prescribed doses for 3 days prior to the first follow-up visit. A cost-effectiveness ratio was calculated for either groups, the adherent and the non-adherent. Univariate and multivariate analysis were performed using multiple linear and binary logistic regression models. RESULTS: 79.7% of the 197 participants was adherent to the ARV treatment and the ratio cost-effectiveness obtained for this group (2667.67 Eros) was smaller than the ratio observed among the non-adherent group. Multivariate analysis (p < 0.05) showed that adherence to ARV therapy and use of protease inhibitors in the treatment were associated with higher direct cost of care. The favorable global evolution was associated with being asymptomatic, TCD4+ linphocyte count >200 cels/mm3 and be adherent to the ARV treatment. CONCLUSIONS: The observed results supported the ARV therapy as a cost-effective intervention. However, low adherence increases the risk of therapeutic failure and illness progression that results in a negative impact on the cost-efectiveness of the ARV therapy.