RESUMO
Resumen El VIH es una enfermedad crónica que afecta a los receptores CD4 del sistema inmunológico. El Tratamiento Antirretroviral (TARV) es vital para disminuir la carga viral, pero su éxito depende del grado de adherencia al mismo. El objetivo de este estudio fue revisar los factores asociados a la eficacia de las intervenciones psicológicas para incrementar la adherencia al TARV y agregar los hallazgos en estimaciones cuantitativas de su impacto en la adherencia. La revisión de la literatura fue realizada desde agosto de 2017 hasta abril de 2020 en PubMed, EBSCO y Springer Link, utilizando los siguientes criterios de elección de los estudios: (1) que estuvieran publicados en revistas indexadas con revisión por pares, (2) que fueran experimentales o cuasiexperimentales, (3) que emplearan técnicas para el incremento de la adherencia, (4) que estuvieran publicados en español o inglés, (5) que reportaran los estadísticos necesarios para el cálculo del tamaño de efecto. De los 15 estudios seleccionados (. total = 1669), se obtuvieron 38 tamaños del efecto. El cálculo de los tamaños de efecto individuales y global se realizó usando el programa Comprehensive Meta-Analysis (Biostat, 2011, v. 2.2.064). Todos los tamaños de efecto fueron calculados usando la diferencia estandarizada de medias y un modelo de efectos aleatorios. El tamaño de efecto global fue moderado (. = 0.56, . = 38, IC95 % = 0.39 - 0.72, . < .001), mostrando que las intervenciones fueron significativamente superiores al grupo de comparación. Debido a la alta heterogeneidad de los estudios (I. = 82.25), se analizaron 12 variables moderadoras, de las cuales 11 fueron significativas (. < .005). Los resultados del análisis de variables moderadoras indican un mayor efecto en el incremento de la adherencia al TARV en intervenciones con marcos teóricos basados en el apoyo social por pares y con metodologías adaptables a la vivencia cotidiana de la persona.
Abstract HIV is a chronic disease that affects the CD4 receptors of the immune system, so it is necessary for people with the virus to be under Antiretroviral Treatment (ART) to reduce the viral load in the body. The success of ART is related to adherence to treatment, understood as: the intake of antiretroviral drugs, follow-up of medical controls and implementation of healthy lifestyles. There are personal, social and health systems problems that prevent people from adhering to ART in an adequate way. This situation has become a public health problem because inappropriate taking of drugs often leads to drug resistance. In this way, it is necessary to implement effective psychological interventions aimed at increasing adherence to ART, to contribute to a better use of antiretrovirals and to the improvement of the quality of life of people with HIV. Accordingly, the objective was to review the factors associated with the efficacy of psychological interventions, to increase adherence to ART and to aggregate the findings in quantitative estimates of its impact on adherence. For this purpose, meta-analysis was used as a research technique that allows a quantitative analysis of results by calculating specific statistics. The literature search and review were carried out from August 2017 to May 2019 in the PubMed, Academic Search Complete (EBSCO Host) and Springer Link databases, for the identification of experimental studies that met the eligibility criteria (studies published in peer-reviewed indexed journals, experimental or quasi-experimental research, using techniques to increase adherence, published in Spanish and English and reporting the necessary statistics for effect size calculation). Of the 15 studies (total n = 1669) selected, 38 effect sizes were obtained. The calculation of the individual and global effect size was performed using the Comprehensive Meta-Analysis software (Biostat, 2011, v. 2.2.064). All the effect sizes were calculated using the standardized mean difference and a random effects model. To find out if individual effect sizes were homogeneous and therefore represent a similar measure of treatment efficacy, the Cochran Q homogeneity test was applied; based on this, the I. was calculated. Also, it was performed a publication bias calculation, the objective of which was to estimate the number of non-significant effect sizes that are required for a reduction of the global effect size to a smaller and non-significant one. The overall effect size was moderate (. = 0.56, . = 38, 95 % CI = 0.39 - 0.72, . < .001) and presented high heterogeneity (I. = 82.25). Twelve moderator variables were analyzed (year of publication, percentage of men, average age, measurement time, number of sessions / interactions, duration of sessions, total duration of intervention, economic remuneration for intervention, place where the intervention was carried out, type of intervention, intervention modality and adherence measurement), of which 11 were significant (all but intervention modality: individual vs. group therapy). The results suggest that the success of an intervention proposal to improve adherence to ART will be related to its ability to consider the components of the environment and the social situation in which the person with HIV develops, as well as their intrinsic characteristics in interaction with their context. Likewise, it is necessary to consider that the presence of adherence barriers should be treated specifically in young people and adults, as well as in men and women. Finally, it is more important to establish interventions aimed not only to increase adherence, but maintaining it, which is why it is considered necessary to propose studies aimed at maintaining adherence, as well as offering practical tools for people to make better decisions about their health.
RESUMO
Resumen La privación de libertad es un suceso que impacta los niveles de estrés y requiere estrategias de afrontamiento. En la cárcel Jorge Arturo Montero Castro de Costa Rica se implementó un proceso grupal de meditación con personas recluidas para ayudarles a sobrellevar el encarcelamiento. Para aportar evidencia científica sobre la efectividad de esta intervención, se realizó un estudio mixto de triangulación con modelo de convergencia. Cuantitativamente, se evaluó si la intervención generó cambios en los niveles de estrés percibido de los participantes. El diseño fue experimental con preprueba-posprueba y grupo control de lista de espera. La muestra fue de 32 hombres (16 en cada grupo). Cualitativamente, se exploró cómo influyó la intervención en los estilos de afrontamiento dentro del ambiente carcelario. El diseño fue un estudio de casos múltiples con muestreo intencional y se realizó una entrevista semiestructurada a cada participante del grupo de tratamiento. Además, se revisaron las consignas, los contenidos y el diseño de la intervención para evaluar su idoneidad. Los resultados cuantitativos no evidenciaron diferencias entre el grupo experimental y el grupo control; sin embargo, sobresalió la diferencia significativa en la subescala cognitiva (F(1, 15) = 5.01, p = .04) entre la preprueba y la posprueba del grupo de tratamiento. En los resultados cualitativos, los participantes expresaron que con el proceso lograron utilizar estrategias como autocontrol, reevaluación positiva y distanciamiento. Sobre el diseño de la intervención, sobresalen las fortalezas; pero, se considera que la intervención puede rediseñarse al incorporar los aspectos por mejorar para maximizar los beneficios.
Abstract: Because privation of liberty in jail affects health, a group meditation process with prisoners was implemented at the Jorge Arturo Montero Castro Institutional Care Center, in Costa Rica, to help cope with imprisonment. Due to gaps in the scientific approach to meditation effectiveness with prisoners in Costa Rica, a mixed method using conver- gence design and triangulation was carried out. A quantitative evaluation was made to ascertain if the meditation process generated changes in participant stress levels. A pretest-posttest experimental design with a wait-list con- trol group was used. The sample was 32 men (16 in each group). A qualitative evaluation was made to explore how the intervention influenced coping in participants. Multiple case study design was used. Intentional sampling was performed, which resulted in working with 16 men of the meditation process group. Additionally, instructions, con- tents and design of the intervention were reviewed. Quantitatively, there were no differences between experimental group and control group on stress levels after the intervention; however, in the experimental group there was a significant difference in the cognitive subscale (F(1, 15) = 5.01, p = .04). Qualitatively, participants expressed that they began to use strategies like self-control, positive reevaluation and taking distance from the situation. Finally, streng- ths were recognized in the intervention, but also that there was room for improvement in order to maximize benefits.