Adherence to antiretroviral therapy in an urban, free-care HIV clinic in Guatemala City, Guatemala.

BACKGROUND: Numerous studies have demonstrated that, in addition to inherent qualities of antiretroviral (ARV) medications, adherence is affected by demographic, socioeconomic, and psychological factors. There are limited data about factors affecting adherence to antiretroviral therapy (ART) among HIV-infected persons in urban Guatemalan HIV care centers. METHODS: Participants were patients at an urban, free-care public clinic in Guatemala City and obtained medications from a closed-pharmacy system. Nonpregnant patients ≥18 years who received medications from the Global Fund to Fight AIDS, Tuberculosis & Malaria, who had taken ARV medications for ≥12 weeks, who arrived for an appointment at the clinic, and who provided informed consent were interviewed. Adherence was measured using pharmacy pill counts and patient self-reports. Recent biological markers for each patient were collected from the clinic's database, and χ( 2) and descriptive statistics were used to analyze results. RESULTS: Among 122 patients interviewed, mean adherence by pill count was 97%. A total of 110 patients (90%) had adherence ≥95% using pharmacy pill counts, and 108 (89%) had adherence ≥95% using self-reports. Virologic failure (viral load [VL] ≥500 copies/mL) was significantly less common among patients with ≥95% adherence (P = .02). Family and spousal support for treatment were significantly associated with ≥95% adherence (P = .01 and .003, respectively). The presence of stavudine (d4T) in a patient's regimen was significantly associated with <95% adherence according to self-reports (P < .01). The most common self-reported cause for missing medications was forgetfulness, followed by leaving medications at home. Inability to travel to the clinic was a major cause of missing medications, and only 51 patients (41.8%) reported always having sufficient economic resources to reach the clinic for appointments and to refill prescriptions. CONCLUSIONS: In this urban Central American population, high levels of adherence were measured by both self-report and pharmacy pill count. Socioeconomic and demographic conditions associated with adherence and specific reasons for missing medications were identified.

Brote epidemiológico de Cólera en el cantón Salcedo Hospital "Yerovi Mackuart": período 1991-1994

Se presenta un estudio retrospectivo de los casos de cólera atendidos en el hospital "Yerovi Mackuart" del cantón Salcedo, provincia de Cotopaxi, durante el período 1991-1994. Se analizan varios parámetros de tipo clínico-epidemiológico, social y de saneamiento en una población afectada, especialmente campesina-indigena. La mayoría de casos eran producto del contagio a través de alimentos (n-512) y aguas contaminadas, que en el presente caso son agua de vertiente y de canal de riego, (n=403 y n=317 respectivamente)debido a la distancia, dificultad de transporte, tradiciones, deciden curarse en sus comunidades (la mayoría no dispone de infraestructura sanitaria básica, debido a lo cual la disposición de excretas lo hacen al aire libre, mientras que los pocos que poseen letrina o no la usan o la usan para guardar animales). La población de más de 20 años es la más afectada debido posiblemente al tipo de actividad cotidiana. Un gran número de casos corresponde a la raza indigena (n=701) equivalente a un 61.56 porciento), en donde la incredulidad y el escepticismo iniciales ante los mensajes emitidos retardó la atención médica oportuna. La mayoría de casos (n=748) presentó deshidratación moderada. El tratamiento antibiótico más utilizado fue a base de tetraciclina (n=965).