HIV knowledge and its correlation with the Undetectable = Untransmittable slogan in Brazil.

Knowledge about HIV transmission and prevention is a necessary step for adopting preventive behaviors. We assessed HIV knowledge and its correlation with the perceived accuracy of the "Undetectable = Untransmittable" (U=U) slogan in an online sample with 401 adult Brazilians. Overall, 28% of participants showed high HIV knowledge level. The perceived accuracy of the U=U slogan significantly correlated with HIV knowledge. Younger participants, those reporting lower income or lower education, or who had never tested for HIV showed poorer HIV knowledge. Filling gaps of knowledge among specific populations is urgent in order to increase preventive behaviors and decrease HIV stigma.

Development and Evaluation of Short-Form Measures of the HIV/AIDS Knowledge Assessment Tool Among Sexual and Gender Minorities in Brazil: Cross-sectional Study.

BACKGROUND: In theoretical models of health behavior, knowledge about disease transmission and self-protective behaviors are conceptualized as important drivers of behavior change. Several studies conducted in Brazil point to an unfortunate convergence of sexual and gender minority (SGM) populations with low levels of HIV knowledge and younger age, lower education, engagement in higher-risk sexual behavior, and never having tested for HIV. Measures to assess level of HIV knowledge have been previously published, including the 12-item HIV/AIDS Knowledge Assessment (HIV-KA) tool. However, measure length can be a barrier to assessment. OBJECTIVE: We started from the 12-item HIV-KA tool and developed candidate short forms using statistical procedures, evaluated their psychometric properties, and tested the equivalency of their associations with other measures of HIV knowledge compared to the 12-item version. METHODS: A convenience sample of SGM was recruited during September 2020 to complete an online survey through advertisements on two social networking apps (Grindr and Hornet). The survey instrument included items on sociodemographic information, prior HIV testing and HIV test results, preexposure prophylaxis (PrEP) and antiretroviral treatment use, sexual behavior, and 3 HIV knowledge measures: the HIV-KA, World Health Organization Knowledge About HIV Transmission Prevention Indicator, and the Brief HIV Knowledge Questionnaire. We used exploratory factor analysis and confirmatory factor analysis (CFA) to assess the factor structure of the of the HIV-KA. We used optimal test assembly (OTA) methods to develop candidate short forms of the HIV-KA and evaluated them based on prespecified reliability, concurrent validity, and statistically equivalent convergent validity criteria. RESULTS: Among 2552 SGM individuals from Brazil, mean age was 35.1 years, 98.2% (2507/2552) cisgender men and 1.8% (45/2552) transgender/nonbinary, 56.5% (1441/2552) White, and 31.0% (792/2552) self-reported HIV positive. CFA indicated a 1-factor structure for the 12-item HIV-KA. Concurrent validity correlations were high for all short forms with 6 items, but only versions with 9 items were as reliable as the full-length form and demonstrated equivalency for convergent validity correlations. Suggesting post hoc convergent validity, HIV knowledge scores using the 9- and 10-item short forms were higher for participants who perceived the Undetectable Equals Untransmittable (U=U) slogan as completely accurate versus not accurate. Suggesting post hoc concurrent validity, participants of younger age, of Black, Pardo or indigenous race, and reporting lower education and lower income scored lower on HIV knowledge. Participants who never tested for HIV scored lower than those who tested negative or positive, while those currently using PrEP scored higher than those reporting past or never use. CONCLUSIONS: OTA methods were used to shorten the 12-item HIV-KA to 9-item and 10-item versions while maintaining comparable reliability and validity among a large sample of Brazilian SGM. However, these short forms did not shorten sufficiently to justify deviation from the full measure.

HIV knowledge and its correlation with the Undetectable = Untransmittable slogan in Brazil

ABSTRACT Knowledge about HIV transmission and prevention is a necessary step for adopting preventive behaviors. We assessed HIV knowledge and its correlation with the perceived accuracy of the "Undetectable = Untransmittable" (U=U) slogan in an online sample with 401 adult Brazilians. Overall, 28% of participants showed high HIV knowledge level. The perceived accuracy of the U=U slogan significantly correlated with HIV knowledge. Younger participants, those reporting lower income or lower education, or who had never tested for HIV showed poorer HIV knowledge. Filling gaps of knowledge among specific populations is urgent in order to increase preventive behaviors and decrease HIV stigma.

Validation and standardization of the Brazilian version of the Medication Regimen Complexity Index for older adults in primary care.

AIM: To validate and standardize the Brazilian version of the Medication Regimen Complexity Index (MRCI) for older adults in primary healthcare. METHODS: A cross-sectional methodological study was carried out with elderly patients attending primary healthcare centers in southeastern Brazil. Convergent validity was tested by correlating MRCI scores with medication number. Divergent validity was tested by correlating MRCI scores with age, sex, cognition, and basic and instrumental activities of daily living. Reliability was assessed by interrater and test-retest reliability. Regarding standardization, percentiles were calculated for the total MRCI scores. RESULTS: A total of 227 older adults were included, with a mean age of 71.4 years (standard deviation 7.5 years) and mostly women (70.9%). There was a correlation between MRCI scores and medication number (rho = 0.890; P = 0.000). There was no correlation between MRCI scores and age (P = 0.192), sex (P = 0.052), cognition (P = 0.369), and basic (P = 0.682) and instrumental (P = 0.582) activities of daily living. High interrater (intraclass correlation coefficient = 0.98; rho = 0.991) and test-retest (intraclass correlation coefficient = 0.996; rho = 0.985) reliability was obtained. The following complexity was considered: low, MRCI ≤ 9.0 points; average 0.9 < MRCI ≤ 16.5 points; and high, MRCI > 16.5 points. CONCLUSIONS: MRCI showed satisfactory psychometric qualities for measuring regimen complexity of older adults attending the primary healthcare centers evaluated. Standardization might increase the applicability of MRCI to the health research context. Geriatr Gerontol Int 2018; 18: 853-859.

Evaluation of the impact of pharmaceutical care for tuberculosis patients in a Secondary Referral Outpatient Clinic, Minas Gerais, Brazil.

Pharmaceutical care is a professional practice seeking the responsible provision of drug therapy by identifying, resolving, and preventing Drug-Related Problems (DRP). The study aims to describe and evaluate the impact of pharmaceutical care given to patients being treated for tuberculosis (TB). Study concurrent, longitudinal, prospective conducted during pharmaceutical care in the TB outpatient clinic, Clinical Hospital, Federal University of Minas Gerais during the period August 2009 to July 2012. The Pharmacotherapy Workup proposed by Cipolle et al. (2004) was used. Statistical analyses were performed by X2 or Fisher exact test, as appropriate. A total of 62 patients were followed up, and 128 drug-related problems (DRP) were identified: 69.5% related to safety, 13.3% to effectiveness, 12.5% ​​to indication, and 4.7% to treatment adherence, and 62.1% of the DRP were resolved. A total of 115 pharmaceutical interventions were performed. The impact of pharmaceutical care was satisfactory for 73.9% of patients with a resolution rate of 77%. There was a greater impact on pharmaceutical care (index ≥ 0.50) for those patients who were not smokers (p <0.05). The impact of pharmaceutical care was important, so the pharmacist should work alongside the multidisciplinary team to monitor treatment and perform interventions.

Evaluation of the impact of pharmaceutical care for tuberculosis patients in a Secondary Referral Outpatient Clinic, Minas Gerais, Brazil

ABSTRACT Pharmaceutical care is a professional practice seeking the responsible provision of drug therapy by identifying, resolving, and preventing Drug-Related Problems (DRP). The study aims to describe and evaluate the impact of pharmaceutical care given to patients being treated for tuberculosis (TB). Study concurrent, longitudinal, prospective conducted during pharmaceutical care in the TB outpatient clinic, Clinical Hospital, Federal University of Minas Gerais during the period August 2009 to July 2012. The Pharmacotherapy Workup proposed by Cipolle et al. (2004) was used. Statistical analyses were performed by X2 or Fisher exact test, as appropriate. A total of 62 patients were followed up, and 128 drug-related problems (DRP) were identified: 69.5% related to safety, 13.3% to effectiveness, 12.5% ​​to indication, and 4.7% to treatment adherence, and 62.1% of the DRP were resolved. A total of 115 pharmaceutical interventions were performed. The impact of pharmaceutical care was satisfactory for 73.9% of patients with a resolution rate of 77%. There was a greater impact on pharmaceutical care (index ≥ 0.50) for those patients who were not smokers (p <0.05). The impact of pharmaceutical care was important, so the pharmacist should work alongside the multidisciplinary team to monitor treatment and perform interventions.

[Patient's understanding of information on antiretroviral therapy: an application of the latent trait model]. / Compreensão da terapia anti-retroviral: uma aplicação de modelo de traço latente.

The aim of this study was to develop a score to determine the level of understanding regarding information on antiretroviral therapy (ART) among patients initiating treatment. This was a cross-sectional analysis based on interviews with HIV patients in outpatient public referral centers (Belo Horizonte, Minas Gerais State, Brazil). The score for patients' understanding of their medicines was obtained using a latent trait model, estimated by the Item Response Theory, based on the concordance between each patient answer and the written prescription. Hierarchical linear regression was used to assess patients' global understanding of ART, considering each class of drugs (level 1) and the individual (level 2). Among 406 patients, 37.9% failed to reach a minimum level of understanding of their treatment. The item with the highest level of difficulty was "precaution in use". The item "dosage" showed the most varied understanding of ART. A high proportion of patients displayed minimal understanding of ART, indicating a high potential risk for non-adherence to therapy. It is thus necessary to identify factors associated with insufficient understanding of ART.

Compreensão da terapia anti-retroviral: uma aplicação de modelo de traço latente / Patient's understanding of information on antiretroviral therapy: an application of the latent trait model

O objetivo do estudo foi desenvolver um escore para determinar o nível de compreensão de informações sobre terapia anti-retroviral (TARV) em pacientes no início do tratamento. Estudo transversal baseado em entrevistas com pacientes infectados pelo HIV em serviços públicos de referência (Belo Horizonte, Minas Gerais, Brasil). O escore da compreensão dos medicamentos foi obtido utilizando-se modelo de traço latente estimado pela Teoria de Resposta ao Item, após análise de concordância entre a resposta do paciente e a informação contida na prescrição. Realizou-se análise de regressão linear hierárquica para obter a compreensão global dos medicamentos, considerando cada classe de medicamentos (nível 1) e o individuo (nível 2). Dos 406 pacientes avaliados, 37,9 por cento não atingiram um nível mínimo de compreensão do tratamento. O item com maior nível de dificuldade foi precaução de uso. O item dose foi o que mais diferenciou os pacientes quanto à compreensão da TARV. Observou-se alta proporção de pacientes com nível mínimo de compreensão da TARV, o que pode indicar um alto risco potencial de não-adesão à terapia. É necessário identificar fatores associados com este baixo nível de compreensão.

The aim of this study was to develop a score to determine the level of understanding regarding information on antiretroviral therapy (ART) among patients initiating treatment. This was a cross-sectional analysis based on interviews with HIV patients in outpatient public referral centers (Belo Horizonte, Minas Gerais State, Brazil). The score for patients' understanding of their medicines was obtained using a latent trait model, estimated by the Item Response Theory, based on the concordance between each patient answer and the written prescription. Hierarchical linear regression was used to assess patients' global understanding of ART, considering each class of drugs (level 1) and the individual (level 2). Among 406 patients, 37.9 percent failed to reach a minimum level of understanding of their treatment. The item with the highest level of difficulty was precaution in use. The item dosage showed the most varied understanding of ART. A high proportion of patients displayed minimal understanding of ART, indicating a high potential risk for non-adherence to therapy. It is thus necessary to identify factors associated with insufficient understanding of ART.

Non-adherence among patients initiating antiretroviral therapy: a challenge for health professionals in Brazil.

OBJECTIVE: To assess the incidence, magnitude and factors associated with the first episode of non-adherence for 12 months after the first antiretroviral prescription. DESIGN: A prospective study of HIV-infected patients receiving their first antiretroviral prescription in public referral centers, Belo Horizonte, Brazil. Baseline assessment occurred at the moment of the first prescription and follow-up visits at the first, fourth and seventh month, from May 2001 to May 2003. METHODS: Non-adherence was self-reported and defined as the intake of less than 95% of the prescribed doses for 3 days before the follow-up interviews. Cumulative and person-time incidence were estimated and Cox's proportional model was used to assess the relative hazard (RH) of non-adherence with 95% confidence interval for both univariate and multivariate analysis. RESULTS: Among 306 patients, the cumulative incidence of non-adherence was 36.9% (incidence rate 0.21/100 person-days). Multivariate analysis (P < 0.05) showed that unemployment (RH = 2.17), alcohol use (RH = 2.27), self-report of three or more adverse reactions (RH = 1.64), number of pills per day (RH = 2.04), switch in antiretroviral regimen (RH = 2.72), and a longer time between the HIV test result and the first antiretroviral prescription (RH = 2.27) were associated with an increased risk of non-adherence, whereas the use of more than one health service indicated a negative association (RH = 0.54). CONCLUSION: The current analysis has pointed out the importance of clinical and health service characteristics as potential indicators of non-adherence after initiating therapy. Early assessment and intervention strategies should be priorities in these AIDS public referral centres. Feasible and reliable indicators for the routine monitoring of adherence should be incorporated in clinical practice.