Adesão a terapia antirretroviral: percepção das mulheres que vivem com HIV/aids

A adesão ao esquema terapêutico antirretroviral é ao mesmo tempo um dos maiores desafios para o sucesso do tratamento do HIV/aids e a mais poderosa arma contra a aids. Este estudo teve como objetivos: Medir o grau de adesão a Terapia Antirretroviral; Descrever a percepção que as mulheres que vivem com HIV/aids tem sobre o significado da adesão ao tratamento; Identificar os fatores que facilitam e/ou dificultam as mulheres que vivem com HIV/aids na adesão ao tratamento; Discutir formas de melhorar a adesão ao tratamento, na visão das mulheres que vivem com HIV/aids. Para fundamentar a dissertação, o referencial teórico baseia-se no conceito de cuidado de si de Michel Foucault. Trata-se de uma pesquisa do tipo descritiva exploratória, com abordagem mista. Os participantes do estudo foram 87 mulheres que vivem com HIV/aids e estão em acompanhamento ambulatorial há pelo menos 6 meses. Os cenários escolhidos foram quatro ONG do município do Rio de Janeiro, o Projeto Reiki e Floral (EEAN/UFRJ) e o Serviço de Atendimento Especializado do Hospital Escola São Francisco de Assis. No seguimento quantitativo, a estratégia adotada para a coleta de dados foi a de aplicação do “Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral” (CEAT-VIH), utilizado para avaliar a adesão à terapia antirretroviral. No seguimento qualitativo, foi utilizado um roteiro semi estruturado que apresentava uma breve caracterização e abordava a percepção da mulher em relação à adesão ao tratamento. Os dados qualitativos foram tratados e analisados utilizando-se análise temática proposta por Laurence Bardin e para a análise dos dados quantitativos foi utilizado o programa estatístico Epi Info®...

Adherence to antiretroviral treatment regimen is both a major challenge for the successfultreatment of HIV / AIDS and the most powerful weapon against AIDS. This study aimed to:Measure the degree of adherence to Antiretroviral Therapy; Describe the perception thatwomen living with HIV / AIDS have on the meaning of adherence to treatment; Identify thefactors that facilitate and / or hinder women living with HIV / AIDS treatment adherence;Discuss some ways to improve adherence to treatment, in view of women living with HIV /AIDS. In support of the thesis, the theoretical reference is based on the concept of self-care ofMichel Foucault. This is an exploratory descriptive survey, with mixed approach. The studyparticipants were 87 women living with HIV / AIDS, are in attendance for at least 6. Thescenarios chosen were four ONG in the city of Rio de Janeiro, the project Reiki and Floral(EEAN / UFRJ) and the Specialized Service of the São Francisco de Assis Hospital. Thequantitative follow-up, the strategy adopted for data collection was the application of the“Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral” (CEATVIH),used to evaluate adherence to antiretroviral therapy. In the qualitative follow-up, it wasused a semi-structured script with a brief description and the perception of women in relationto treatment adherence. Qualitative data were processed and analyzed using the thematicanalysis proposed by Laurence Bardin and for the analysis of quantitative data, the Epi Info® program was used...

Accession of children and adolescents to anti-retroviral therapy: strategies for care / Adesão de crianças e adolescentes à terapia antirretroviral: estratégias para o cuidado / Adhesión de los niños y adolescentes a la terapia antirretroviral: Estrategias para el cuidado

Objectives: To describe the strategies used for children and adolescents adherence to anti-retroviral therapy, described in the scientific literature, and discuss the role of nursing staff across the adherence of children and adolescents with anti-retroviral therapy. Method: An exploratory bibliography of articles selected by VHL. Results: We found 15 scientific works related to the theme. Conclusion: We found individual strategies of approach, focused on children and adolescents, and group centered on the family / caregivers. It was found that regardless of the approach used, the family / caregiver is directly involved in the disease process of the child and adolescent anti-retroviral therapy. We conclude that the practice of care needs to be constantly evaluated to develop appropriate interventions for its improvement. The care strategies were shown to be the way to successful adherence to anti-retroviral therapy, as were evaluative and interventional later problems related to adherence.

Objetivos: Descrever as estratégias utilizadas para a adesão de crianças e adolescentes à terapia antirretroviral, descritas na literatura científica; e discutir o papel da equipe de enfermagem frente à adesão de crianças e adolescentes à terapia antirretroviral. Método: Estudo bibliográfico de caráter exploratório de artigos selecionados através da BVS. Resultados: Encontraram-se 15 produções científicas relacionadas ao tema. Conclusão: Foram encontradas estratégias de abordagem individual, centrada na criança e no adolescente; e em grupo, centrada na família/cuidadores. Verificou-se que independente do tipo de abordagem utilizada, a família/cuidador está diretamente envolvida no processo saúde-doença da criança e adolescente em uso de terapia antirretroviral. Concluímos que a prática de cuidar precisa ser constantemente avaliada para que desenvolvamos intervenções apropriadas para seu aprimoramento. As estratégias de cuidado nos mostraram ser esse o caminho para o sucesso da adesão à terapia antirretroviral, pois foram avaliativas e posteriormente intervencionistas nos problemas relativos à aderência.

Objetivos: Describir las estrategias utilizadas por los niños y adolescentes de adherencia a la terapia antirretroviral, que se describe en la literatura científica, y discutir el papel del personal de enfermería a través de la observancia de los niños y adolescentes con la terapia. Método: Bibliografía exploratoria de los artículos seleccionados por VHL. Resultados: Se encontraron 15 trabajos científicos relacionados con el tema. Conclusión: Encontramos las estrategias individuales de enfoque, centrado en los niños y adolescentes, y el grupo se centró en la familia. Se encontró que, independientemente del método utilizado, el cuidador familiar está directamente involucrado en el proceso de la enfermedad del niño y de la terapia antirretroviral adolescente. Llegamos a la conclusión de que las estrategias de atención, se mostró a ser el camino a la adhesión satisfactoria a la terapia antirretroviral, así como los problemas posteriores de evaluación y de intervención relacionadas con la adhesión.

Adesao ao tratamento antirretroviral: assistencia integral baseada no modelo de atencao as condicoes cronicas / Adherencia al tratamiento antirretroviral: atención integral basada en el modelo de atención a las condiciones crónicas / Adherence to antiretroviral treatment: comprehensive care based on the care model for chronic conditions

OBJECTIVE: To evaluate the adherence to antiretroviral therapy (ART), identifying possible interventions based on the Care Model for Chronic Conditions. METHODS: Observational, quantitative, cross-sectional study, involving 215 people with HIV/aids using antiretroviral drugs, between March and June 2012, in Fortaleza, Ceará. From the specific adherence questionnaire, we used nine questions for discussion in the light of the Care Model for Chronic Conditions (MACC). RESULTS: 35.4% failed to adhere to medication at least once. In view of the MACC, gaps were identified, such as the need for more professional intervention, showing possibilities to apply new strategies, such as self-care actions, motivational interviews, operative group and others. CONCLUSION: A significant percentage of non-adherence to ART was found, whose interventions are still incipient. Actions based on the MACC can favor comprehensive care for patients with HIV/aids.

O objetivo deste estudo foi avaliar a adesão à terapia antirretroviral (TARV), identificando possibilidades de intervenções embasadas no modelo de atenção às condições crônicas. MÉTODOS: Estudo observacional, quantitativo, transversal, desenvolvido com 215 pessoas com HIV/ AIDS em uso de antirretrovirais, entre março e junho de 2012, em Fortaleza, Ceará. De um questionário específico para avaliar a adesão utilizaram-se nove quesitos para discussão à luz do Modelo de Atenção às Condições Crônicas (MACC). RESULTADOS: 35,4% das pessoas estudadas deixaram de aderir ao tratamento pelo menos alguma vez, por se sentirem melhor/pior, ou tristes/deprimidas. Sob a luz do MACC, foram identificadas lacunas, como necessidade de mais intervenção profissional, evidenciando possibilidades de aplicar novas estratégias, como ações para o autocuidado, entrevista motivacional, grupo operativo, e outras. CONCLUSÃO: Constatou-se que há um percentual significativo de não adesão à TARV, cujas intervenções ainda são incipientes, e que ações baseadas no MACC podem favorecer uma assistência totalitária aos pacientes com HIV/AIDS.

OBJETIVO: Evaluar la adherencia a la terapia antirretroviral (TARV), identificando las posibles intervenciones basadas en el modelo de atención de las condiciones crónicas. MÉTODOS: Estudio observacional, cuantitativo, transversal, desarrollado con 215 personas con VIH/SIDA con medicamentos antirretrovirales, entre marzo y junio de 2012, en Fortaleza, Ceará. De un cuestionario específico para valorar la adherencia, se utilizaron nueve preguntas para su discusión a la luz del Modelo de Atención a las Condiciones Crónicas (MACC). RESULTADOS: Se observó que 35,4% de los pacientes dejaron de adherir a la medicación por lo menos una vez. A la luz del MACC, fueron identificadas deficiencias, como la necesidad de más intervención profesional, mostrando las posibilidades de implementar nuevas estrategias, como las acciones de autocuidado, entrevista motivacional, grupo operativo y otros. CONCLUSIÓN: Se encontró un porcentaje significativo de no adherencia al tratamiento antirretroviral, cuyas intervenciones son aún incipientes y las acciones basadas en el MACC pueden.

Pharmacological considerations in human immunodeficiency virus-infected adults in the intensive care unit.

According to estimates, 1.2 million Americans are infected with human immuno deficiency virus (HIV). Because of antiretroviral therapy, persons who have HIV infection or have progressed to AIDS are living longer. As a result, the likelihood that they will need critical care nursing is increasing. Unlike in years past, when these patients were often admitted because of the consequences of immunosuppression, today they are also being cared for in critical care units for other conditions associated with aging, other chronic health conditions, and trauma. When persons who have HIV disease or AIDS are admitted to the intensive care unit, nurses must be prepared to provide care, especially management of complexities associated with antiretroviral therapy. Therefore, this article examines critical care nurses' role in initiating and administering antiretroviral therapy in the intensive care unit and reducing the risk of drug interactions associated with the therapy.

Nurse-initiation and maintenance of patients on antiretroviral therapy: are nurses in primary care clinics initiating ART after attending NIMART training?

OBJECTIVES: To determine the percentage of nurses initiating new HIV-positive patients on therapy within 2 months of attending the Nurse Initiation and Maintenance of Antiretroviral Therapy(NIMART) course, and to identify possible barriers to nurse initiation. METHODS: A brief telephonic interview using a structured questionnaire of a randomly selected sample (126/1736) of primary care nurses who had attended the NIMART course facilitated by the Foundation for Professional Development (FPD) between October 2010 and 31 March 2011 at primary care clinics in 7 provinces. Outcome measures were the number of nurses initiating ART within 2 months of attending the FPD-facilitated NIMART course. RESULTS: Of the nurses surveyed, 62% (79/126) had started initiating new adult patients on ART, but only 7% (9/126) were initiating ART in children. The main barrier to initiation was allocation to other tasks in the clinic as a result of staff shortages. CONCLUSIONS: Despite numerous challenges, many primary care nurses working in the 7 provinces surveyed have taken on the responsibility of sharing the task of initiating HIV-positive patients on ART. The barriers preventing more nurses initiating ART include the shortage of primary care nurses and the lack of sufficient consulting rooms. Expanding clinical mentoring and further training in clinical skills and pharmacology would assist in reaching the target of initiating a further 1.2 million HIV-positive patients on ART by 2012.

Primary, secondary, and tertiary prevention of cardiovascular disease in patients with HIV disease: a guide for nurse practitioners.

HIV infection elevates a patient's risk for developing cardiovascular disease (CVD), due in part to direct effects of increased infection-producing inflammation and to drugs used to treat the infection, which can have untoward effects on serum lipid profiles. HIV-infected older adults often present with multiple comorbidities, including CVD, making disease management more challenging. Treatment paradigms are evolving, and nurse practitioners (NPs) are expected to play an ever-larger role in the management of HIV infection. Due to their accessibility and close patient contact, NPs are especially well suited to work with and educate patients to manage multiple risk factors. Appropriate use of primary, secondary, and tertiary CVD prevention strategies, including education to modify lifestyle risks, individualized antiretroviral treatment regimens to achieve serum lipid targets, and use of additional lipid-modifying strategies to minimize a patient's overall CVD risk profile will be important throughout the treatment lifecycle.

An integrated approach for antiretroviral adherence and secondary HIV transmission risk-reduction support by nurses in Kenya.

Ongoing antiretroviral therapy (ART) adherence and secondary HIV transmission-risk reduction (positive prevention) support are needed in resource-limited settings. We evaluated a nurse-delivered counseling intervention in Kenya. We trained 90 nurses on a brief counseling algorithm that comprised ART and sexual-risk assessment, risk-reduction messages, and health-promotion planning. Self-reported measures were assessed before, immediately after, and 2 months post-training. Consistent ART adherence assessment was reported by 29% of nurses at baseline and 66% at 2 months post-training (p < .001). Assessment of patient sexual behaviors was 25% at baseline and 60% at 2 months post-training (p < .001). Nurse practice behaviors recommended in the counseling algorithm improved significantly at 2 months post-training compared with baseline, odds ratios 4.30-10.50. We found that training nurses in clinical counseling for ART adherence and positive prevention is feasible. Future studies should test impact of nurse counseling on patient outcomes in resource-limited settings.

Fatores associados à não adesão ao tratamento antirretroviral em adultos acima de 50 anos que têm HIV/Aids / Factors associated to non adherence to antirretroviral treatment in adults above 50 years old who have HIV/Aids

Introdução: a tecnologia medicamentosa implicou na redução da morbimortalidade das pessoas que têm HIV/aids. Os níveis de adesão ao uso dos antirretrovirais influenciam no sucesso ou não do tratamento. Considera-se a adesão como o maior determinante da resposta terapêutica, entretanto, não está estabelecido um método padronizado para sua avaliação. Objetivo: identificar os fatores associados à não adesão ao tratamento antirretroviral em adultos acima de 50 anos que têm aids. Método: delineamento transversal com uma população de 72 pacientes. A coleta de dados foi desenvolvida após aprovação do comitê de ética, com entrevista estruturada, no período de abril/2009 a outubro/2010. Foi realizada análise bivariada, cruzando o desfecho (adesão ao TARV) com as variáveis comportamentais de classificação de não aderentes. Resultados: a prevalência de não adesão foi de 29,2%. Os fatores associados à não adesão foram: conhecimento sobre carga viral e motivo do tratamento; bebidas alcoólicas; efeitos colaterais; coincidência entre o horário de trabalho e o de ingerir alguma dose do medicamento; tempo de acompanhamento no Serviço; comparecimento nas consultas; e necessidade de que alguém acompanhe o paciente ao Serviço. Conclusão: estes fatores implicam na saúde do paciente e estão associados ao cuidado de si, a fim de minimizar possibilidades de adoecimento, e ao cuidado do outro, no que se refere ao potencial de transmissão da infecção em nível coletivo.

Drug technology implied on morbidity and mortality reduction of people who have HIV/aids. Levels of adherence to antiretroviral use influenceson treatment's success or not. Adherence is considered as the biggest determinant as therapeutic response, however there's not a standard method established for its evaluation. Objective: to identify factors associated to the non-adherence to antiretroviral treatment in adults above 50 years old who have aids.Method: cross-sectional design with a population of 72 patients. Data collection was developed, after ethics committee approval, with structured interview,from April/2009 to October/2010. It was developed bi-varied analysis, crossing the result (adherence to ARVT) with behavioral varies of non-adherence classifications. Results: non-adherence prevalence was of 29,2%. Factors associated to non-adherence were: knowledge about viral load and treatment motive;alcoholic beverage; side effects; coincidence between work time and time to ingest any medicine dose; assistance time in the Service; frequency to consults;and necessity of someone that takes one to the Service. Conclusion: these factors imply on patient's health and it's going to be associated on caring for oneself,in order to minimize illness possibilities, and caring for the other, referring to infection transmission potential on collective level.

HIV-infected patients' adherence to highly active antiretroviral therapy: a phenomenological study.

Adherence to the treatment regimen is essential to the success of highly active antiretroviral therapy for patients who are infected with HIV. The evidence suggests that poor adherence to antiretroviral drug therapy is a major problem that has the potential to diminish effective viral suppression, promote viral resistance, and place patients at risk for hospitalization, opportunistic infections, and an increased risk of HIV transmission. The primary aim of this study was to understand patients' experiences regarding their adherence to antiretroviral drug therapy. Thus, 19 participants were recruited for in-depth interviews regarding their adherence to drug regimens. All the interviews were transcribed verbatim and analyzed by using Benner's phenomenological analysis approach. Four main themes emerged from the data: (i) choosing to live and the decision to start taking medications; (ii) strategies for adhering to the regimen and managing the side-effects; (iii) relationships with healthcare providers; and (iv) advantages of the medications as a motivator to continue one's adherence to the regimen. Studying and understanding the experiences of patients can provide new insights and strategies in order to enhance patients' adherence to highly active antiretroviral therapy.

Overlooked potential: older-age parents in the era of ART.

The advent of widespread ART provision in low- and middle-income countries requires not just medical attention, but also social and psychological support to encourage and monitor strict adherence to drug regimens. Developing innovative approaches to providing this broad support is a major challenge, especially within the financial constraints of resource-limited countries hardest hit by the epidemic. In this study, we examine the role of older-age parents in monitoring ART treatment and caring for their HIV-infected children and grandchildren in Cambodia. Our results are based on 25 open-ended interviews with older-age parents of people with AIDS (PWHA). A high level of co-residence when PWHA become ill and a sense of parental responsibility and emotional attachment facilitate high parental involvement in their children's and grandchildren's illness, care and treatment. Our interviews indicate that parents play an important role in encouraging their children to get tested and to access treatment if they test positive. They consistently monitor antiretroviral therapy (ART) adherence and opportunistic infections and remind PWHA to attend medical appointments and support-group meetings. Parents also provide for the nutrition and hygiene of PWHA essential to the success of ART treatments. We find that despite low levels of education, older parents were able to express clear, correct and detailed knowledge of complicated ART treatment regimens, nutrition and hygiene. Overall, our findings show that older parents play a pivotal role in care and treatment if they are provided with proper resources and training and have the ability to understand the necessity and details of ensuring strict adherence to medications. Based on these results, we suggest that explicitly including older parents in policy and programs for care and treatment would allow Cambodia and other countries to take advantage of this unique and effective but overlooked asset in AIDS care and treatment.

Virologic response using directly observed therapy in adolescents with HIV: an adherence tool.

Virologic response to highly active antiretroviral therapy (HAART) treatment of HIV infection depends on viral sensitivity to antiretrovirals and excellent medication adherence. Adolescents with vertically acquired HIV may require complicated regimens because of significant treatment experience and often have poor medication adherence. A retrospective chart review identified five adolescents with vertically acquired HIV and plasma HIV viral load rebound or nonresponse on a stable HAART regimen followed by a period of directly observed therapy (DOT) in a clinic or hospital setting with serial viral load measurements. Four subjects had a virologic response (mean decline, 1.15 log10) after DOT. A response to HAART can be seen despite antiretrovirals resistance using DOT and treatment-experienced patients seemingly unresponsive to HAART may be nonadherent even with reassuring adherence measures. A period of clinic-monitored DOT may allow diagnosis of nonadherence, discussion of medication barriers, and avoidance of unnecessary medication changes.

Distal sensory polyneuropathy in the context of HIV/AIDS.

Peripheral neuropathy, or distal sensory polyneuropathy (DSPN), is the most common neurological problem in HIV disease. DSPN also represents a complex symptom that occurs because of peripheral nerve damage related to advanced HIV disease and in association with the use of antiretroviral therapy-particularly in individuals treated with dideoxynucleosides. Although DSPN is a frequent symptom, the specific pathophysiology is not well understood. The HIV-related neuropathies are commonly categorized as distal sensory polyneuropathies, although antiretroviral toxic neuropathies are described in the literature. Recently, mitochondrial toxicity has been identified as a possible etiology of DSPN. As individuals with HIV/AIDS survive longer, often living for decades with the disease, chronic symptoms like DSPN must be addressed. Pharmacologic approaches, complementary therapies, and self-care behaviors that may improve quality of life and limit symptoms of DSPN are important interventions for clinicians and those living with HIV/AIDS to consider in the management of peripheral neuropathy.

A nurse- and pharmacist-led treatment advice clinic for patients attending an HIV outpatient clinic.

AIM: This paper is a report of a study to map care pathways, examine the approach of different treatment advisors and explore the acceptability of a nurse- and pharmacist-led treatment advice clinic in order to aid decision-making for the future development and evaluation of the clinic. BACKGROUND: High levels of adherence to antiretroviral drugs are a prerequisite for a successful and durable virological and immunological response to HIV. Treatment guidelines acknowledge that adherence is a process, not a single event, and that adherence support must be integrated into clinical follow-up for all patients receiving these drugs. METHOD: Data were collected between September 2004 and January 2005 through 17 consultation observations and 10 patient interviews in a specialist treatment advice clinic located within a central London HIV outpatient clinic providing care for over 2200 patients, of whom more than 1300 are taking highly active antiretroviral therapy. FINDINGS: The nurses and pharmacist had similar consultation approaches, although follow-up care varied in extent. Benefits of the clinic approach included permitting patients to observe real tablets, tailoring regimens to lifestyles and telephone follow-up. These factors, particularly telephone support, were perceived by patients to assist with adherence. CONCLUSION: The role of telephone support, perceived to assist with initial adherence, requires further investigation. Future work is also needed to explore the health economics of this approach and to determine the actual impact of the clinic on clinical and adherence outcomes.

Tratamiento de la hepatitis crónica B en pacientes infectados por el VIH / Treatment of chronic hepatitis B in HIV-positive patients

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Testing a nurse-tailored HIV medication adherence intervention.

BACKGROUND: The relationship between patient adherence and treatment outcomes has been documented across chronic health conditions, but the evidence base for effective adherence interventions in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) requires more rigorous research and reporting. OBJECTIVES: The aims of this study were to determine whether a tailored, nurse-delivered adherence intervention program--Client Adherence Profiling and Intervention Tailoring (CAP-IT)--improved adherence to HIV medications, compared with standard care, and to identify the relationship among adherence measures. METHODS: A randomized controlled trial (RCT) with repeated measures was used to test the efficacy of CAP-IT over a 6-month period. A convenience sample of 240 participants was recruited from a freestanding public HIV/AIDS clinic in Houston, TX, that provides medical, psychological, and pharmaceutical services for over 5,000 clients. Study instruments and measures included demographics; chart audit to capture CD4 count, viral load, and prescribed medications; health literacy; and five measures of adherence (AIDS Clinical Trial Group-Revised Reasons for Missing Medications, Morisky Self-Report of Medication Non-Adherence, Pill Count, Medication Event Monitoring System [MEMS] caps, and Pharmacy Refill). RESULTS: A logistic regression using generalized estimating equations method showed no significant differences over time on the five medication-adherence measures between the experimental and control groups. Little correlation was documented among the five different adherence measures, and there was minimal correlation with clinical markers. DISCUSSION: It is unclear why the tailored adherence intervention was not efficacious in improving medication adherence. The findings suggest that these measures of medication adherence did not perform as expected and that, perhaps, they are not adequate measures of adherence. Effective and efficient adherence interventions are needed to address the barriers to medication adherence in HIV/AIDS.

Dealing with the obstacles in adhering to highly active antiretroviral therapy.

Improving patient adherence to highly active antiretroviral therapy (HAART) is essential to effective treatment and represents a major challenge confronting healthcare providers. Because of their holistic perspective, nurses are uniquely qualified to identify the psychosocial and practical obstacles to full adherence and help patients deal with these problems. Studies have shown that many factors related to the disease, the patient, the provider, and the treatment regimen all play important roles in adopting and maintaining adherent behavior. Therefore, any attempt toward improving adherence should include adherence assessment and an approach that targets the patient, the provider, and the regimen. The availability of antiretroviral agents that are administered once daily and/or are associated with lower toxicity can help to simplify treatment regimens and avoid certain side effects, thereby facilitating greater adherence to highly active antiretroviral therapy.