ABSTRACT
Use of alcohol and illicit drugs is a common finding among HIV-infected individuals, but there are many open questions about its impact on adherence to antiretroviral therapy and virological outcomes. Our study aimed to evaluate the impact of the use of alcohol and illicit drugs on the adherence to antiretroviral therapy (ART) among patients starting ART in Salvador, Brazil. We followed up 144 AIDS patients initiating ART for a 6-month period. At baseline, they were interviewed about demographics, behavior, and use of illicit drugs and alcohol. All of them had HIV-1 RNA plasma viral load and CD4(+)/CD8(+) cells count measured before starting therapy. After 60 days of treatment they were asked to answer a new questionnaire on adherence to ART. All patients were monitored during the following months, and new CD4(+) cell count/HIV-1 RNA plasma viral load determinations were performed after 6 months of therapy. Optimal adherence to therapy was defined by self-reported questionnaire, by 95% use of prescribed drug doses, and by using plasma HIV-1 RNA viral load as a biological marker. A total of 61 (42.4%) patients reported alcohol use, 7 (4.9%) used illicit drugs, and 17 (11.8%) used both alcohol and illicit drugs. Being in a steady relationship was protective to nonadherence (95% CI: 0.18-0.84). Missing more than two medical visits was also associated with a 68% higher likelihood of nonadherence (95% CI: 0.10-1.02). After logistic regression we detected a higher risk of nonadherence for patients declaring use of alcohol plus illicit drugs (odds ratio=6.0; 95% CI: 1.78-20.28) or high-intensity use of alcohol (odds ratio=3.29; 95% CI: 1.83-5.92). AIDS patients using alcohol and/or illicit drugs are socially vulnerable, and need specific and flexible programs, combining mental health care, harm reduction strategies, and assisted drug therapy to maximize the chances of successful use of ART.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Alcoholism/complications , Anti-HIV Agents/therapeutic use , Medication Adherence/psychology , Substance-Related Disorders/complications , Acquired Immunodeficiency Syndrome/psychology , Adult , Aged , Brazil/epidemiology , CD4-CD8 Ratio , Female , HIV-1 , Humans , Logistic Models , Male , Medication Adherence/statistics & numerical data , Middle Aged , Surveys and Questionnaires , Viral Load , Young AdultABSTRACT
We conducted a randomized trial to test an intervention aimed at increasing adherence to antiretroviral therapy (ART) among HIV-positive, ART-naïve patients in Salvador, Brazil. Participants (N = 107) were randomized to either educational workshops based on the information-motivation-behavioral skills model (n = 52) or a control video session (n = 55). Changes in self-reported ART adherence, viral load, CD4 cell counts and ART pharmacy records were measured periodically over 12 months. After 3-6 months, ART adherence (> or = 95%) was 77.8% in the workshop group and 85.7% in video group (as treated) and 53.8% and 65.5%, respectively, using intention-to-treat (ITT) analysis (both P > 0.05) At 9-12 months, ART adherence decreased to 73.7% in the workshop group and 79.1% in the video group (as treated) and 53.8% and 61.8% using ITT, respectively. No differences were found in self-reported adherence, viral load or pharmacy records between groups. We found that the educational workshop intervention does not increase adherence to ART.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , Patient Compliance , Patient Education as Topic , Reverse Transcriptase Inhibitors/therapeutic use , Adult , Anti-HIV Agents/administration & dosage , Drug Therapy, Combination , Female , HIV Infections/virology , HIV-1/drug effects , Humans , Interviews as Topic , Male , Motivation , Patient Education as Topic/methods , Reverse Transcriptase Inhibitors/administration & dosage , Treatment Outcome , Viral LoadSubject(s)
Humans , Adolescent , Male , Female , Adolescent , Adolescent Behavior , Adolescent Health Services , Psychology, AdolescentABSTRACT
A autora descreve a experiência na realizaçäo de curso de curta duraçäo, destinado a pais de adolescentes e profissionais que lidam com essa faixa etária. O grupo de participantes foi formado por 18 mäes de diferentes papéis profissionais: diretora de escola de I grau, coordenadora padagógica de escola de I e II graus, pedagogas, estudante de pedagogia e estudante de psicopedagogia. Os motivos das escolhas apresentados pelos participantes centravam-se em dificuldades no relacionamento entre os pais e seus filhos e na busca de formas mais satisfatórias e funcionais da díade pais-filhos...
