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IntroductionViral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. MethodsWe conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data-collection period, followed by intervention periods comprising 8 weeks of rapid (<48h) and 4 weeks of longer-turnaround (5-10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVID-19 infections (HOCIs; detected [≥]48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospital-acquired infections (HAIs) was evaluated. ResultsA total of 2170 HOCI cases were recorded from October 2020-April 2021, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (IRR 1.60, 95%CI 0.85-3.01; P=0.14) or rapid (0.85, 0.48-1.50; P=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a per-protocol sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. ConclusionWhile we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days.
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OBJETIVO: O objetivo deste estudo foi analisar a força de associação entre as variáveis autorrelato de adesão à medicação e uso problemático de álcool em uma população de indivíduos com AIDS que fazem uso de HAART. MÉTODO: Foram entrevistados 103 pacientes com AIDS, em uso de HAART há pelo menos seis meses, que frequentavam o ambulatório do Instituto de Doenças Tropicais Natan Portela (IDTNP), localizado na cidade de Teresina, PI. A variável independente estudada foi o uso problemático de álcool, além de variáveis sociodemográficas. O questionário utilizado para avaliar o uso problemático de álcool foi o AUDIT (Alcohol Use Disorders Identification Test). A variável dependente avaliada neste estudo foi o autorrelato de adesão ao tratamento para o HIV. Para sua mensuração, optou-se por utilizar o QSAM (Questionário Simplificado de Adesão à Medicação), por tratar-se de um questionário bastante simples e de fácil aplicação. RESULTADOS: A frequência de AUDIT > 08 foi de 33 por cento; já o autorrelato de adesão, avaliado pelo QSAM, foi positivo em 45 por cento da amostra. Testada a associação entre a frequência de QSAM positivo e o AUDIT positivo, encontrou-se forte associação entre essas variáveis (p = 0,004). CONCLUSÃO: Conclui-se deste estudo que o autorrelato de falha na adesão ao HAART aferido por meio do QSAM é um fator de risco para a presença de uso problemático de álcool.
OBJECTIVE: The aim of this study was to analyze the strength of association between the variables self-report of adherence to medication and problematic use of alcohol in a population of individuals with AIDS making use of HAART. METHOD: 103 patients with AIDS, using HAART for at least six months and which visited the infirmary of the Natan Portela Institute for Tropical Diseases (DNPITD), located in the city of Teresina-PI, were interviewed. The independent variable studied was problematic use of alcohol, and sociodemographical variables. The questionnaire used to evaluate the problematic use of alcohol was the AUDIT (Alcohol Use Disorders Identification Test). The dependent variable evaluated in this study was the self-report of adherence to HIV treatment. For its measurement we chose to use the SQAM (Simplified Questionnaire of Adherence to Medication), for its simplicity and ease of application. RESULTS: The frequency of AUDIT > 08 was of 33 percent. The self-report of adherence, evaluated by the SQAM, was positive in 45 percent of the sample. Once tested the association between the frequency of positive SQAM and the positive AUDIT, a strong association was found between those variables (p = 0,004). CONCLUSION: We conclude from this study that the self-report of failure of adherence to HAART, gathered by the SQAM is a risk factor to the presence of problematic use of alcohol.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Alcoholismo , Cumplimiento de la Medicación/psicología , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Brasil , Estudios de Casos y Controles , Consumo de Bebidas Alcohólicas/psicología , Encuestas y Cuestionarios , Factores Socioeconómicos , Insuficiencia del Tratamiento , Terapia Antirretroviral Altamente ActivaRESUMEN
OBJETIVO: O objetivo deste trabalho foi fazer uma revisão sistemática da literatura, utilizando a base de dados MedLine, sobre o tema: uso/abuso/dependência de álcool como um fator de risco à redução da adesão, à redução na supressão da carga viral ou ao pior desfecho clínico em pacientes com AIDS em uso de highly active antiretroviral therapy (HAART). MÉTODO: Foi realizada uma pesquisa sistemática na base de dados MedLine utilizando como unitermos "HAART", "adherence" e "alcohol", na busca de artigos que versassem sobre a temática: avaliação ou associação de uso/abuso/dependência de álcool e adesão/supressão da carga viral/ desfecho clínico nos pacientes em uso de terapia antirretroviral. RESULTADOS: A busca resultou em 65 artigos. Contudo, apenas 21 deles contemplaram os critérios de inclusão e foram selecionados. Foi encontrada associação positiva entre uso/abuso/dependência de álcool e baixa adesão/baixa supressão da carga viral/pior desfecho clínico em 18 (85,7 por cento) artigos. CONCLUSÃO: O uso/abuso/dependência de álcool é um fator de risco para baixa adesão/baixa supressão da carga viral/pior desfecho clínico nos indivíduos em uso de HAART.
OBJECTIVE: The purpose of this work was to make a systematic review of the literature, using the MedLine data basis, about the alcohol usage/abuse/dependence as a risk factor to the adherence reduction, the viral load reduction or even a worse clinical outcome in HIV patients in the usage of highly active antiretroviral therapy (HAART). METHOD: It was made a systematic research in the MedLine data basis using the words: "HAART", "adherence" and "alcohol" with the purpose of finding articles about the themes: evaluations or association between the alcohol usage/abuse/dependence and adherence/suppression of the viral load/clinical outcome in HIV patients in the usage of antiretroviral therapy. RESULTS: The search found 65 articles. However, only 21 of this achieved the pre-established criteria and have been selected. It was found a positive association among the usage/abuse/dependence of the alcohol and the low adherence/low viral load suppression/worse clinical outcome in 18 (85,7 percent) of the articles. CONCLUSION: We could conclude that the alcohol usage/abuse/dependence is a risk factor to the low adherence/low viral load suppression/worse clinical outcome in HIV patients in the usage of HAART.