Síndrome de Guillain-Barré en Argentina: su importancia para la salud pública ante la emergencia del virus del zika / Guillain-Barré syndrome in Argentina: its public health relevance in light of zika virus emergence

Ante la emergencia del virus del Zika y sus complicaciones, entre ellas el Síndrome de Guillain-Barré (SGB), la Organización Mundial de la Salud declaró la emergencia de salud pública de importancia internacional, en la que insta a los Estados Miembros a fortalecer la vigilancia y desarrollar investigaciones. Esto constituye una oportunidad para construir una línea de base del SGB, caracterizarlo y diseñar una estrategia de vigilancia.

Motivational Interviewing among HIV Health Care Providers: Challenges and Opportunities to Enhance Engagement and Retention in Care in Buenos Aires, Argentina.

In Argentina, providers' response to motivational interviewing (MI) to improve engagement and retention in care among challenging patients with HIV was evaluated. Twelve HIV care physicians participated, and their video recordings pre- and post-MI training were also obtained. One week post-training, 11 of the 12 participants were committed to using MI strategies during consult session. Of the 12 participants, 9 demonstrated appropriate utilization of MI techniques and change in HIV education provided during consultation (Z = -2.375, P = .018). Motivational interviewing appears to be a viable strategy to enhance engagement and retention in challenging HIV-positive patients.

Obstáculos a la adherencia y retención en los sistemas de salud público y privado según pacientes y personal de salud / Barriers to adherence and retention in public and private healthcare according to patients and health workers

Introducción: el Programa Nacional de Sida garantiza el acce-so universal a los antirretrovirales, aun así las personas que reciben me-dicamentos a través del sistema público no logran obtener una carga vi-ral indetectable en la misma proporción que los pacientes del sistema privado. Este estudio cualitativo tiene como objeto identificar los facto-res asociados a la adherencia y retención en la cascada de atención de VIH de los sistemas de salud público y privado de Buenos Aires, según las percepciones de pacientes y del personal de salud.Métodos: se registraron datos cualitativos de 12 entrevistas semi-es-tructuradas a informantes clave y 4 grupos focales de pacientes y per-sonal de salud tanto del sistema público como privado. Se codificaron y analizaron temas predeterminados sobre adherencia, utilizando el soft-ware QRS Nvivo9® de análisis de datos cualitativos.Resultados: pacientes y personal de salud de ambos sistemas coinci-den en la importancia del estigma asociado al VIH, la relación médico-paciente, la comunicación entre ambos y la división de responsabilida-des en relación al tratamiento como aspectos fundamentales para la adherencia y retención en la cascada de atención. Se observan diferen-cias entre los sistemas en la forma en que algunos de estos aspectos ac-túan. Las barreras estructurales se presentan como principales obstácu-los del sistema público.Discusión: se resalta la necesidad de intervenciones focalizadas en la díada médico-paciente que consi-dere las particularidades de cada sistema de aten-ción para facilitar el compromiso del paciente en la adherencia

Introduction: The National Program of AIDS guarantees universal access to antiretroviral medication, yet people receiving treatment through the public healthcare system do not achieve an undetectable viral load in the same rate than patients in the private system. This qualitative study aims to identify factors associated with adherence and retention in the HIV-cascade of care at public and private setting from Buenos Aires, based on patients and healthcare workers' perceptions.Methods: Qualitative data from 12 semi-structured interviews with key informants and 4 focus groups of patients and healthcare workers from the public and private systems were recorded. Transcripts were coded and analyzed, using the QRS Nvivo9® software for qualitative data analysis, into set themes on adherence.Results: Patients and healthcare workers of both systems agree on the importance of HIV-related stigma, professional-patient relationship and communication, and the division of treatment-related responsibilities as fundamental aspects for adherence and retention in the HIV-cascade of care. Differences in the manner these factors interact were observed between healthcare systems. Structural barriers are presented as the main adherence barrier in the public system.Discussion: The need for interventions focused on the doctor-patient dyad considering the features of each healthcare is highlighted in order to facilitate patient engagement in adherence

Patient-provider perceptions on engagement in HIV care in Argentina.

Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient-provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.

[Barriers to adherence and retention in public and private healthcare according to patients and health workers]. / Obstáculos a la adherencia y retención en los sistemas de salud público y privado según pacientes y personal de salud.

INTRODUCTION: The National Program of AIDS guarantees universal access to antiretroviral medication, yet people receiving treatment through the public healthcare system do not achieve an undetectable viral load in the same rate than patients in the private system. This qualitative study aims to identify factors associated with adherence and retention in the HIV-cascade of care at public and private setting from Buenos Aires, based on patients and healthcare workers' perceptions. METHODS: Qualitative data from 12 semi-structured interviews with key informants and 4 focus groups of patients and healthcare workers from the public and private systems were recorded. Transcripts were coded and analyzed, using the QRS Nvivo9® software for qualitative data analysis, into set themes on adherence. RESULTS: Patients and healthcare workers of both systems agree on the importance of HIV-related stigma, professional-patient relationship and communication, and the division of treatment-related responsibilities as fundamental aspects for adherence and retention in the HIV-cascade of care. Differences in the manner these factors interact were observed between healthcare systems. Structural barriers are presented as the main adherence barrier in the public system. DISCUSSION: The need for interventions focused on the doctor-patient dyad considering the features of each healthcare is highlighted in order to facilitate patient engagement in adherence.