Background There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). Methods This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann–Whitney test, Chi square test, and Yates correction. Results The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. Conclusions Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.
Objetive: To describe illness related knowledge features, mental health, adherence to therapy and quality of life on type 2 diabetes patients from two hospitals from northern Peru. Material and Methods: Cross sectional descriptive study. A cense was made. Descriptive statistics and exploratory analysis were employed. Results: there were 382 diabetes patients: 289 in Lambayeque and 93 in Piura:112 people were interviewed. The mean age was 59.5 +/- 11.6 years, 58% were women, 59% were from Piura, 43.8% only had primary school and 41.5% referred 2 to 4 outpatient evaluations in the last two years; 28.6% reported to have been infected by COVID-19: 35,5% in Lambayeque and 23.8% in Piura; 17.8% had poor knowledge about the disease. About mental health, 91.9% had Depression, 75% Anxiety and 72.8%, both; 50.6% had adequate adherence to therapy. The median of quality of life was 161.5 (IQR=127.1-215) and 24.1% had poor quality of life. In descending order, the more affected dimensions of quality of life were: “control of diabetes”, “energy and mobility”, “social burden”, “anxiety” and “sexual performance”. In the exploratory multivariate analysis, depression was associated with high quality of life. Conclusion: disease related-knowledge features, mental health, adherence to therapy and quality of life were poor on type 2 diabetics from these two northern cities of Peru. There were no association between sociodemographic characteristics, mental health, knowledge, adherence, with quality of life.
BackgroundTo achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America.MethodsA constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality.ResultsThe core category ‘staying alive’ emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers.ConclusionAdherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.
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