The objective of this study was to assess if a simple evaluation, adherence to antiretroviral therapy, would correlate to clinical and laboratory outcomes. We followed an open cohort of patients from a public teaching hospital AIDS outpatient clinic. Patients were categorized according to adherence as: regular (Reg), optimal, all doses all days, tolerating only irregular timing (+/- 2 hours) of intake; quasi-regular (qReg), those missing up to four doses or 1 full day during a month; irregular (Irreg), all other irregular regimens, and ignored (Ign), those without information. The results from a simple questionnaire were compared to CD4+ cell counts and human immunodeficiency virus type 1 (HIV-1) RNA plasma viremia. One hundred eighty-two HIV-1-infected patients (126 males, 69%; 56 females, 31%) were analyzed. Information on adherence was available for 168 (90%). Reg adherence was reported by 75 (41%) patients, qReg adherence by 35 (19%), and Irreg by 53 (29%) of patients. The main reasons for nonadherence were forgetfulness, intolerance, use of alcohol, and misunderstanding of prescription. A significant increase of CD4+ T-cell counts and absolute gain were only observed among Reg and qReg users (p < 0.001). The median viral RNA load log10 decreases were -1.68, -1.45, -0.9 log, respectively, for Reg, qReg, and Irreg patients (p = 0.043, Kruskal-Wallis). Development of and death from AIDS occurred almost exclusively among those with Ign or Irreg adherence. Previous use of antiretroviral therapy may have had an impact in treatment response. Individuals who were treatment-naive were more likely to be Reg users (41%). Although more refined methods to assess adherence should be implemented when available, the inability to do so should not prevent simple, albeit subjective measurements that also correlate with favorable outcome. Mechanisms to improve adherence should be considered an integral part of antiretroviral therapy.
Este trabalho busca apresentar uma ação de Educação Ambiental (EA) que teve sua origem no seguinte problema motivador: a EA política pode auxiliar para que ocorra a participação da comunidade da área rural do município de Novo Hamburgo, estado do Rio Grande do Sul (RS), nas discussões e elaboração do seu Plano Municipal de Saneamento Básico (PMSB)? Para tentar responder a esta pergunta foram pensadas e realizadas quatro práxis fundamentadas nos objetivos da Carta de Belgrado e orientadas pela metodologia dialógica, a qual aposta nas interações comunicativas em busca de estabelecer um objetivo comum. Assim, os principais resultados decorrentes da ação foram a participação da comunidade nas discussões com o Poder Público para a construção do PMSB, porém a falta de poder deliberativo da população nas políticas públicas é a principal lacuna a preencher para a conquista da participação popular no exercício da cidadania.
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