Utilização dos registros de dispensação da farmácia como indicador da não-adesão à terapia anti-retroviral em indivíduos infectados pelo HIV

Abstract

The objectives of this study were to evaluate anti-retroviral (ARV) prescription pickups during twelve months following the first prescription and to identify factors associated with irregular pickups or permanent dropout in two public HIV/AIDS referral centers in Belo Horizonte, Minas Gerais State, Brazil. Participants (n = 323) were antiretroviral naïve and were recruited from May 2001 to May 2002. A total of 98 (30.3%) patients abandoned treatment, and 187 (57.9%) had at least one irregular pickup. Patients with irregular pickups and dropouts were compared to those with regular pickups. Multinomial multivariate analysis showed that living outside Belo Horizonte, CD4+ T-lymphocyte count greater than 200/mm(3), and antiretroviral regimen without protease inhibitors were associated with irregular pickups. In addition to these variables, not being on other medications, and any non-adherence recorded on patient charts were associated with treatment dropout. Pharmacy records are important potential indicators of non-adherence and should be incorporated as such in clinical practice. Strategies should be prioritized to reach out to dropouts or patients with irregular ARV pickups.

Evaluation of inadequate anti-retroviral treatment in patients with HIV/AIDS

“…This finding supports the results of Carmody et al 11 , Carrieri et al 12 , Gomes et al 9 , and Carvalho et al 13 The average age of the patients found in this study was 44.0 ± 9.9 years, similar to the findings of Pinto Neto et al 14 (42.76 ± 10.29 years). However, Carrieri et al 12 and Carvalho et al 13 reported an average age of 37 years and 36.5 years, respectively, while Gomes et al 9 reported that 53.2% of their patients were younger than 35 years. These results reinforce the importance of local epidemiological studies, since knowledge of patient characteristics is crucial for effective health promotion campaigns.…”

“…This might be explained by the fact that treatments without a PI are simpler and have less adverse effects than other therapies. However, Gomes et al 9 found significant results concerning combined therapy without a PI and non-adherence to treatment, contradicting the previous study. In the present study, those combinations containing LPV/r or ATV and AZT plus 3TC showed higher rates of inadequate treatment (85% and 83.3%, respectively).…”

“…Likewise, in the study of Gomes et al 9 , 30.7% of patients used this combination therapy. However, regarding the combination of 2 NRTIs and a PI, Gomes et al 9 found that 23.5% of patients used the combination of nelfinavir and AZT/3TC, whereas in the present study, lopinavir/ritonavir (LPV/r) combined with AZT/3TC was the most common NRTI-IP combination (17.5%).…”

“…From the model, which was adapted from Gomes et al 9 , patients that did not adhere to therapy or who did not acquire their drugs at the appropriate time were classified as receiving inadequate treatment, which could be described as: a) irregular adherence, i.e., the interval between collecting medication was >34 days, considering that the drugs are distributed for 30 days; and b) treatment dropout, i.e., not collecting medication for >2 months.…”

“…This statement is possibly due to the numerous studies available on this drug combination, its toxicity, and its security level, and that fact that these drugs are also available as a co-formulation 20 with a lower cost than other combinations of drugs of the same class 9 . However, when the AZT/3TC combination was used in therapy, we observed a significant increase in the number of patients who abandoned their treatment or showed irregular adherence.…”