Individual and contextual factors of influence on adherence to antiretrovirals among people attending public clinics in Rio de Janeiro, Brazil

Abstract

Background: There are inconsistencies in the determinants of adherence to antiretrovirals (ARVs) across settings as well as a lack of studies that take into consideration factors beyond the individual level. This makes it necessary to examine factors holistically in multiple settings and populations while taking into consideration the particularities of each context, in order to understand the patterns of ARV adherence. This research explored ARV adherence and individual, relational and environmental-structural factors. Methods: A cross-sectional survey was conducted from August 2008 through July 2009 among participants currently on ARVs recruited from 6 public health clinics, selected to maximize diversity in terms of caseload and location, representing the range of clinics within Rio de Janeiro city, Brazil. Multivariate logistic regression analysis was used to assess the association between our multilevel factors with ARV adherence among participants with complete cases (n = 632). Results: Eighty-four percent of respondents reported adherence to all of their ARV doses in the last 4 days. Of the socio-demographic variables, those who had one child were positively associated with adherence (AOR 2.29 CI [1.33-3.94]). On the relational level, those with high social support (AOR 2.85 CI [1.50-5.41]) were positively associated with adherence to ARVs. On the environmental-structural level, we found gender was significant with women negatively associated with adherence to ARVs ) while those with a high asset index ) were positively associated with adherence to ARVs. Conclusions: This research highlights the importance of examining the multiple levels of influence on ARV adherence. Intervention research in lower and middle-income settings should address and evaluate the impact of attending to both gender and economic inequalities to improve ARV adherence, as well as relational areas such as the provision of social support.

Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study

“…Adherence to ART stands out as one plausible explanation for the increased risk. However, among ART users, 88% of MSM had an undetectable value in their last viral load measurement compared to 80% of women suggesting adherence might be lower among women, a finding that aligns with recent results from public clinics in Rio de Janeiro (20). Additionally, MSM were less likely to start ART which could be linked with an increased risk of AIDS-related deaths.…”

Adherence to antiretroviral therapy for HIV/AIDS in Latin America and the Caribbean: Systematic review and meta‐analysis

“…The flow diagram of study selection is shown in Figure . Fifty‐three studies, composed of 22,603 participants in ART from 25 LAC countries, met eligibility criteria for the systematic review (Table ) . The median number of participants in ART per study was 201 [range: 13 – 3343; interquartile range (IQR): 394 – 125].…”

“…Statistically significant factors ( p < 0.05) associated with adherence to ART found by these studies are presented in Table . Some factors positively associated with adherence to ART were: high social support , good relationship with the physician ; satisfaction with the healthcare service ; and use of counselling services . Some factors negatively associated with adherence to ART were: alcohol use or alcohol use disorders ; substance use ; high pill burden ; depression symptoms ; unemployment or irregular employment ; and high or detectable HIV viral load .…”

Social determinants of pulmonary tuberculosis in Argentina

“…The association between socioeconomic status and poor access to health services for TB diagnosis has been examined in numerous studies conducted in different countries and regions, using different methodologies and indicators. Hanif et al 27 evaluated factors influencing adherence to antiretroviral treatment and concluded that socioeconomic factors were often a proxy for other barriers, such as the cost of transportation, lack of time, difficulties in obtaining information, and discrimination 27 . A study conducted in the Dominican Republic 28 showed that the poorest patients experienced the greatest economic impact and identified the main direct and indirect costs as follows: necessary expenses for supplementary food during treatment, transportation costs to attend health services, loss of income due to the interruption of the working day, and loss of time incurred to attend health services and as a result of delays in care 28 .…”