Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy

Abstract

OBJECTIVE:We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription.METHODS:A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method.RESULTS:The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p = 0.010). Marital status (being married or in stable union; p = 0.022), alcohol use in the month prior to the baseline interview (p = 0.046), and current tobacco use (p = 0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p = 0.028) also presented an increased risk of non-adherence.CONCLUSIONS:In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services.

Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012

“…This low level of non-adherence to ART highlights the success of the national ART program in Kenya, where non-adherence levels are lower than reported in other sub-Saharan African countries, including: Rwanda, where 23% of ART patients were non-adherent based on 30-day recall [14]; Ghana, where 14% of ART patients were non-adherent [15]; rural Zambia where 40% of ART patients were not adherent [16], and a pooled analysis of African adherence studies, where overall non-adherence levels were reported to be 23% [17]. Data from developed countries also suggest higher non-adherence levels, with estimates of 45% in a pooled analysis of adherence studies in North America [17], 37% in Sweden [18], 34% in Brazil [19], and 43% in Spain [20]. Studies that have combined indicators of dose, timing, food and other measures have also generally reported higher non-adherence rates, [21–22].…”

Association between Temporomandibular Dysfunction and Depression in People Living with HIV/AIDS

“…The psychological changes often associated with HIV and their predictive factors are mood disorders, anxiety, depression, stress related to the health-disease process, history of psychiatric disorder, drug use and suicide in the family. Social support and early detection of those factors and symptoms of psychological distress, quality of life and adherence to treatment where are essential so that they do not adversely affect the treatment adherence and quality of life of people living with HIV/AIDS (PLHA) [16][17][18][19][20][21][22].…”

Development and validation of a satisfaction measure of outpatient care for people living with AIDS

“…The Brazil is the country in Latin America with the largest number of reported cases since the beginning of the epidemic, being logged, according to the Ministry of health (MS) from 1982 until June 2014, 656,701 cases of AIDS [2,3]. On the other hand, has advanced in public policies to combat the disease, with the support of international agencies, becoming focus of civil society organizations, philanthropic, religious, among others [1,4].…”

“…According to the Joint United Nations programme on HIV/aids (UNAIDS) worldwide there is 35.3 million people living with HIV. It is estimated that 0.8% of adults aged 15-49 years in the world living with the virus and 9,700,000 people are in treatment [2,3].…”

“…intentional process, political and technical, configuring itself as an ethical and social responsibility. In this evaluation process, are conspicuous by their user satisfaction in all the peculiarities of local services for adherence to treatment is increasingly effective [2,3].…”