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      Variables Psicológicas y Adhesión en Personas con VIH: Evaluación en función del Tiempo de Infección Translated title: Psychological Variables and Adherence Among HIV Persons: Evaluation based on Length of Infection

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          Abstract

          Se realizó un estudio transversal con el objetivo de evaluar la influencia de un conjunto de variables psicológicas sobre los comportamientos de adhesión al tratamiento en función del tiempo de infección en meses. Participaron 93 personas con VIH, quienes contestaron dos instrumentos: 1) Variables psicológicas y comportamientos de adhesión, y 2) Situaciones vinculadas con estrés. Se emplearon los siguientes procedimientos estadísticos: la ji al cuadrado de Pearson, la U de Mann-Whitney y un análisis de regresión múltiple. Los análisis de regresión revelaron una influencia diferenciada de las variables psicológicas en función del tiempo de infección: en el grupo de personas con < 42 meses, los predictores de los comportamientos de adhesión fueron una buena motivación, un óptimo desempeño competencial presente y bajos niveles de estrés vinculados con tolerancia a la frustración. En el grupo con 43 o más meses los predictores fueron una buena motivación y bajos niveles de estrés vinculados con toma de decisiones. El tiempo de infección en meses constituye una variable crítica respecto de la forma en que operan las variables psicológicas sobre la práctica de los comportamientos de adhesión en personas con VIH expuestas a tratamiento con medicamentos antirretrovirales.

          Translated abstract

          This cross-sectional study was carried out to assess the influence of psychological variables on antiretroviral treatment adherence behaviors, based on length of infection in months. Participants included ninety-three HIV-positive persons, who answered two self-administered questionnaires: 1) Psychological variables and adherence behaviors, and 2) Stress-related situations. Three consecutive statistical testing procedures were applied for data analysis: Pearson's chi-square, Mann-Whitney U, and multiple regressions. Regression analyses found psychological variables influencing adherence behaviors in different ways based on length of infection: in the group of persons with < 42 months, psychological predictors were a good motivation, an optimal competential performance and low stress-related with tolerance to frustration, whereas in the group of persons with 43 or more months predictors were a good motivation and low stress-related with decision-making. Results strongly support the tenet that length of infection is a critical variable related to psychological variables influencing adherence behaviors among HIV-positive persons under antiretroviral treatment.

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          Most cited references 31

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          Psicología y salud: un análisis conceptual

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            Is patients' preferred involvement in health decisions related to outcomes for patients with HIV?

            Previous studies suggest that patients who are more involved in their medical care have better outcomes. We sought to compare health care processes and outcomes for patients with HIV based on their preferred level of involvement in health decisions. Cross-sectional analysis of audio computer-assisted interviews with patients at an urban HIV clinic. One thousand and twenty-seven patients awaiting an appointment with their primary care provider. Patients were asked how they preferred to be involved in decisions (doctor makes most or all decisions, doctor and patient share decisions, patient makes all decisions). We also asked patients to rate the quality of communication with their HIV provider, and their self-reported receipt of and adherence to HAART. Overall, 23% patients preferred that their doctor make all or most decisions, 63% preferred to share decisions with their doctor, and 13% preferred to make all final decisions alone. Compared to patients who prefer to share decisions with their HIV provider, patients who prefer that their provider make all/most decisions were significantly less likely to adhere to HAART (OR [odds ratio] 0.57, 95% CI 0.38-0.86) and patients who preferred to make decisions alone were significantly less likely to receive HAART or to have undetectable HIV RNA in unadjusted analyses (OR 0.52, 95% CI 0.31-0.87 for receipt of HAART; OR 0.64, 95% CI 0.44-0.95 for undetectable HIV RNA). After controlling for potentially confounding patient characteristics and differences in patient ratings of communication quality, patients who preferred that their provider make all/most decisions remained significantly less likely to adhere to HAART (OR 0.58, 95% CI 0.38-0.89); however, the associations with receipt of HAART and undetectable HIV RNA were no longer significant (OR 0.60, 95% CI 0.34-1.05 for receipt of HAART; OR 0.80, 95% C.I 0.53-1.20 for undetectable HIV RNA). Although previous research suggests that more patient involvement in health care decisions is better, this benefit may be reduced when the patient wants to make decisions alone. Future research should explore the extent to which this preference is modifiable so as to improve outcomes.
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              Treatment adherence: the role of behavioral mechanism and some implications for health care interventions

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                terpsicol
                Terapia psicológica
                Ter Psicol
                Sociedad Chilena de Psicología Clínica (Santiago )
                0718-4808
                December 2011
                : 29
                : 2
                : 149-157
                Affiliations
                [1 ] Universidad Nacional Autónoma de México Mexico
                [2 ] Universidad de Sonora Mexico
                [3 ] Universidad Autónoma de Tamaulipas Mexico
                [4 ] SECRETARIA DE SALUD DE SONORA Mexico
                Article
                S0718-48082011000200001
                10.4067/S0718-48082011000200001
                Product
                Product Information: website
                Categories
                PSYCHOLOGY, CLINICAL

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