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      Adherence to antiretroviral treatment and associated factors in people living with HIV/AIDS in Quindío, Colombia Translated title: Adhesión al tratamiento antirretroviral y factores asociados en personas viviendo con VIH/sida en Quindío, Colombia

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          Abstract

          Abstract Introduction: HIV/AIDS is a chronic disease; therefore, recognizing which factors favor adherence to antiretroviral treatment is necessary. Objective: To determine the association between adherence to antiretroviral treatment and depression, anxiety, perception of social support and sociodemographic variables in people living with HIV/ AIDS in Quindío, Colombia. Materials and methods: An observational, cross-sectional study was performed in an intentional sample of 70 adults, who were applied the Morisky-Green questionnaire, the Beck Depression Inventory, the Beck Anxiety Inventory, the Medical Outcomes Study (MOS) Social Support Survey, and a sociodemographic survey. Univariate and bivariate analyzes were performed by calculating the odds ratio to determine association (p<0.05). Results: 57.1% ofthe participants reported low adherence to treatment, 30% had moderate or severe depressive symptoms, 71.4% scored minimal or mild anxiety levels, and 77.1% had a low perception of social support. A statistical association between depression (high levels tripled the risk of non-adherence) and self-report on how treatment is followed (excellent or good self-report increased by five times the probability of adherence) was found. Conclusion: Depression and self-report on compliance were associated with adherence to antiretroviral therapy. A comprehensive study on the perception of social support and cognitive variables, such as self-efficacy and risk perception, is highly recommended for people living with HIV/AIDS.

          Translated abstract

          Resumen Introducción. El VIH/sida es una enfermedad crónica, por ello es necesario reconocer qué factores favorecen la adhesión al tratamiento antirretroviral. Objetivo. Determinar la asociación entre adhesión al tratamiento antirretroviral y depresión, ansiedad, percepción de apoyo social y variables sociodemográficas en personas viviendo con VIH/sida en Quindío, Colombia. Materiales y métodos. Se realizó un estudio observacional analítico de tipo transversal en una muestra intencional de 70 adultos, a quienes se les aplicó el cuestionario autorreferido de Morisky-Green, el Inventario de Depresión de Beck, el Inventario de Ansiedad de Beck, el cuestionario MOS (Medical Outcomes Study) de Apoyo Social y una encuesta sociodemográfica. Se realizaron análisis univariados y bivariados calculando Odds Ratio para determinar asociación (p<0.05). Resultados. 57.1% de los participantes reportó poca adhesión al tratamiento, 30% presentó síntomas depresivos moderados o graves, 71.4% puntuó niveles mínimos o leves de ansiedad y 77.1% tuvo baja percepción de apoyo social. Se encontró asociación estadística entre depresión -niveles altos triplicaron el riesgo de no adhesión- y autoevaluación de la manera como se sigue el tratamiento -excelente o buena aumentó cinco veces la probabilidad de adhesión-. Conclusión. La depresión y la autoevaluación del cumplimiento se asociaron con adhesión al tratamiento antirretroviral. Se sugiere profundizar el estudio de la percepción de apoyo social y variables cognitivas, como la autoeficacia y percepción de riesgo, en personas que viven con VIH/sida.

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          Barriers to access to antiretroviral treatment in developing countries: a review.

          To present a review of barriers impeding people living with HIV/AIDS in developing countries from accessing treatment, and to make recommendations for further studies. Electronic databases, websites of main global agencies and international AIDS conferences were searched for relevant articles published between 1996 and 2007. Articles were reviewed using the Andersen and May framework of access to health services and barriers were categorized as either population-level or health system-level barriers. A total of 19 studies (7 articles and 12 abstracts) in English were reviewed. The barriers most frequently cited at the population level were lack of information about antiretroviral therapy (ART), perceived high costs for ART and stigma. Barriers most frequently cited at the health system level were long distance from home to the health facility, lack of co-ordination across services and limited involvement of the community in the programme planning process. Dissemination of information about HIV/AIDS and alternative related care, and alternative health financing policies seem to be the most relevant policy measures to remove barriers. In view of the paucity of evidence on barriers to access to ART, research should address the relative importance of barriers, include a mix of qualitative and quantitative research methods and evaluate barriers in different settings.
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            Adherencia a los tratamientos a largo plazo: pruebas para la acción

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              "It's all the time in my mind": facilitators of adherence to antiretroviral therapy in a Tanzanian setting.

              Although HIV positive patients' adherence to antiretroviral therapy (ART) is relatively high in African nations, as compared with industrialized nations, few studies have explored why. In the research presented here we aimed to understand the dynamics of good adherence to ART among patients receiving free ART and HIV-related services from a clinic in Arusha, Tanzania. We conducted individual semi-structured interviews with 6 health care providers and 36 patients at a health care center in Arusha in 2006. Interviews were conducted in Swahili using interview guides informed by social cognitive theory. All interviews were audio-recorded, transcribed in Kiswahili, translated into English and coded for themes and patterns with ATLAS.ti. Of the 36 patients interviewed (mean time on ART 9.8 months; range 1-23 months), 32 reported perfect adherence in the previous month. Self-reported adherence was high despite economic hardship, depression, low rates of HIV disclosure and high perceived HIV-associated stigma. Five factors emerged to explain excellent adherence in the face of such barriers. First, all respondents experienced substantial improvements in their health after starting ART; this supported their confidence in the medication and motivated them to adhere. Second, their perceived need to be able to meet their family responsibilities motivated respondents to stay healthy. Third, respondents developed specific strategies to remember to take pills, particularly routinizing pill-taking by linking it with daily activities or events. Fourth, material and emotional support received from others facilitated adherence. Finally, respondents trusted the advice and instructions of their health care providers, who regularly emphasized adherence. The facilitating factors identified were consistent with the constructs of social cognitive theory and highlighted the importance of interventions that address multiple levels of influence on adherence.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rfmun
                Revista de la Facultad de Medicina
                rev.fac.med.
                Universidad Nacional de Colombia (Bogotá, Distrito Capital, Colombia )
                0120-0011
                September 2017
                : 65
                : 3
                : 403-410
                Affiliations
                [1] orgname Colombia
                [3] orgname Colombia
                [2] orgname Colombia
                Article
                S0120-00112017000300403
                10.15446/revfacmed.v65n3.55535
                c3beccc4-f6ac-4268-a0ed-c8fb7c29ecc5

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 02 February 2016
                : 16 June 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 63, Pages: 8
                Product

                SciELO Colombia


                Depresión,Ansiedad,Apoyo social (DeCS),HIV,Antiretroviral Therapy Highly Active,Medication Adherence,Depression,Anxiety,Social Support (MeSH),VIH,Terapia antirretroviral altamente activa,Adhesión al tratamiento

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