RESUMO
Of those in the general population hospitalized for suicidal ideation and suicide attempts in Argentina, many reattempt suicide and are readmitted. However, few studies in Argentina have examined suicidal ideation and suicide-related behaviors among people living with HIV (PLHIV) and none have examined these factors among nonadherent PLHIV, though the prevalence of suicidal ideation in this group may be higher than in the general population and also than in other groups of PLHIV. This study of PLHIV in Buenos Aires, Argentina, examined the correlates of suicidal ideation in nonadherent PLHIV. Nonadherent patients with HIV (N = 118) were recruited from two clinics providing outpatient healthcare services to PLHIV in Buenos Aires, Argentina. Participants completed assessments on demographic characteristics, depression and suicidality, stigma, and self-efficacy. Participants were HIV-infected men (51%) and women (49%) with a median age of 40 years (IQR = 11). About half had completed high school or more, two-thirds were employed, and had a mean monthly income of 4196.79 (SD = 3179.64) Argentine pesos (USD$221). Thirty-three (28% [95% CI 20.3, 37.3]) participants reported suicidal ideation in the past two weeks, and one-third (35.6% [27.1, 44.9]) reported lifetime suicidal ideation. In bivariate analyses, attending a public clinic, being female, younger, unemployed, and experiencing greater stigma and depression were associated with suicidal ideation. In multivariable logistic regression, stigma interacted with the number of years since HIV diagnosis to predict suicidal ideation. The impact of stigma on suicidal ideation decreased with time since HIV diagnosis, suggesting that suicidal ideation may arise following HIV diagnosis due to perception of HIV-related stigma. Interventions to reduce perceived stigma during the period following HIV diagnosis may reduce suicidal ideation in this population. Organizational initiatives that explore HIV stigma microagressions in the healthcare setting may be needed to optimize health outcomes.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Ideação Suicida , Tentativa de Suicídio , Adolescente , Adulto , Argentina , Criança , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estigma SocialRESUMO
Challenging HIV-infected patients, those neither adherent nor actively engaged in care, represent an important opportunity for intervention if the HIV epidemic is to be contained. This pilot study assessed the feasibility and acceptability of an adapted patient adherence intervention and a motivational interview-based provider intervention in urban Buenos Aires, Argentina, in order to optimize health benefits in challenging HIV-infected patients. To maximize implementation and uptake of both strategies, interventions were adapted to the local setting. Qualitative data and a short quantitative assessment from patients, staff, fellows, residents and physicians (n = 84) were examined to establish the feasibility and acceptability of offering patient and provider evidence-based interventions in both public and private health-care settings. Results identified key themes on provision of information, use of specialized communication techniques and group support in the utilization of the interventions. Both providers (n = 12) and patients (n = 120) endorsed the acceptability and value of the interventions, and the feasibility of their delivery. Findings support the use of both intervention modalities with challenging patients in diverse urban health-care settings.
Assuntos
Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Entrevista Motivacional , Educação de Pacientes como Assunto , População Urbana , Argentina , Atitude do Pessoal de Saúde , Comunicação , Estudos de Viabilidade , Processos Grupais , Humanos , Médicos , Projetos Piloto , Apoio SocialRESUMO
Many HIV-infected patients fail to achieve undetectable viral load and are not retained in care. This pilot study examined patients lost to care in public and private clinics in Buenos Aires, Argentina. The impact of patient and provider interventions was compared separately and collectively. In Phase 1, participants prescribed antiretrovirals and non-adherent to treatment in the prior 3-6 months (n = 60) were randomized to patient intervention or standard of care (SOC) and assessed over 12 months. In Phase 2, providers were trained in interviewing techniques and 60 additional patients were randomized to patient intervention or SOC condition. Averaged across patient intervention status, Phase 2 provider intervention patients reported the most improved adherence and viral suppression at 6 and 12 months. Adherence in "patient intervention only" improved at midpoint and returned to baseline at 12 months. Results suggest provider training sustained patient adherence and viral suppression among "hard to reach" patients.
Assuntos
Antirretrovirais/uso terapêutico , Atenção à Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Educação de Pacientes como Assunto/métodos , Relações Profissional-Paciente , Adulto , Argentina , Aconselhamento , Feminino , Infecções por HIV/psicologia , Infecções por HIV/virologia , Letramento em Saúde , Humanos , Masculino , Adesão à Medicação/etnologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Entrevista Motivacional , Aceitação pelo Paciente de Cuidados de Saúde , Projetos Piloto , Setor Privado , Setor Público , Resultado do Tratamento , Carga ViralRESUMO
In Argentina, providers' response to motivational interviewing (MI) to improve engagement and retention in care among challenging patients with HIV was evaluated. Twelve HIV care physicians participated, and their video recordings pre- and post-MI training were also obtained. One week post-training, 11 of the 12 participants were committed to using MI strategies during consult session. Of the 12 participants, 9 demonstrated appropriate utilization of MI techniques and change in HIV education provided during consultation (Z = -2.375, P = .018). Motivational interviewing appears to be a viable strategy to enhance engagement and retention in challenging HIV-positive patients.
Assuntos
Infecções por HIV/psicologia , Médicos/psicologia , Adulto , Argentina , Educação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Entrevista Motivacional , Encaminhamento e Consulta , Adulto JovemRESUMO
Treatment engagement, retention and adherence to care are required for optimal HIV outcomes. Yet, patients may fall below the treatment recommendations for achieving undetectable viral load or not be retained in care. This study examined the most challenging patients in Buenos Aires, Argentina, those non-adherent to HIV care. Men (n = 61) and women (n = 59) prescribed antiretrovirals (ARVs) and non-adherent to treatment in the prior 3-6 months were enrolled and assessed regarding adherence, knowledge, motivation and attitudes regarding treatment. Private clinic patients had lower viral load and higher self-reported adherence than public clinic patients. Motivations to be adherent and positive beliefs regarding ARVs were associated with increased adherence in public clinic participants. Increased self-efficacy was associated with increased adherence among participants from both clinics. Results support patient and provider interventions that strengthen the characteristics supporting adherence, engagement and retention in public and private clinic settings.
Assuntos
Antirretrovirais/uso terapêutico , Atenção à Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Setor Privado , Setor Público , Adulto , Argentina/epidemiologia , Feminino , Infecções por HIV/psicologia , Humanos , Modelos Logísticos , Masculino , Adesão à Medicação/etnologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários , Resultado do Tratamento , Carga ViralRESUMO
Introducción: el Programa Nacional de Sida garantiza el acce-so universal a los antirretrovirales, aun así las personas que reciben me-dicamentos a través del sistema público no logran obtener una carga vi-ral indetectable en la misma proporción que los pacientes del sistema privado. Este estudio cualitativo tiene como objeto identificar los facto-res asociados a la adherencia y retención en la cascada de atención de VIH de los sistemas de salud público y privado de Buenos Aires, según las percepciones de pacientes y del personal de salud.Métodos: se registraron datos cualitativos de 12 entrevistas semi-es-tructuradas a informantes clave y 4 grupos focales de pacientes y per-sonal de salud tanto del sistema público como privado. Se codificaron y analizaron temas predeterminados sobre adherencia, utilizando el soft-ware QRS Nvivo9® de análisis de datos cualitativos.Resultados: pacientes y personal de salud de ambos sistemas coinci-den en la importancia del estigma asociado al VIH, la relación médico-paciente, la comunicación entre ambos y la división de responsabilida-des en relación al tratamiento como aspectos fundamentales para la adherencia y retención en la cascada de atención. Se observan diferen-cias entre los sistemas en la forma en que algunos de estos aspectos ac-túan. Las barreras estructurales se presentan como principales obstácu-los del sistema público.Discusión: se resalta la necesidad de intervenciones focalizadas en la díada médico-paciente que consi-dere las particularidades de cada sistema de aten-ción para facilitar el compromiso del paciente en la adherencia
Introduction: The National Program of AIDS guarantees universal access to antiretroviral medication, yet people receiving treatment through the public healthcare system do not achieve an undetectable viral load in the same rate than patients in the private system. This qualitative study aims to identify factors associated with adherence and retention in the HIV-cascade of care at public and private setting from Buenos Aires, based on patients and healthcare workers' perceptions.Methods: Qualitative data from 12 semi-structured interviews with key informants and 4 focus groups of patients and healthcare workers from the public and private systems were recorded. Transcripts were coded and analyzed, using the QRS Nvivo9® software for qualitative data analysis, into set themes on adherence.Results: Patients and healthcare workers of both systems agree on the importance of HIV-related stigma, professional-patient relationship and communication, and the division of treatment-related responsibilities as fundamental aspects for adherence and retention in the HIV-cascade of care. Differences in the manner these factors interact were observed between healthcare systems. Structural barriers are presented as the main adherence barrier in the public system.Discussion: The need for interventions focused on the doctor-patient dyad considering the features of each healthcare is highlighted in order to facilitate patient engagement in adherence
Assuntos
Humanos , Masculino , Feminino , Relações Médico-Paciente , Cuidados Médicos , Adesão à Medicação , Estigma Social , Retenção nos CuidadosRESUMO
Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient-provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Programas Nacionais de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Percepção Social , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Argentina , Comunicação , Feminino , Grupos Focais , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Relações Médico-Paciente , Pesquisa Qualitativa , Autoeficácia , Apoio Social , Confiança , Carga ViralRESUMO
INTRODUCTION: The National Program of AIDS guarantees universal access to antiretroviral medication, yet people receiving treatment through the public healthcare system do not achieve an undetectable viral load in the same rate than patients in the private system. This qualitative study aims to identify factors associated with adherence and retention in the HIV-cascade of care at public and private setting from Buenos Aires, based on patients and healthcare workers' perceptions. METHODS: Qualitative data from 12 semi-structured interviews with key informants and 4 focus groups of patients and healthcare workers from the public and private systems were recorded. Transcripts were coded and analyzed, using the QRS Nvivo9® software for qualitative data analysis, into set themes on adherence. RESULTS: Patients and healthcare workers of both systems agree on the importance of HIV-related stigma, professional-patient relationship and communication, and the division of treatment-related responsibilities as fundamental aspects for adherence and retention in the HIV-cascade of care. Differences in the manner these factors interact were observed between healthcare systems. Structural barriers are presented as the main adherence barrier in the public system. DISCUSSION: The need for interventions focused on the doctor-patient dyad considering the features of each healthcare is highlighted in order to facilitate patient engagement in adherence.
RESUMO
We have limited information regarding the sexual risk behaviors of HIV-positive individuals in Argentina. It is important to understand these behaviors in order to develop strategies oriented at decreasing unsafe sex practices. A random sample of 140 HIV-positive individuals was recruited from an HIV primary care clinic in Buenos Aires, Argentina, between August and September 2005. Participants responded survey questions regarding their sexual behaviors in the previous three months. Logistic regression analysis was used to determine factors associated with inconsistent condom use during vaginal, anal, and oral sex. Of the 140 participants surveyed, 69% were male, the mean age was 38 years old, 29% reported having less than a high school education, and 84% reported having engaged in vaginal, anal, and/or oral sex in the past 3 months. Of 53 participants who reported engaging in anal sex, 60% were men who have sex with men, and 40% were heterosexuals. Inconsistent condom use was reported by 31% of participants engaging in anal sex, 39% of participants engaging in vaginal sex, and 71% of participants engaging in oral sex. When adjusting for other factors, participants reporting symptoms of depression were 5.2 times more likely to use condoms inconsistently during vaginal sex, and 4.3 times more likely to use condoms inconsistently during anal sex compared to participants reporting no depression symptoms. Providers should assess sexual risk practices of HIV-positive individuals reporting symptoms of depression, and provide counseling regarding the importance of consistent condom use to those patients who are engaging in unsafe sex practices.
Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Assunção de Riscos , Comportamento Sexual , Adulto , Argentina/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , HIV-1 , Heterossexualidade , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/transmissão , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
Se estudiaron en forma retrospectiva las historias clínicas de 64 pacientes que cunplían con los criterios diagnósticos de endocarditis infecciosa (EI) en el Hospital Vargas de Caracas entre enero de 1990 y diciembre de 1995. Se analizó la casuística en base a diagnóstico definitivo o probable de EI, sexo, edad, signos y síntomas más frecuentes, factores predisponentes, hallazgos microbiológicos, ecocardiográficos, evolución clínica, complicaciones y mortalidad durante su hospitalización. De acuerdo al análisis de los resultados, la endocarditis infecciosa no es una patología despreciable en nuestro medio, presentándose la mayoría de los casos entre la segunda y cuarta década de vida en pacientes en su mayoría con valvulopatias subyacentes, con un predominio de Gram positivos como agente causal y una mortalidad superior a la reportada en otras series internacionales, principalmente por complicaciones cardíacas