RESUMO
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
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.