Cruz Maria L S, Cardoso Claudete A A, Darmont Mariana Q, Souza Edvaldo, Andrade Solange D, D'Al Fabbro Marcia M, Fonseca Rosana, Bellido Jaime G, Monteiro Simone S, Bastos Francisco I
Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, RJ, Brazil; Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
J Pediatr (Rio J). 2014 Nov-Dec;90(6):563-71. doi: 10.1016/j.jped.2014.04.007. Epub 2014 Jun 20.
To evaluate treatment adherence among perinatally-infected pediatric human immunodeficiency virus (HIV) patients followed in pediatric centers in Brazil.
This was a cross-sectional multicenter study. Medical records were reviewed and adherence scale, assessment of caregivers' quality of life (WHOQOL-BREF), anxiety, depression, and alcohol/substances use/abuse were assessed. Outcomes included self-reported 100% adherence in the last three days and HIV viral load (VL)<50 copies/mL. Statistical analyses included contingency tables and respective statistics, and multivariable logistic regression.
260 subjects were enrolled: 78% children and 22% adolescents; 93% of caregivers for the children and 77% of adolescents reported 100% adherence; 57% of children and 49% of adolescents had VL<50 copies/mL. In the univariate analyses, HIV diagnosis for screening due to maternal infection, lower caregiver scores for anxiety, and higher scores in physical and psychological domains of WHOQOL-BREF were associated with 100% adherence. Shorter intervals between pharmacy visits were associated with VL<50 copies/mL (p ≤ 0.01). Multivariable regression demonstrated that caregivers who did not abuse alcohol/other drugs (OR=0.49; 95% CI: 0.27-0.89) and median interval between pharmacy visits<33 days (OR=0.97; 95% CI: 0.95-0.98) were independently associated with VL<50 copies/mL; whereas lower caregiver scores for anxiety (OR=2.57; 95% CI: 1.27-5.19) and children's HIV diagnosis for screening due to maternal infection (OR=2.25; 95% CI: 1.12-4.50) were found to be independently associated with 100% adherence.
Pediatric HIV programs should perform routine assessment of caregivers' quality of life, and anxiety and depression symptoms. In this setting, pharmacy records are essential to help identify less-than-optimal adherence.
评估在巴西儿科中心接受随访的围产期感染人类免疫缺陷病毒（HIV）的儿科患者的治疗依从性。
这是一项横断面多中心研究。查阅医疗记录，并评估依从性量表、照顾者生活质量（世界卫生组织生活质量简表，WHOQOL - BREF）、焦虑、抑郁以及酒精/物质使用/滥用情况。结局指标包括自我报告的过去三天100%依从性以及HIV病毒载量（VL）<50拷贝/毫升。统计分析包括列联表及相应统计量，以及多变量逻辑回归。
共纳入260名受试者：78%为儿童，22%为青少年；93%的儿童照顾者和77%的青少年照顾者报告100%依从；57%的儿童和49%的青少年VL<50拷贝/毫升。在单变量分析中，因母亲感染而进行筛查的HIV诊断、照顾者较低的焦虑评分以及WHOQOL - BREF身体和心理领域的较高评分与100%依从性相关。药房就诊间隔时间较短与VL<50拷贝/毫升相关（p≤0.01）。多变量回归显示，不滥用酒精/其他药物的照顾者（比值比[OR]=0.49；95%置信区间[CI]：0.27 - 0.89）以及药房就诊间隔时间中位数<33天（OR=0.97；95% CI：0.95 - 0.98）与VL<50拷贝/毫升独立相关；而照顾者较低的焦虑评分（OR=2.57；95% CI：1.27 - 5.19）以及因母亲感染而进行筛查的儿童HIV诊断（OR=2.25；95% CI：1.12 - 4.50）被发现与100%依从性独立相关。
儿科HIV项目应常规评估照顾者的生活质量、焦虑和抑郁症状。在此背景下，药房记录对于帮助识别依从性欠佳情况至关重要。
