Arístegui Inés, Dorigo Analía, Bofill Lina, Bordatto Alejandra, Lucas Mar, Cabanillas Graciela Fernández, Sued Omar, Cahn Pedro, Cassetti Isabel, Weiss Stephen, Jones Deborah
Fundación Huésped.
University of Miami Miller School of Medicine.
Actual SIDA Infectol. 2014 Nov;22(86):71-80.
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.
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.
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.
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.
国家艾滋病项目确保了抗逆转录病毒药物的普遍可及性，但通过公共医疗系统接受治疗的人群实现病毒载量不可检测的比例低于私立系统的患者。这项定性研究旨在基于患者和医护人员的认知，确定布宜诺斯艾利斯公立和私立机构中与艾滋病连续护理过程中的依从性和持续性相关的因素。
记录了来自12次对关键信息提供者的半结构化访谈以及4个分别来自公立和私立系统的患者及医护人员焦点小组的定性数据。使用QRS Nvivo9®软件对定性数据分析转录本进行编码和分析，归纳出关于依从性的既定主题。
两个系统的患者和医护人员均认同，与艾滋病相关的污名、医患关系与沟通以及治疗相关责任的划分是艾滋病连续护理过程中依从性和持续性的基本要素。不同医疗系统在这些因素相互作用的方式上存在差异。在公立系统中，结构性障碍被视为主要的依从性障碍。
强调了需要根据每个医疗体系的特点，开展针对医患二元组的干预措施，以促进患者坚持治疗。
