Skip to main content

Advertisement

SpringerLink
Log in

Examining Adherence Among Challenging Patients in Public and Private HIV Care in Argentina

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

Resumen

El compromiso, la retención en el cuidado y adherencia al tratamiento son esenciales para el manejo óptimo del paciente con VIH. Sin embargo, muchos pacientes con VIH no siguen las el tratamiento para lograr tener una carga viral indetectable, o no permanecen bajo cuidado médico. Este estudio examina los pacientes más difíciles de retener en el cuidado médico en Buenos Aires, Argentina. Hombres (n = 61) y mujeres (n = 59) a los que se les habían recetado antiretrovirales pero seguían el tratamiento en los últimos 3 - 6 meses participaron en el estudio. Adherencia, conocimiento, motivación y actitudes frente al tratamiento fueron evaluados. Los pacientes en la clínica privada tenían menor carga viral y mejor adherencia que los de la clínica pública. Motivación y pensamientos positivos con respecto a antiretrovirales estaban asociados con mejor adherencia en los pacientes de la clínica pública. La autoeficacia estaba asociada con mejor adherencia en los pacientes en las dos clínicas. Los resultados indican que son necesarias intervenciones en pacientes y médicos para mejorar adherencia, compromiso y retención en el cuidado tanto en clínicas públicas como privadas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Organización Panamericana de la Salud (2013) Tratamiento antirretroviral bajo la lupa: un análisis de salud pública en Latinoamérica y el Caribe 2013. [cited 2014; Available from: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23711+&Itemid=999999&lang=es.

  2. Ministerio de Salud de la Nación (2013) Boletín sobre el VIH-sida e ITS en Argentina, Buenos Aires. [cited 2014; Available from: http://www.msal.gov.ar/images/stories/bes/graficos/0000000325cnt-2014-01_sintesis-boletin-VIH-2013.pdf.

  3. Crabtree-Ramirez B, Caro-Vega Y, Shepherd BE, Wehbe F, Cesar C, et al. Cross-sectional analysis of late HAART initiation in Latin America and the Caribbean: late testers and late presenters. PLoS One. 2011;6(5):e20272.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Mocroft A, Horban A, Clotet B, d’Arminio Monforte A, Bogner JR, et al. Regional differences in the risk of triple class failure in European patients starting combination antiretroviral therapy after 1 January 1999. HIV Med. 2008;9(1):41–6.

    Article  CAS  PubMed  Google Scholar 

  5. Mgbere O, Khuwaja S, Bell TK, Rodriguez-Barradas MC, Arafat R, et al. System and Patient Barriers to Care among People Living with HIV/AIDS in Houston/Harris County, Texas: HIV Medical Care Providers’ Perspectives. J Int Assoc Provid AIDS Care. 2014. doi: 10.1177/2325957414539045.

    Google Scholar 

  6. Kempf MC, McLeod J, Boehme AK, Walcott MW, Wright L, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDS. 2010;24(8):515–20.

    Article  PubMed  Google Scholar 

  7. Ballester R, Garcia S, Reinoso I, Campos A. Gender differences in adherence to treatment and illness behaviour in HIV-AIDS patients: an exploratory study in Spain. Int J Psychol Psychol Ther. 2002;2:219–36 Almería: Ed. AAC.

    Google Scholar 

  8. González JS, Penedo FJ, Antoni MH, Durán RE, Fernández MI. Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS. Health Psychol. 2004;23:413–8.

    Article  PubMed  Google Scholar 

  9. Ballester R. Adhesión terapéutica: revisión histórica y estado de la cuestión en la infección por VIH/SIDA. Revista de Psicopatología y Psicología Clínica. 2002;7:151–75 Madrid: Asociación Española de Psicología Clínica y Psicopatología y Ed.Dykinson.

    Google Scholar 

  10. Davila T, Pina Lopez, JA, Lopéz JJ, Sanchez-Sosa JJ (2008) Variables psicológicas y comportamientos de adhesión al tratamiento en personas con VIH: Un análisis en función del sexo. En S. Rivera A., R. Díaz L., R. Sánchez A. & I. Reyes L. (Coords.), La psicología social en México Vol. 12. México: AMEPSO, pp. 61–66.

  11. Piña Lopez JA, Davila Tapia M, Sánchez-Sosa JJ, Cázares Robles O, Togawa C, et al. Efectos del tiempo de infección sobre predictores de adherencia en personas con VIH. Int J Psychol Psychol Ther. 2009;9:67–78.

    Google Scholar 

  12. Piña Lopez JA, Dávila Tapia M, Sánchez-Sosa JJ, Togawa C, Cázares Robles O. Asociación entre los niveles de estrés y depresión y la adhesión al tratamiento en personas seropositivas al VIH en Hermosillo, México. Revista Panamericana de Salud Pública. 2008;23:377–83.

    Article  PubMed  Google Scholar 

  13. Gordillo V, del Amo J, Soriano V, González-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13(13):1763–9.

    Article  CAS  PubMed  Google Scholar 

  14. Sánchez-Sosa JJ, Piña Lopez JA, Corrales Robles AE (2008) Interacción entre la edad y variables psicológicas: Su influencia sobre los comportamientos de adhesión en personas seropositivas al VIH. En J. A. Piña y J. J. Sánchez-Sosa (Coords.), Aportaciones de la psicología al problema de la infección por VIH: Investigación e intervención. México: Universidad de Sonora, pp. 125–140.

  15. Cataife G. Public versus private treatment of chronic diseases in seniors: Argentina, Brazil, Chile and Uruguay. Glob Public Health. 2012;7(10):1157–69.

    Article  PubMed  Google Scholar 

  16. Fisher JD, Amico KR, Fisher WA, Harman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep. 2008;5(4):193–203.

    Article  PubMed  Google Scholar 

  17. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462–73.

    Article  PubMed  Google Scholar 

  18. Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16(2):269–77.

    Article  PubMed  Google Scholar 

  19. Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, et al. The role of self-efficacy in HIV treatment adherence: validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med. 2007;30(5):359–70.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Raykov T. Estimation of composite reliability for congeneric measures. Appl Psychol Measure. 1997;21(2):173–84.

    Article  Google Scholar 

  21. The LifeWindows Project Team (2006) The LifeWindows Information Motivation Behavioral Skills ART Adherence Questionnaire (LW-IMB-AAQ). Center for Health, Intervention, and Prevention. University of Connecticut.

  22. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555–67.

    Article  CAS  PubMed  Google Scholar 

  23. De las Cuevas C, Rivero-Santana A, Perestelo-Perez L, Gonzalez-Lorenzo M, Perez-Ramos J, Sanz EJ. Adaptation and validation study of the beliefs about Medicines Questionnaire in psychiatric outpatients in a community mental health setting. Hum Psychopharmacol. 2011;26(2):140–6.

    Article  PubMed  Google Scholar 

  24. Ekstrand ML, Chandy S, Heylen E, Steward W, Singh G. Developing useful highly active antiretroviral therapy adherence measures for India: the Prerana study. J Acquir Immune Defic Syndr. 2010;53(3):415–6. doi:10.1097/QAI.0b013e3181ba3e4e.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Jones D, Cook R, Rodriguez A, Waldrop-Valverde D. Personal HIV knowledge, appointment adherence and HIV outcomes. AIDS Behav. 2013;17(1):242–9.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Beck AT, Steer RA, Brown GK. Manual for Beck Depression Inventory-II. San Antonio: Psychological Corporation; 1996.

    Google Scholar 

  27. Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Rev Bras Psiquiatr. 2013;35(4):416–31. doi:10.1590/1516-4446-2012-1048.

    Article  PubMed  Google Scholar 

  28. Brandt J, Benedict R. The Hopkins Verbal Learning Test-Revised. Lutz: Psychological Assessment Resources; 2001.

    Google Scholar 

  29. D’Elia LF, Satz P, Uchiyama CL. White T Color Trails Test Professional Manual. Odessa: Psychological Assessment Resources; 1996.

    Google Scholar 

  30. Tjur T. Coefficients of determination in logistic regression models—a new proposal: the coefficient of discrimination. Am Stat. 2009;63:366–72.

    Article  Google Scholar 

  31. Beach MC, Keruly J, Moore RD. Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med. 2006;21(6):661–5.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.

    PubMed  Google Scholar 

  33. Saha S, Jacobs EA, Moore RD, Beach MC. Trust in physicians and racial disparities in HIV care. AIDS Patient Care STDS. 2010;24(7):415–20.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Piña Lopez JA, Gonzalez MT. Un modelo psicológico de adhesión en personas VIH+: modelamiento con ecuaciones estructurales. Revista Iberoamericana de Psicología y Salud. 2010;1(2):185–206.

    Google Scholar 

  35. Mallinson RK, Rajabiun S, Coleman S. The provider role in client engagement in HIV care. AIDS Patient Care STDS. 2007;21(Suppl 1):S77–84.

    PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by a grant from the NIMH/National Institutes of Health, R34MH097609, and was made possible with the support of the men and women participating.

Conflict of interest

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA

    Deborah Jones, Ryan Cook, Lina Bofill, Stephen Weiss, Maria R. Lopez & Andrew Spence

  2. Helíos Salud, Buenos Aires, Argentina

    Diego Cecchini

  3. Hospital Fernández, Fundación Huésped, Buenos Aires, Argentina

    Omar Sued

  4. Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA

    Drenna Waldrop-Valverde

Authors
  1. Deborah Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Diego Cecchini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omar Sued
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lina Bofill
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Drenna Waldrop-Valverde
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria R. Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Andrew Spence
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah Jones.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jones, D., Cook, R., Cecchini, D. et al. Examining Adherence Among Challenging Patients in Public and Private HIV Care in Argentina. AIDS Behav 19, 1619–1629 (2015). https://doi.org/10.1007/s10461-015-1037-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-015-1037-7

Keywords

Search

Navigation