Vl Silveira

Desenvolvimento de uma escala de auto-eficácia para adesão ao tratamento anti-retroviral

A 21-item scale of efficacy-expectation for adhesion to antiretroviral therapy in high-risk situations was developed by content analysis of interviews with HIV/AIDS patients undergoing and dropouts from therapy. Internal consistency and construct validity were examined in 60 patients attending at an ambulatory for patients in advanced stages of the disease (day-hospital). A score of self-efficacy for treatment adhesion was derived from the first component of the principal component analysis. The mean score was 0.25 among adherent patients and n0.33 among those who were non-adherent (t test, p < 0.046). The odds of treatment adhesion increased 2,07 times when the efficacy-expectation score increased by one unit (OR = 2,07; IC95% = 1,002 a 4,26). The internal consistency was high (Cronbach-alpha = 0.96). The scale demonstrated construct validity and reliability as a measure of self-efficacy for antiretroviral therapy in these patients.

Predictors of Undetectable Plasma Viral Load in HIV-Positive Adults Receiving Antiretroviral Therapy in Southern Brazil

Factors associated with undetectable viral load (<80 copies/ml) were investigated among non-pregnant adults in antiretroviral treatment in a specialized service for HIV/AIDS in Southern Brazil. Use of antiretrovirals was investigated in two interviews (one month interval). Clinical data were collected from the clinical records; viral load previous to adherence measurement was defined the viral load previous to the first interview; the final viral load, the viral load subsequent to the second interview (interval between measures approximately 6 months). Undetectable final viral load occurred in 48% of the patients and was positively associated with levels of treatment adherence (p<0.001), being 19% for less than 60% of adherence and about 60% for adherence greater than 80%. In the multivariate model, the odds of undetectable final viral load was four times greater for 80-94% and > or =95% of adherence (CI 95% 1,80-13,28; CI 95% 1,73-9,53), compared with less than 60% adherence; it was greater for less than 6 months in treatment (OR = 3.37; CI 95% 1.09-10.46); and smaller for viral load previous to adherence measurement 5.2 log10 (OR = 0.19; CI95% 0.06-0.58), adjusted for these variables and sex, age, clinical status, current immune status, group of drugs and interval between the two measurements of viral load. The crude odds were lower for age 16-24 years and use of Nucleoside Analog Reverse Transcriptase Inhibitors only, but these effects were not significant in the multivariate model. There was no evidence of effect of sex, clinical status, current immune status, and changes in treatment regimen. Treatment adherence gave the largest effect. Motivational interventions directed at adherence may improve treatment effectiveness.