EDITORIAL

REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2019 - Universidad Ricardo Palma DOI 10.25176/RFMH.v19.n1.1792

FACTORS ASSOCIATED WITH HAART ADHERENCE IN PATIENTS WITH HIV / AIDS AT THE CENTRAL HOSPITAL OF THE POLICE FORCES

FACTORES ASOCIADOS A LA ADHERENCIA AL TARGA, EN PACIENTES CON VIH/SIDA EN EL HOSPITAL CENTRAL PNP “LUIS N. SAENZ” EN LOS MESES DE OCTUBRE A DICIEMBRE DEL 2015

Gustavo Eugenio Orellana-Zanabria

ABSTRACT
Objective: To determine the associated factors and the degree of adherence to HAART in patients with HIV / AIDS at the PNP Central Hospital "Luis N. Saenz" from October to December 2015. Methods: Observational, crosssectional, analytical and descriptive study where 123 patients with a CEAT-HIV questionnaire were evaluated. Data collection was performed in the Microsoft Excel program and statistical analysis using the SPSS v.22 program. Results: Where we found that the average age of all patients evaluated was 40.11 years. The infection time of the evaluated patients was an average of one year and 7 months. Treatment time with HAART averaged 20 months. Fifty-two percent (64 patients) of the study population were any family members of the holder, either wife (s), child (ren) or parents. The gender that prevails in the sample is male with 63.4% (78 patients). And viral load, 77.2% is undetectable (< 400 copies / ml). The grade found was adequate adherence to HAART, with a score of 82.51. And relating the degree of adherence to socio-demographic characteristics are not significant. But if the degree of adherence to viral load was found to be related. Conclusion: In the study population has adequate adherence to antiretroviral treatment. And the 5 factors measured by the questionnaire: adherence to treatment, history of lack of adherence, physician-patient interaction, patient's beliefs and strategy for taking medications; Have a very good influence on adherence to HAART.
Key words: Adherence to treatment; HAART; Factors associated with adherence. (source: MeSH NLM)

RESUMEN
Objetivo: Determinar los factores asociados y el grado de adherencia al TARGA en los pacientes con VIH/SIDA en el Hospital Central PNP “Luis N. Saenz” en los meses de octubre a diciembre del 2015. Métodos: Estudio observacional, transversal, analítico y descriptivo donde se evaluó a 123 pacientes con un cuestionario CEAT-VIH. Se realizó la recolección de datos en el programa Microsoft Excel y el análisis estadístico mediante el programa SPSS v.22. Resultados: Donde encontramos que la edad promedio de los todos los pacientes evaluados es 40.11 años. El tiempo de infección de los pacientes evaluados fue un promedio un año y 7 meses. El tiempo de tratamiento con el TARGA consto de un promedio de 20 meses. El 52 % (64 pacientes) de la población estudiada fue algún familiar del titular, ya sea esposa (o), hijo (a) o padres. El género que prevalece en la muestra es masculino con el 63.4 % (78 pacientes). Y la carga viral, el 77.2 % es indetectable (< 400 copias/ml). El grado encontrado fue una adecuada adherencia al TARGA, con una puntuación de 82.51. y al relacionar el grado de adherencia con las características socio-demográficas no son significativas. Pero si se encontró relación el grado de adherencia con la carga viral. Conclusión: En la población estudiado tiene una adecuada adherencia al tratamiento antirretroviral. Y los 5 factores que mide el cuestionario: cumplimento del tratamiento, antecedentes de la falta de adherencia, interacción médico-paciente, creencias del paciente y estrategia para la toma de medicamentos; tienen muy buena influencia en la adherencia al TARGA.
Palabras clave: Adherencia al tratamiento; TARGA; Factores asociados a la adherencia. (fuente: DeCS BIREME)

INTRODUCTION The human immunodeficiency virus (HIV) infects the cells of the immune system and alters or cancels their function, this infection produces a progressive deterioration of the immune system, with the consequent "immunodeficiency". Also, the immune system is considered to be deficient when it fails to fulfill its role of fighting infection and disease. The acquired immunodeficiency syndrome is considered a public health problem of a great nature due to the magnitude of the damage that is evidenced in the morbidity and mortality of the population. In the world, more than 35.3 million people are living with HIV infection, of which 2.1 million are adolescents (10 to 19 years old); Furthermore, the vast majority of people infected with HIV live in low- and middle-income countries, and it is estimated that, in 2012, some 2.3 million people contracted this infection. To this date, Peru had about 76,000 HIV carriers, and it is necessary to promote a specialized comprehensive treatment together with a multidisciplinary health team that faces this disease, considering that the existing obstacles faced by patients with HIV are based on the non-acceptance of the illness itself, followed by the lack of family support, among others. Also, it is necessary to recognize that there are political factors (indifference or carelessness, interference with the free flow of information), sociocultural (regulations, roles, taboos), and economic (poverty, lack of resources, income inequality) that directly affect the problem of HIV¹ infection.

A broad and convenient advance for the control of HIV infection has been the discovery of highly active antiretroviral treatment (HAART) and its universal trajectory. Likewise, the Ministry of Health of Peru (MINSA) began the provision of HAART in May 2004. It has been possible since to increase its coverage, optimizing the quality of life of people living with HIV and delaying the progression of the infection to evolutionary and incipient stages, where the State makes an effort to consolidate the HAART program¹.

The MINSA has an infectious diseases service. This program carries out a set of activities aimed at the population of all ages to detect risk groups early and reduce vertical and blood transmission. Among the activities carried out by this program, there is screening, HIV screening, syphilis screening, HIV confirmation, pre-test counseling, post-test counseling, STI-HIV doctor, social control, home visits, focused and group education, which accompanies HAART treatment1. The objective of this article is to determine the associated factors and the degree of adherence to HAART in patients with HIV / AIDS at the PNP “Luis N. Sáenz” Central Hospital from October to December 2015.

METHODS The present research study corresponds to an observational, cross-sectional, analytical, and descriptive design. We worked with 123 patients with HIV / AIDS, who are cared for in the infectious disease service of the PNP “Luis N. Saenz” Central Hospital in 2015. We used a survey validated by CEAT HIV (annex 1) and reviewed the medical records. Where patients older than 18 and younger than 65 years of age were included, patients with a minimum antiretroviral treatment time of three months, patients who are not pregnant, and patients who agree to take the survey. Patients younger than 18 years and older than 65 years with HIV / AIDS, patients with an antiretroviral treatment time of fewer than three months, patients who are pregnant, and patients who refuse to participate in the survey were excluded.

RESULTS

A. Reliability

Table 1 evaluates Cronbach's alpha, which is a coefficient of reliability or internal consistency. When the alpha coefficient is > 0.7 it indicates that it is acceptable for research use. In our study, Cronbach's alpha is 0.765.

B. Descriptive analysis

Table 2 shows the characteristics in general, where we see that the average age of all the patients evaluated is 40.11 years. The time of infection of the evaluated patients was an average of one year and 7 months. The treatment time with HAART consisted of an average of 20 months. 52% (64 patients) of the population studied was a relative of the holder, be it the wife, child, or parents. The prevailing gender in the sample is male with 63.4% (78 patients) and the viral load in 77.2% is undetectable (<400 copies/ml).

The 20 responses to the questionnaire that were made to the 123 patients of the Central Hospital of the PNP “Luis N. Sáenz” (Table 3) are observed. Where the mean of the 20 items of the questionnaire is 82.51, and according to the 4 levels of classification of the degree of adherence: where adherence is low (85 points). It would be in "adequate adherence" since it is within the range of 81 - 85 points.

Regarding adherence measured by the CEAT-HIV (Table 4), it is observed that compliance with treatment has a maximum score of 18, a history of lack of adherence has a maximum score of 15, interaction with the doctor has a maximum score of 10, the patient's beliefs have a maximum score of 45 and the strategies for remembering the taking of drugs with a maximum score of 1. Four of the five associated factors have a very good influence on adherence to treatment since his fashion reaches the maximum score. The missing factor, patient beliefs, is not that it does not have a good influence, only that its mode reaches 42. So, it also influences the treatment, but not as high as the previous four.

C. Inferential analysis

The association between gender and degree of adherence was studied, using the chi-square test. This test allows us to associate two qualitative variables. The p value> 0.005 (0.856) would indicate that there is no association between the degree of adherence and gender. (Table 5)

Table 6 shows the association between the degree of adherence and the owner-family member, and the p value> 0.005 (0.242) would indicate that there is no relationship between the degree of adherence and the owner-family member.

In Table 7 the Spearman test is used, this test allows us to associate non-parametric variables. The p value> 0.005 (0.502) would indicate that there is no association between the degree of adherence and age.

Table 8 shows the Spearman test, where we correlate the treatment time with the degree of adherence. And we can see that the p value> 0.005 (0.066) would indicate that there is no correlation between the variables.

In Table 9 we use the Spearman test, where we correlate the time of infection and degree of adherence. Where the p-value> 0.005 (0.094), where it would indicate that there is no correlation between the variables.

Table 10 shows the relationship between viral load and the degree of adherence, using the Mann-Whitney U test. This test is used when we want to evaluate an ordinal variable. Where it can be seen that the p-value <0.05 (0.000), this would indicate that there is a relationship between these two variables, where a better adherence there is a lower viral load.

DISCUSSION

The acquired immunodeficiency syndrome is considered a public health problem of great nature due to the great magnitude of the damage observed in the morbidity and mortality of the population.

A good strategy to reduce or eliminate morbidity and mortality is HAART, for this reason, the population must have good adherence to antiretroviral treatment. One of the main problems is poor patient adherence to treatment since there are many factors associated with poor adherence. When analyzing the data obtained concerning the factors associated with adherence to HAART, we found:

The reliability or internal consistency of the instrument can be estimated with Cronbach's alpha. Cronbach's alpha value ranges from 0 to 1, the closer the alpha value is to 1, the greater the internal consistency of the analyzed items, it is said that when the alpha coefficient is> 0.7, it can be said that it is acceptable For an investigation, although some authors consider that the alpha coefficient> 0.6 is also acceptable. In this work, the alpha coefficient gave us 0.765, which indicates that it is acceptable for a scientific investigation; a similar result to the study carried out in Peru by Tafur² with a reliability analysis of 0.706. Another study carried out in Brazil by Remor³ showed a Cronbach's alpha of 0.64 and another in Portugal4 with a Cronbach's alpha of 0.709. This makes us say that our instrument has greater reliability than those compared to the others carried out in other countries and inclusive with one carried out in Peru.

Regarding the degree of adherence, this evaluation questionnaire measures the degree and classifies it into 4 levels: low adherence (<73 points), insufficient adherence (74 and 80 points), adequate adherence (81 and 85 points), and adherence strict (> 85 points), in our study the mean of the 20 questions asked to the 123 patients was 82.51, which indicates that it is within the range of adequate adherence, different results reported by the Brazilian Remor³, who obtained 74.89 points, in Portugal Ries⁴ 77.61 points and the Brazilian Lorscheider⁵, who reported a score of 79.45, all with insufficient adherence. But there are studies where strict adherence was found, such as in Romania, by Dima⁶ and in Brazil by Casotti⁷. But if we compare it with Peruvian studies, Rivas⁸ found a score of 73.5, which makes us indicate low adherence; while in the study carried out by Tafur2 with a score of 74.29, the degree of adherence is insufficient. In another similar study carried out by the same author, Tafur⁹ obtained a score of 75.12, with insufficient adherence.

Regarding the questionnaire, it consists of 20 questions, of which 17 contain 5 answers, 2 have 2 answers, and 1 with 3 answers. Comparing with the 2 Peruvian studies by Rivas8 and Tafur⁹ where they obtained low adherence and insufficient adherence, respectively, the responses are not so different, but the difference is that in our study more than 70% of the population responded with a good alternative, which it was not the case with the two previous studies.

This questionnaire assesses 5 factors associated with adherence: adherence to treatment, history of lack of adherence, doctor-patient interaction, patient beliefs, and strategy for taking medications, in our study all 4 of the 5 factors have a very good influence on adherence to HAART. The Remor³ and Tafur⁹ studies carried out in Peru report a good influence on the factor of "history of lack of adherence" which indicates that these patients never stopped taking their medications. We can highlight that in our study it is 4 of the 5 factors that have a very good influence on adherence to treatment. The factor "patient beliefs" also influences adherence to HAART, but not as much as the other 4 factors.

In our study, we associated the degree of adherence with sex, age, treatment time, time of illness, family-holder, and viral load. Where when relating the degree of adherence to sex; the degree of adherence with the owner-family member; and using the Chi-square test, it gave us a p value> 0.005 (0.856 and 0.242, respectively), this indicates that the relationship is insignificant. Our result is related to other studies, such as the Brazilian one whose researcher is Remor³ where it indicates that there is no significant relationship between sex and the degree of adherence (p = 0.25); Another Brazilian study conducted by Lemos¹⁰ indicates that there is no significant relationship. The Peruvian studies that support our result are that of Tafur² where p = 0.321 and that of Rivas⁸ with a value of p = 0.31.

When relating the degree of adherence with age, the Spearman test was used and it gave us a p value> 0.005 (0.502), this would indicate that there is no significant relationship. The studies that are related to our results are that of Remo^r3 (p = 0.39), Resende11 and Dima⁶ (p> 0.005) and that of the Peruvian Tafur² (p = 0.356). Also, there are studies where they tell us the opposite concerning the degree of adherence and age, such as that of Lorscheider⁵ where it indicates that adherence increases with age, but above 75 years, we cannot define the aforementioned in our study. that we only had patients under 65 years of age. We also related the degree of adherence to treatment time and illness time were using the Spearman test we obtained a p value> 0.005, which indicates that there is no significant relationship. These results were also found in the Tafur² and Remor³ study.

And finally, we related the viral load and the degree of adherence, using the Mann-Whitney U test it gave us a p-value <0.005 (0.000) that would indicate that there is a significant relationship, that is, the higher the degree of adherence there is a lower viral load. The studies that support our result are the investigation by Reis⁴ (p = 0.001) and the studies by Tafur² and Resende¹¹ where they obtained a p-value <0.005.

CONCLUSION

• The reliability of the questionnaire, which is measured with Cronbach's alpha, yielded 0.765, indicates that the questionnaire is very reliable.
• It is concluded that the studied population has adequate adherence to antiretroviral treatment at the PNP “Luis N. Sáenz” central hospital.
• The 5 factors measured by the questionnaire: compliance with treatment, history of lack of adherence, doctor-patient interaction, patient beliefs, and strategy for taking medications, have a very good influence on adherence to HAART.
• Sociodemographic characteristics, such as age, sex, and owner-relative, are not related to the degree of adherence. The time of illness and time of treatment has no significant relationship.
• There is a very good relationship between viral load and the degree of adherence, since the higher the degree of adherence, the lower the viral load.

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Authorship contributions: The authors participated in the conception, design, writing, critical review and approval of the final version of the article.
Financing: Self-financed.
Conflict of interest: The authors declare that they have no conflict of interest in the publication of this article.
Received: March 23, 2018
Approved: November 20, 2018

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Correspondence: Dr. Eduardo Morales Rezza
Address: Avenida Brasil, cuadra 26, Jesús María, Lima-Perú
Telephone: +51 987253775
Email: moralesrezza@yahoo.es

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