Quality of care and adherence to antiretroviral drugs in specialized HIV services in Pernambuco/Brazil, 2017-2018

Moraes, Danielle Chianca de Andrade; Cabral, Juliana da Rocha; Oliveira, Regina Célia de; Souza, Vanessa Alves de

doi:10.1590/0103-1104202113111I

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ORIGINAL ARTICLE • Saúde debate 45 (131) • Oct-Dec 2021 • https://doi.org/10.1590/0103-1104202113111I copy

Quality of care and adherence to antiretroviral drugs in specialized HIV services in Pernambuco/Brazil, 2017-2018

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim of this study was to evaluate health care quality and medication adherence in people living with human immunodeficiency virus in specialized care services. This is a cross-sectional, evaluative study, with a quantitative approach, carried out in ten services in Pernambuco. Two instruments were validated and analyzed by statistical tests were used and 306 adults and their service managers participated. The quality standard was equivalent for most indicators. Only in the countryside, the indicators referring to the availability of antiretroviral drugs and care in the absence of medication were associated with low adherence (p-value=0.033 and p-value=0.011), the latter being a predictor for low adherence. Services with insufficient quality standards showed a 19% higher occurrence of low medication adherence. 81% of users had low adherence to antiretroviral drugs. There is a deficiency in adherence to antiretroviral drugs, and those assisted in services in the countryside have more complicating factors related to the quality of health care for satisfactory adherence.

KEYWORDS
Quality of health care; Medication adherence; Anti-retroviral agents

Question	Dimension	Domain	Criteria of Indicator
A30	Organization of the care process	Specific medication adherence activities	Interval between medical appointments, at the beginning or at the change of ARV
A31	Organization of the care process	Specific medication adherence activities	Monitoring of patients' antiretroviral use
A33	Organization of the care process	Specific medication adherence activities	Behaviors for patients with difficulty in using the medication
A34	Organization of the care process	Specific medication adherence activities	Forms of care for patients who were left without medication
G32	Technical management of work	Records, evaluation, monitoring and planning	Monitoring of ARV adherence rates
R51	availability of resources	Medicines, supplies, exams and references	Antiretroviral drugs

Adherence Level^* * p-value by Chi-square test for homogeneity.	n	%	Capital		Countryside		p-value
	n	%	n	%	N	%	p-value
Low adherence	248	81.0	183	77.9	65	91.5	0.010^* * p-value by Chi-square test for homogeneity.
Good adherence	58	19.0	52	22.1	6	8.5	0.010^* * p-value by Chi-square test for homogeneity.

Quality indicators	n	%	Capital		Countryside		p-value
Quality indicators	n	%	n	%	N	%	p-value
A30. Interval between medical appointments. at the beginning or at the change of antiretroviral
Acceptable standard	67	21.9	58	24.7	9	12.7	0.032^* * p-value using Chi-square test for homogeneity.
Expected standard	239	78.1	177	75.3	62	87.3	0.032^* * p-value using Chi-square test for homogeneity.
A31. Monitoring of patients' antiretroviral use
Insufficient standard	291	95.1	235	100.0	56	78.9	<0.001^ p-value using Fisher’s exact test.
Expected standard	15	4.9	-	-	15	21.1	<0.001^ p-value using Fisher’s exact test.
A33. Behaviors for patients with difficulty in using the medication
Insufficient standard	16	5.2	-	-	16	22.5	<0.001^ p-value using Fisher’s exact test.
Acceptable standard	290	94.8	235	100.0	55	77.5	<0.001^ p-value using Fisher’s exact test.
A34. Forms of care for patients who were left without medication
Insufficient standard	46	15.0	-	-	46	64.8	<0.001^* * p-value using Chi-square test for homogeneity.
Acceptable standard	64	20.9	58	24.7	6	8.4
Expected standard	196	64.1	177	75.3	19	26.8
G32. Monitoring of Antiretroviral Therapy adherence rates
Insufficient standard	290	94.8	235	100.0	55	77.5	<0.001^ p-value using Fisher’s exact test.
Acceptable standard	16	5.2	-	-	16	22.5	<0.001^ p-value using Fisher’s exact test.
R51. Availability of Antiretroviral Drugs
Insufficient standard	230	75.2	177	75.3	53	74.6	<0.001^* * p-value using Chi-square test for homogeneity.
Acceptable standard	18	5.9	-	-	18	25.4
Expected standard	58	19.0	58	24.7	-	-

Quality indicator	Adherence level
	General		Capital		Countryside
	Low	Good	Low	Good	Low	Good
A30. Interval between medical appointments, at the beginning or at the change of antiretroviral
Acceptable standard	53(79.1%)	14(20.9%)	46(79.3%)	12(20.7%)	7(77.8%)	2(22.2%)
Expected standard	195(81.6%)	44(1.4%)	137(77.4%)	40(22.6%)	58(93.5%)	4(6.5%)
p-value	0.646^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.	0.761^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.	0.164**	0,761^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.		0,164**
A31. Monitoring of patients' antiretroviral use
Insufficient standard	235(80.8%)	56(19.2%)	183(77.9%)	52(22.1%)	52(92.9%)	4(7.1%)
Expected standard	13(86.7%)	2(13.3%)	-	-	13(86.7%)	2(13.3%)
p-value	0.745**	-	0.600**	-		0,600**
A33. Conducts for patients with difficulty in using medication
Insufficient standard	14(87.5%)	2(12.5%)	-	-	14(87.5%)	2(12.5%)
Acceptable standard	234(80.7%)	56(19.3%)	183(77.9%)	52(22.1%)	51(92.7%)	4(7.3%)
p-value	0.745**		0.611**			0,611**
A34. Forms of care for patients who were left without medication
Insufficient Standard	45(97.8%)	1(2.2%)	-	-	45(97.8%)	1(2.2%)
Acceptable standard	52(81.3%)	12(18.7%)	46(79.3%)	12(20.7%)	6(100.0%)	0(0.0%)
Expected standard	151(77.0%)	45(23.0%)	137(77.4%)	40(22.6%)	14(73.7%)	5(26.3%)
p-value	0.005^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.	0.761^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.	0.011**	0,761^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.		0,011**
G32. Monitoring of Antiretroviral Therapy adherence rates
Insufficient standard	235(81.0%)	55(19.0%)	183(77.9%)	52(22.1%)	52(94.5%)	3(5.5%)
Acceptable standard	13(81.3%)	3(18.7%)	-	-	13(81.3%)	3(18.7%)
p-value		1,000^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.		-		0,123**
R51. Availability of Antiretroviral Drugs
Insufficient Standard	188(81.7%)	42(18.3%)	137(77.4%)	40(22.6%)	51(96.2%)	2(3.8%)
Acceptable standard	14(77.8%)	4(22.2%)	-	-	14(77.8%)	4(22.2%)
Expected standard	46(79.3%)	12(20.7%)	46(79.3%)	12(20.7%)	-	-
p-value		0,856^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.		0,761^* * p-value using the Wald test. PR = Prevalence Ratio. CI = Confidence Interval.		0,033**

Quality Indicator	PR	CI(95%)	p-value^* * p-value using the Chi-square test for independence.
A34. Forms of care for patients who were left without medication
Insufficient standard	1.19	1.09 - 1.30	<0.001
Acceptable standard	1.05	0.92 - 1.20	0.476
expected standard	1.00	-	-

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[1] Conflict of interests: non-existent