Avaliação dos registros de dispensação dos anti-retrovirais em indivíduos infectados pelo HIV em serviços de referência

Abstract

The objectives of this study were to evaluate the anti-retroviral (ARV) pickups during twelve months following the first prescription and to determine the factors associated with irregular pickups or permanent drop-out in two HIV/AIDS public referral centers, Belo Horizonte (MG), Brazil, Participants (n=323) were antiretroviral naive and were recruited from May 2001 thru May 2002. Dates of antiretroviral medication pickups, antiretroviral regimens delivered by the pharmacy (number of pills, doses) and antiretroviral switches during the follow-up period were evaluated. Prescription pickups were categorized as irregular, permanent drop-out and regular, according to the time between pickups and number of pills delivered. The magnitude of the associations between selected variables and irregular pickups or permanent drop-out, as compared with regular pickups, were estimated by the odds ratio (OR) with 95% confidence interval. Multinomial logistic regression modeling was used to evaluate the independent effect of exposure variables. Most participants were male (67.2%), 35 years old or younger (53.2%), single or divorced (64.4%), lived in Belo Horizonte (60.7%) and reported some family income (83.4%). Overall, 98 (30.3%) patients abandoned their therapy and 187 (57.9%) had at least one irregular pickup. Multivariate analysis (p.0.05) showed that living outside Belo Horizonte (OR=3.21), CD4+ T-lymphocyte count greater than 200 cells/mm3 (OR=2.97) and antiretroviral regimen without protease inhibitors (OR=2.76) were associated with irregular pickups, while living outside Belo Horizonte (OR=2.91), not being on any other medications (OR=4.61), CD4+ T-lymphocyte count greater than 200 cells/mm3 (OR=2.60), antiretroviral regimen without protease inhibitors (OR=3.74) and any registered non-adherence in medical charts (OR=6.39) were associated with therapy drop-out. Pharmacy records are highlighted as potential indicators of non-adherence, and should be incorporated as such in clinical practice. Strategies for reaching out for drop-outs or patients with irregular pickups must be prioritized in order to prevent therapy discontinuation or non-adherence.