Fatores associados à má adesão ao tratamento antirretroviral: uma revisão sistemática da literatura

Abstract

Monitoring adherence to antiretroviral treatment (ART) for patients living with HIV (PLHIV) is a major challenge in the health area, due to the lack of a standardized method. However, it is an essential task because, by monitoring we get answers of the proposed interventions, aiming to improve the continuity of care, in addition to understanding the barriers to accession. The article aimed to analyze the factors associated with poor adherence to antiretroviral treatment (ART), in order to better understand them, as well as to diagnose the dynamics related to adherence and which methods are used to assess adherence to treatment. For this, a search was made in the Biblioteca Virtual em Saúde* using the descriptors “HIV”, “antirretroviral”, “adesão ao tratamento” e “adesão à medicação”**. Articles published in the period from January 2014 to September 2019, performed with adults aged 18 years or older, under antiretroviral treatment, which presented factors that negatively interfered with adherence to antiretroviral treatment were included. There were excluded works developed with children or young people under the age of 18, pregnant women and women who have recently given birth, patients with co-infections, studies that assess adherence to a specific ARV scheme, as well as studies that assess adherence to post-exposure prophylaxis ( PEP) or pre-exposure prophylaxis (PREP). 41 articles were selected, which identified the factors involved in poor adherence to ARV drugs. Those that appeared more frequently were alcohol consumption, depressive symptoms or depression, forgetfulness and the stigma associated with the diagnosis of HIV.In addition, the main strategy for assessing adherence was based on self-report, in some cases using a structured questionnaire or visual analog scale, with few studies associating more than one method to monitor adherence. Thus, it became evident that there is still much to be investigated about the dynamics of adherence and ways of monitoring treatment, to allow the development of strategies to obtain sustained adherence to antiretroviral treatment.