Background and importance In the context of the COVID-19 pandemic, many patients avoided moving from their homes, even to acquire essential drugs, such as antiretroviral therapy (ART). High adherence (more than 95%) is essential to acquire viral suppression and is associated with reduced mortality and morbidity. Furthermore, poor ART adherence is the first cause of therapeutic failure in HIV patients and HIV drug resistant strains.
Aim and objectives To evaluate and characterise the effect of the COVID-19 pandemic on adherence to ART and identify the main factors that influenced adherence during the pandemic.
Material and methods A retrospective, transversal, comparative study was conducted over the first semester of 2019 and 2020. HIV patients receiving ART were included. Exclusion criteria were: deaths, initiated ART during or after the first semester in 2019 and transfer to another hospital. To measure adherence, dispensing records were analysed. Registered variables were sex, risk factors that could compromise adherence and pill numbers. Data were obtained from the electronic medical records. For the statistical analysis, the paired t test was used to determine if there were differences in patient adherence before and after the COVID-19 pandemic.
Results 100 patients were analysed during the study period, with an average age of 48.9±12.3 years and 61% were men. ART adherence was 67% in 2019 (67% male non-adherent) whereas in 2020 it was 43% (58% male non-adherent). Comparing both years, there was a decrease of 24% in the adherence rate, which was significant (p=0.006). The main reasons for this reduction were: rescheduling of doctor appointments or blood tests, mandatory confinement due to COVID-19 or fear of using the hospital facilities.
Conclusion and relevance The study results suggested that the COVID-19 pandemic affected HIV patient adherence. All efforts made to ensure continuity of treatment (medication delivery in the community and hospital pharmacies, teleconsultation) were not enough. It is important that pharmacists continue to promote therapeutic adherence and education about COVID-19. The main limitation of the study was the reduced sample used. It is highly important to monitor patients with ART to ensure their adherence rate and to understand how and why the COVID-19 pandemic affected their treatment. Further research is needed to know the real impact of the COVID-19 pandemic on the health of HIV patients.
Conflict of interest No conflict of interest
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