Background and Importance Loss of adherence to antiretroviral treatment (ART) is one of the leading causes of virological failure in people living with HIV (PLWHIV). Lack of adherence is associated with a loss of follow-up by the health system, particularly in the Pharmacy Department.
Aim and Objectives To identify factors in PLWHIV which cause their follow-up to fail by the Pharmacy Department.
Material and Methods Case-control study conducted in a tertiary hospital which attends 3,000 PLWHIV. Patients who had run out of medication for more than one month, according to pharmacy registrations between September 2020 and September 2021, were identified and named after cases if the reason to not come to the Pharmacy were not justified (death, hospital transfer, inclusion in a clinical trial, etc.). We conducted a case-control study (1:4), and cases were matched according to age ( 5 years) and date of the last dispensation.
Statistical analysis was performed using the STATA 17.0 program (StataCorp LLC). All models were performed univariately, and a p<0.05 was considered significant.
Variables studied were: gender, age, region of birth, studies, stable housing, route of HIV transmission, CD4 nadir, years after diagnostic, type of ART, years on ART, stage, adverse effects to ART, number of lines of treatment, pharmacy registrations of adherence, alcohol use, drug use, and psychiatric problems. Data were obtained from the clinical database
Results Sixty-one cases were identified and matched with 244 controls. Statistical differences were found in gender, where cis-man have an OR=4.5 (CI95% 1.0−19.6,p=0.047) and trans-man have an OR=23.9 (CI 95% 2.9−195.8,p=0.003) in comparison with women, and region where Latin-American have an OR=2.7 (CI 95% 1.3−5.6, p=0.008). Patients who fail to adhere to treatment according to the records in Pharmacy have an OR=0.04 (CI 95% 0.01−0.11, p=0.000) and patients who are alcoholics or drug abusers, have an OR=3.24 (CI 95% 1.30−8.04, p=0.011) and an OR=2.01 (CI 95% 1.03-3.93, p=0.039), respectively.
Conclusion and Relevance Clinicians should pay special attention to cis or trans-men, Latin Americans, historic bad adherence registrations by pharmacists and alcoholic or drug abusers who are more prone to losing follow-up in their treatments. This enhances the importance of multidisciplinary team approach to these patients. Clinical, pharmacist and nurse interventions and information registration are crucial to identify these patients.
Conflict of Interest No conflict of interest
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