Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy.
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2013
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OBJECTIVE: We conducted a study to identify gender differences in factors associated with the first episode of
non-adherence in the 12 months following the first antiretroviral prescription.
METHODS: A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted
from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the
prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All
analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of nonadherence,
and the time to non-adherence was estimated using the Kaplan-Meier method.
RESULTS: The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women,
respectively; p = 0.010). Marital status (being married or in stable union; p = 0.022), alcohol use in the month
prior to the baseline interview (p = 0.046), and current tobacco use (p = 0.005) increased the risk of nonadherence
among female participants only, whereas a self-reported difficulty with the antiretroviral treatment
was associated with non-adherence in men only. For both men and women, we found that a longer time
between the HIV test and first antiretroviral therapy prescription (p = 0.028) also presented an increased risk of
non-adherence.
CONCLUSIONS: In this cohort study, the incidence of non-adherence was 1.5 times greater among women
compared to men. Our results reinforce the need to develop interventions that account for gender differences
in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence
levels, it is important to understand the barriers to seeking and utilizing health care services.
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BONOLO, P. de F. Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy. Clinics, São Paulo, v. 68, p. 612-620, 2013. Disponível em: <http://www.scielo.br/pdf/clin/v68n5/1807-5932-clin-68-05-612.pdf>. Acesso em: 21 out. 2015.