RESUMO
A incidência da Síndrome da Imunodeficiência Adquirida (AIDS) continua a aumentar em nosso país, mesmo com o avanço da Terapia antirretroviral (TARV) e a diminuição da mortalidade. Assim, aspectos relacionados ao cuidado destes pacientes tornam-se relevantes, especialmente quanto ao papel das equipes de saúde provedoras da atenção. O objetivo deste trabalho foi identificar particularidades relacionadas ao cuidado das pessoas com HIV/AIDS em um centro de referência de um município da Foz do Rio Itajaí-Açu, Santa Catarina Brasil. Foi realizado um estudo qualitativo com coleta de dados por meio de grupo focal e utilizada a técnica de análise de conteúdo temático para avaliação e apresentação dos resultados. Identificaram-se duas grandes categorias, com suas respectivas subcategorias sendo: aspectos promotores de cuidado (acolhimento no serviço de saúde, trabalho em equipe, entendimento/aceitação da doença, presença de rede de apoio, existência de grupos nos serviços, atenção individual do profissional e tratamento medicamentoso) e aspectos dificultadores do cuidado (baixo número de profissionais; falta de ambiência/espaço físico adequado no serviço; sigilo/estigma do local e gestão dos serviços). Conclui-se que o cuidado do paciente com HIV/AIDS apresenta dimensões que extrapolam o conhecimento técnico sobre a doença, devendo considerar aspectos relacionados à vida da pessoa, na qual a organização do serviço de saúde apresenta papel determinante. Aspectos estruturais e de gestão também foram identificados como importantes na adesão ao tratamento e no cuidado desses pacientes.
The incidence of Acquired Immunodeficiency Syndrome (AIDS) continues to increase in our country in despite of theadvanceof antiretroviraltherapy (ART) anddecreasedmortality. Thus, related aspects to the care of these patients become relevant, especially about the role of health careproviders. The objective of this study was to identify aspects related to the care of people with HIV/AIDS, in a reference center of a city of Foz do Rio Itajaí-Açu, Santa Catarina - Brazil. A qualitative study was conducted with data collection with a focus group, and the thematic content analysis technique wasused for analysis and presentation of results. Two major categories related to the care of people with HIV/AIDS were identified, with their respective subcategories: care-promoting aspects (health service reception, teamwork, understanding / acceptance of the disease, presence of support network, existence of groups in this service, individual professional attention and drugtreatment) and aspects that hinder the care (low number of professionals; missing ambience/suitable physical space in the service; confidentiality / stigma of the placeand management of the services. It is concluded that the care of patients with HIV/AIDS hás dimensions which go beyond the technical knowledge about the disease, and aspects related to the person's life should be considered, which the organization of the health service plays a determining role. Structural and management aspects were also identified as important aspects that interfere in the patient adherence and care.
RESUMO
Apesar de a Terapia Antirretroviral estar disponível na rede pública de saúde e do comprovado aumento da sobrevida das pessoas vivendo com HIV/Aids ao uso da mesma, os índices de adesão ao tratamento ainda não são satisfatórios. Partindo dessa premissa, o estudo buscou identificar os fatores determinantes na adesão ao tratamento de pessoas vivendo com HIV/Aids. Foi realizado um estudo qualitativo baseado em entrevistas semiestruturadas com pacientes que apresentaram a um período de abandono da Terapia Antirretroviral superior a 3 meses. Para análise dos dados foi utilizada a técnica de análise de conteúdo temático. O estudo demonstrou três grandes blocos de categorias relacionadas a adesão ao tratamento: contexto da pessoa, serviços de saúde e tratamento medicamentoso. A pesquisa concluiu que os aspectos relacionados à medicação não são suficientes para explicar a taxa significativa de não adesão. As dificuldades do paciente no entendimento da história natural da doença, a ausência ou precariedade de uma rede de apoio, a presença de comorbidades e as dificuldades da rotina aparecem como fatores que dificultam a adesão. Ainda assim, o serviço de saúde pode atuar como um meio pelo qual, através de orientações e elaboração conjunta de estratégias de enfrentamento, o paciente enfrenta as dificuldades impostas por seu contexto social.
Despite the antiretroviral therapy being available in the public health system, even with evidence of increased survival of its patients, it has its adherence rates to treatment still unsatisfactory. Assuming this, this study aimed to identify the determinants of adherence to the treatment of people with HIV/Aids. A qualitative study was conducted based on semi-structured interviews with patients who had a period of abandonment of antiretroviral therapy more than 3 months. The thematic content analysis was used to analyze the data. The study revealed three main blocks of categories related to adherence to treatment: the person's context, the health service and drug treatment. The research concluded the drug-related aspects are not enough to explain the significant rate of nonadherence. The patient's difficulties in understanding the natural history of the disease, the absence or precariousness of a public health system, the presence of comorbidities and the difficulties of the routine appear as factors that complicate adherence. However, the health service can operate as a support by which, using guidelines and joint elaboration of coping strategies, the patient faces the difficulties imposed by their social context.
Assuntos
Humanos , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Cooperação do Paciente , Adesão à Medicação , Sistema Único de Saúde , Estudos Transversais , Assistência AmbulatorialRESUMO
ABSTRACT Itajaí is a port city in southern Brazil with one of the highest incidence and mortality rates from AIDS in the country. The prevalence and incidence of HIV infection were investigated in 1085 of 3196 new HIV-1 infection cases evaluated in the counseling and testing center of Itajaí from January 2002 to August 2008. Recent infections were assessed using the BED(tm), and polregion sequencing was performed in 76 samples. The prevalence ranged from 3.08% to 6.17% among women and from 10.26% to 17.36% among men. A total of 17% of infections were classified as recent, with annual incidence varying from 1.6% to 4.8 per 100 patient/year among women and from 2.05% to 8.5 per 100 patient/year among men. Pol sequences were obtained from 38 randomly recent infections selected individuals: 71% were infected by subtype C, 24% B, 2% D, and 2% F1. Among 38 subjects with established infection, 76% were subtype C, and 24% B. Transmitted drug resistance was detected in 18.4% of recent infection subjects (7.8% to nucleoside analog reverse-transcriptase inhibitors, 5.2% to non-nucleoside reverse-transcriptase inhibitors, and 5.2% protease inhibitors) and 5.2% of subjects with established infection had nucleoside analog reverse-transcriptase inhibitors resistance. The high prevalence and incidence of HIV infection in this region is unprecedented in studies involving cases evaluated in the counseling and testing centers in Brazil.
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Aconselhamento/estatística & dados numéricos , Infecções por HIV/epidemiologia , Distribuição por Idade , Brasil/epidemiologia , Genótipo , HIV-1 , Incidência , Prevalência , Estudos Retrospectivos , Distribuição por SexoRESUMO
Itajaí is a port city in southern Brazil with one of the highest incidence and mortality rates from AIDS in the country. The prevalence and incidence of HIV infection were investigated in 1085 of 3196 new HIV-1 infection cases evaluated in the counseling and testing center of Itajaí from January 2002 to August 2008. Recent infections were assessed using the BED™, and pol region sequencing was performed in 76 samples. The prevalence ranged from 3.08% to 6.17% among women and from 10.26% to 17.36% among men. A total of 17% of infections were classified as recent, with annual incidence varying from 1.6% to 4.8 per 100 patient/year among women and from 2.05% to 8.5 per 100 patient/year among men. Pol sequences were obtained from 38 randomly recent infections selected individuals: 71% were infected by subtype C, 24% B, 2% D, and 2% F1. Among 38 subjects with established infection, 76% were subtype C, and 24% B. Transmitted drug resistance was detected in 18.4% of recent infection subjects (7.8% to nucleoside analog reverse-transcriptase inhibitors, 5.2% to non-nucleoside reverse-transcriptase inhibitors, and 5.2% protease inhibitors) and 5.2% of subjects with established infection had nucleoside analog reverse-transcriptase inhibitors resistance. The high prevalence and incidence of HIV infection in this region is unprecedented in studies involving cases evaluated in the counseling and testing centers in Brazil.