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Adesão à terapêutica anti-retroviral em Maputo: o contributo de uma abordagem bottom-up
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A Adesão à Terapêutica Anti-retroviral (TARV) pertence ao grupo das maiores preocupações de saúde pública na área do VIH. O único factor de possibilidade de controlo de sucesso da TARV por parte do paciente VIH+ é o comportamento de adesão ao tratamento. As características do próprio paciente, o enquadramento sócio-cultural do VIH na comunidade e no país, a qualidade da relação com os profissionais de saúde e as próprias dificuldades com o tratamento, são factores amplamente estudados nas últimas décadas, e que medeiam o sucesso da adesão à TARV. A partir de uma abordagem bottom-up, desenvolveu-se um estudo exploratório com o objectivo de
explorar o modo como pacientes TARV em Maputo experienciam estes factores e o impacto dessa experiência na adesão à TARV. A investigação contou com a
colaboração de 602 utentes em TARV na Cidade de Maputo com idades entre os 21 e os 56 anos. Os resultados obtidos ao longo dos quatro estudos realizados indicam que mais
homens revelaram ter interrompido o tratamento que as mulheres, e maioritariamente por mal-estar físico ou por indicação médica. Ao contrário dos homens, as mulheres são quem mais revela ter dificuldades com os profissionais de saúde, assim como, interromper o tratamento por faltas às consultas. A adesão à TARV é mais reduzida quando na presença das seguintes características: género masculino; medos relacionados com estigma e discriminação, com falhar a toma da TARV ou com não sentir melhoras com o tratamento; ter tido dificuldades com os profissionais de saúde, nomeadamente, o paciente sentir que não tem as suas dúvidas esclarecidas, que o médico só se preocupa com a medicação, que o médico não o compreende e que não cria espaço para que o paciente aborde outros aspectos relacionados com a sua saúde. A investigação apela ao desenvolvimento de intervenções que atendam às diferenças de género, nomeadamente no relacionamento com os profissionais de saúde, família e activistas, que possibilitem o desenvolvimento de estratégias de coping com a TARV mais suportadas socialmente. Encoraja-se a continuação do desenvolvimento de actividades formativas da sociedade em geral, sobre o VIH e a TARV. A necessidade de diminuição do estigma é uma das maiores preocupações levantadas por este trabalho.
Antiretroviral treatment (ART) adherence is one of the main concerns of Public Health on HIV field. The behavior of adherence to the treatment is the only factor that HIV+ patient can have under personal control. Patients own characteristics,the HIV socio-cultural outcomes in the community as well as in the country, the quality of the relationship with health professionals and the difficulties on dealing with the treatment, are factors greatly studied during the last decades, and that play a crucial role on ART treatment adherence. From a bottom-upperspective, an exploratory study was developed with the goal to explore how the mentioned factors were experienced by the ART patients in Maputo, and the impact of that experience on ART adherence.The research counted with the collaboration of 602 ART patients in Maputo City, with ages between 21 and 56 years old. The results from the four studies indicate that more men than women revealed having had interrupted the treatment, and in majority due to physical discomfort and medical prescription. Women have revealed having more difficulties with health professionals than men, and treatment interruption due to missing clinical appointments. Male, fears related to stigma and discrimination, to being afraid of missing ART schedules, fear of not feeling health improvement with ART, as well as having had difficulties with health professionals, not having their questions about ART being clarified, feeling that the doctor only cares about medication, not feeling understood by the doctor and feeling that the doctor doesn’t make room to talk about other health issues; are items that have an impact on ART adherence, reducing it. The present study encourages the development of interventions that attempt to gender differences, especially on the relationship with health professionals, with family and with activists, which can promote the development of ART coping strategies with more social support. It is encouraged to keep the development of training and educationalactivities for general society about HIV and TARV. Stigma reduction is one of the main concerns of this research results.
Antiretroviral treatment (ART) adherence is one of the main concerns of Public Health on HIV field. The behavior of adherence to the treatment is the only factor that HIV+ patient can have under personal control. Patients own characteristics,the HIV socio-cultural outcomes in the community as well as in the country, the quality of the relationship with health professionals and the difficulties on dealing with the treatment, are factors greatly studied during the last decades, and that play a crucial role on ART treatment adherence. From a bottom-upperspective, an exploratory study was developed with the goal to explore how the mentioned factors were experienced by the ART patients in Maputo, and the impact of that experience on ART adherence.The research counted with the collaboration of 602 ART patients in Maputo City, with ages between 21 and 56 years old. The results from the four studies indicate that more men than women revealed having had interrupted the treatment, and in majority due to physical discomfort and medical prescription. Women have revealed having more difficulties with health professionals than men, and treatment interruption due to missing clinical appointments. Male, fears related to stigma and discrimination, to being afraid of missing ART schedules, fear of not feeling health improvement with ART, as well as having had difficulties with health professionals, not having their questions about ART being clarified, feeling that the doctor only cares about medication, not feeling understood by the doctor and feeling that the doctor doesn’t make room to talk about other health issues; are items that have an impact on ART adherence, reducing it. The present study encourages the development of interventions that attempt to gender differences, especially on the relationship with health professionals, with family and with activists, which can promote the development of ART coping strategies with more social support. It is encouraged to keep the development of training and educationalactivities for general society about HIV and TARV. Stigma reduction is one of the main concerns of this research results.
Descrição
Palavras-chave
Saúde pública Virologia Sida Adesão à TARV Género Maputo Moçambique
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical