Abstract

PIRES, Paulo Das Neves; MAREGA, Abdoulaye  and  CREAGH, José Miguel. Antiretroviral treatment: primary health care implementation research, Nampula, Mozambique. Rev Port Med Geral Fam [online]. 2018, vol.34, n.5, pp.274-286. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v34i5.12312.

Aim: To evaluate the clinical status of HIV-infected patients under antiretroviral therapy, rates of adherence and discontinuation of medication, and their determinants, aiming to improve the program to fight human immunodeficiency virus in Nampula. Study: Implementation research, descriptive with mixed methods. Place: Nampula Province, Mozambique, involving 10 health centres. Population: Patients on antiretroviral therapy and those who discontinued therapy, primary health care professionals, and traditional healers Methods: Implementation research, applying surveys to patients and traditional healers, semi-structured interviews to health professionals and traditional healers, and documental review. Baseline evaluation was performed in both target and control primary health care centres, followed by health education sessions for patients and traditional healers, and training of health care professionals in target health centres. Finally, we compared clinical and program indicators in all health centres. Results: Food insecurity, discrimination and low accessibility to health care contribute to a discontinuation of antiretroviral therapy in up to 50% of patients. Therapeutic adherence is observed in 69% of the patients. The intervention was carried out in five districts, comprising 63 patients, 59 traditional healers and 96 health professionals. The intervention districts showed more community adherence support groups, higher number of patients referred to primary health care services, and achieved better patient clinical indicators and a lower treatment discontinuation rate, although not statistically significant. Conclusion: There are several reasons for antiretroviral therapy discontinuation and low adherence rates. Discontinuation of antiretroviral therapy is a severe problem in Nampula due to individual, social and health system factors. Interdisciplinary and low-cost interventions such as health education with extension to rural areas may change this scenario.

Keywords : Discontinuation; Antiretroviral; Primary health care; Implementation research; Mozambique; Human immunodeficiency virus.

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