Evaluation of performance in the Brazilian public HIV healthcare facilities: associations between patient adherence measures, size and geographic region of sites and characteristics of structure and process of care

• Grant number: 13/06186-9
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate
• Start date: October 01, 2013
• End date: September 30, 2014
• Field of knowledge: Health Sciences - Collective Health - Public Health
• Principal Investigator: Maria Ines Battistella Nemes
• Grantee: Maria Altenfelder Santos
• Supervisor: Paul D. Cleary
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Institution abroad: Yale University, United States
• Associated to the scholarship: 12/20578-4 - The role of health services in patient adherence to antiretroviral treatment of HIV/AIDS: associations between adherence measures and organizational characteristics of public healthcare sites that assist people living with HIV in Brazil, BP.DR

Abstract

Background: Patient adherence measures can be used to monitor performance in HIV healthcare facilities. Adherence to antiretroviral therapy (ART) predicts good treatment outcomes and patient satisfaction with care received. Few studies have investigated which aspects of care organization contribute to the promotion of higher levels of patient adherence. Objectives: In this study we intend to analyze associations between ART adherence measures and characteristics of the Brazilian public HIV healthcare facilities. Methods: In a cross-sectional study conducted in 2010, fifty-five sites integrated a national sample representing seven Brazilian geographic regions and seven performance groups defined through Qualiaids Questionnaire application (a tool that evaluates performance in sites according to structure and process indicators). A total of 2,424 patients under ART answered WebAd-Q, a web-based questionnaire containing three questions on ART intake in the past seven days, concerning prescribed medicine, number of pills and prescribed time. The managers and team in each site answered Qualiaids Questionnaire and Adherence Related-Activities Questionnaire, which approaches adherence-related activities routinely conducted in the healthcare facilities. Organizational characteristics of sites were also collected, including its size (number of patients under ART) and geographic region. Patient answers to WebAd-Q were categorized according to four non-adherence degrees (0, 1, 2 or 3 non-adherence answers). Analyses variables related to structure and process of care will be constructed from questions contained in Qualiaids and Adherence Related-Activities Questionnaire. Distribution of the characteristics of structure and process will be analyzed according to size and geographic region of sites. Associations between non-adherence degrees and characteristics of structure and process will be tested in multinomial logistic regression models. Characteristics of structure and process associated with non-adherence will be tested in multivariable logistic regression models including size and region of sites. (AU)