Multicenter study on adherence to antiretroviral treatment in young adolescents living with HIV in the City of São Paulo

Abstract

This research is interested in young people living with HIV in Brazil, a country fairly touched by HIV, with more than 10,000 adolescents from 13 to 19 years old affected (UNAIDS, 2008). Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. However, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. Although there is difference on the adherence rate in studies among teenagers, researchers acknowledge therapeutic adherence as a main problem which does not benefit enough attention, in particular studies outside the United States. Numerous researches had considered factors influencing adherence to antiretroviral treatment (ART) among adult living with the HIV. Results revealed the importance to examine individual characteristics, attitudes, the treatments and their effects, (Ickovics & Meade, 2002). The selection of those variables for the study also drives us towards the choice of a theoretical model linking up all the chosen variables. The theoretical model of self control of Rosenbaum (1990), built around the cognitive processes, seems the most appropriate for this study. Using both quantitative and qualitative design, therefore, the purpose of this study is to explore experience of the teenagers living with the HIV in São Paulo and to determine the psychosocial factors which influence adherence to ART among adolescents. Data will be collected with young people in pediatrics and adult hospitals and reference centers for the HIV / AIDS of the city of São Paulo. The longitudinal quantitative approach will be corelational descriptive type with repeated measures (T0 and T1). It aims at describing variables, examining mutual links between variables, and at investigating factors influencing adherence. Sampling is estimated at 400 young people according to statistical tests (descriptive statistics, correlation analysis, simple linear regression, hierarchical logistic regression) with a 95 % confidence interval. Research tools will be self-reported questionnaires about individual characteristics, social support, perceived stress, depression, self-efficacy, attitudes towards treatment as well as adherence behaviors. The other approach is a qualitative phenomenological design conducted by semi-structured interviews with young people recruited among the sampling of the longitudinal study (around 15-20). All research tools will be translated into Portuguese and back into French, insuring reliability. The expected results go with hypotheses of the theoretical model of Rosenbaum (1990) saying a high level of selfefficacy and positive attitudes to the regimen allow teenagers to adopt behavior of health which strengthen their level of adherence in treatment. Furthermore, a high level of social support, weak levels of perceived stress and depression, as well as side effects are associated to self-efficacy of the teenagers as well as positive attitude about regimens. Other themes, categories and relations will appear from the qualitative analysis. The whole schedule of this research is planned for over two years, beginning from September, 2010. (AU)