Acta Paul Enferm. 2022; 35:eAPE03661. 1
Perceptions of people with tuberculosis/HIV regarding treatment adherence
Percepções de pessoas com tuberculose/HIV em relação à adesão ao tratamento
Percepción de personas con tuberculosis/VIH con relación a la adherencia al tratamiento
Alexandra Rodrigues dos Santos Silva1 https://orcid.org/0000-0002-0621-8209
Paula Hino1 https://orcid.org/0000-0002-1408-196X
Maria Rita Bertolozzi2 https://orcid.org/0000-0002-5009-5285
Julia Couto de Oliveira1 https://orcid.org/0000-0002-2311-7143
Marcos VinÃcius de Freitas Carvalho1 https://orcid.org/0000-0003-4633-413X
Hugo Fernandes1 https://orcid.org/0000-0003-2380-2914
Sumire Sakabe3 https://orcid.org/0000-0002-9054-2844
1
Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
2
Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil.
3
Centro de Referência e Treinamento DST/Aids-SP, São Paulo, SP, Brazil.
Conflicts of interest: none to declare.
Abstract
Objective: To analyze aspects related to adherence to tuberculosis treatment in people living with tuberculosis/
human immunodeficiency virus coinfection.
Methods: This is an exploratory, descriptive, qualitative study on adherence to tuberculosis treatment among
people with tuberculosis/human immunodeficiency virus coinfection. The study setting was a reference
center for human immunodeficiency virus/acquired immunodeficiency syndrome located in the capital of the
state of São Paulo. The data collection instrument contained socio-demographic and health profile related
questions. The discourse analysis method was used for the analysis of the empirical material, which allowed
the comprehension of thematic phrases.
Results: Sixteen people were interviewed. Most were male, mixed race, in the age group of 30-39 years, with
9-12 years of study, living alone, single and declared themselves homosexuals. Three categories of analysis
emerged from the analysis of testimonies: Health-disease process: the impact of the diagnosis and the
meanings of living with coinfection; Drug treatment: reasons for follow-up, facilities and difficulties involved;
and Care in the health service: embracement and support networks that favor treatment adherence.
Conclusion: Adherence to treatment in the tuberculosis/human immunodeficiency virus coinfection has shown
a relation to the way people are inserted in society, their living and working conditions. The fact that care in
health services interferes with adherence is also noteworthy, given the importance of the bond between the
health professional and the user.
Resumo
Objetivo: Analisar aspectos relacionados à adesão ao tratamento da tuberculose em pessoas que vivem com
coinfecção tuberculose/vÃrus da imunodeficiência humana.
Métodos: Trata-se de um estudo exploratório, do tipo descritivo, com abordagem qualitativa sobre a adesão ao
tratamento da tuberculose entre pessoas que apresentam a coinfecção tuberculose/vÃrus da imunodeficiência
humana. O cenário do estudo foi um centro de referência para vÃrus da imunodeficiência humana/sÃndrome
da imunodeficiência adquirida do estado de São Paulo, localizado na capital. O instrumento de coleta de dados
continha questões relacionadas ao perfil sóciodemográfico e de saúde. Para a análise do material empÃrico foi
utilizado o método de análise de discurso que permitiu a depreensão de frases temáticas.
Resultados: Foram entrevistadas 16 pessoas, sendo a maioria do sexo masculino, da cor parda, na
faixa etária entre 30 a 39 anos, com 9 a 12 anos de estudo, que moravam sozinhos, solteiros e que
se declararam homossexuais. Da análise dos depoimentos emergiram três categorias de análise:
Processo saúde doença: o impacto do diagnóstico e os significados de viver a coinfecção; Tratamento
Keywords
Medication adherence; Coinfection; HIV; Tuberculosis
Descritores
Adesão à medicação; Coinfecção; HIV; Tuberculose
Descriptores
Cumplimiento de la medicación; Coinfección; VIH;
Tuberculosis
Submitted
December 5, 2020
Accepted
March 25, 2021
Corresponding author
Alexandra Rodrigues dos Santos Silva
E-mail: [email protected]
Associate Editor (Peer review process): Alexandre Pazetto Balsanelli
(https://orcid.org/0000-0003-3757-1061)
Escola Paulista de Enfermagem, Universidade Federal de
São Paulo, São Paulo, SP, Brazil
How to cite:
Silva AR, Hino P, Bertolozzi MR, Oliveira JC, Carvalho
MV, Fernandes H, et al. Perceptions of people with
tuberculosis/HIV regarding treatment adherence. Acta
Paul Enferm. 2022;35:eAPE03661.
DOI
http://dx.doi.org/10.37689/acta-ape/2022AO03661
Original Article
2 Acta Paul Enferm. 2022; 35:eAPE03661.
Perceptions of people with tuberculosis/HIV regarding treatment adherence
Introduction
The epidemiological magnitude of tuberculosis
(TB) represents a global health threat.(1) The disease is among the top ten causes of death caused
by infectious diseases and is the leading cause of
death among people living with HIV and AIDS
(PLWHA). In 2019, 10 million people worldwide
fell ill with TB, of which 8.2% were coinfected with
HIV. Of the total number of TB cases, 1.2 million
people died, and of these, 208,000 deaths occurred
among PLWHA.(2)
The United Nations (UN) and the World
Health Organization (WHO) have long proposed
strategies for ending TB. Tuberculosis is highlighted in the Sustainable Development Goals (SDGs).
The WHO End of TB Strategy, launched in 2014,
aims to eliminate TB, was well as the suffering and
deaths resulting from it by 2035.(2) In consonance
with this plan, the Brazilian Ministry of Health established, as of 2017, the National Plan for the End
of Tuberculosis, also targeting to reduce the TB incidence rate to less than 10 cases per 100 thousand
inhabitants and the TB mortality rate to less than 1
death per 100 thousand inhabitants by 2035.(1)
Among the countries with higher TB burden,
Brazil ranks 19th on TB/HIV coinfection. In Brazil,
rates for treatment default were 11.6%, with 71.9%
cure in 2019.(1) Such rates are still far from the target established at 5% for death and greater than
85% cure rates.(3)
The unfavorable outcomes (abandonment and
death) and failures in the success of TB treatment
among people with TB-HIV coinfection call attention and show the need for studies seeking to identify the determinants of non-adherence to treatment.(4)
Tuberculosis treatment drug interactions with
antiretrovirals, drug resistance and long lasting therapy pose difficulties in the management of TB in
PLWHA.(5) In addition, as a result of immunosuppression, PLWHA are at a higher risk of developing
TB compared to the general population. Social and
health inequities add extra challenge in the control
of both TB and TB/HIV coinfection.(6)
HIV/AIDS implications go beyond clinical aspects and may impact on mental and social status,
with all these being intrinsically interdependent.
TB/HIV coinfection can increase stigma and may
cause rejection by family members and other people of the social circle. In addition, non-adherence
to treatment contributes to clinical worsening with
impact on the quality of life (QoL).(7)
While the TB treatment is performed for a period of at least six months, with the possibility of
cure in almost all cases, the treatment of HIV/AIDS
medicamentoso: motivos para o seguimento, facilidades e dificuldades envolvidas; e Cuidado no serviço de saúde: acolhimento e redes de apoio que
favorecem a adesão ao tratamento.
Conclusão: A adesão ao tratamento na coinfecção tuberculose/vÃrus da imunodeficiência humana mostrou-se relacionada à forma como a pessoa está
inserida na sociedade, suas condições de vida e trabalho. Ressalta-se também que o cuidado nos serviços de saúde interfere na adesão, dada a importância
do vÃnculo entre o profissional de saúde e o usuário.
Resumen
Objetivo: Analizar los aspectos relacionados con la adherencia al tratamiento de tuberculosis en personas que viven con la coinfección tuberculosis/virus de
la inmunodeficiencia humana.
Métodos: Se trata de un estudio exploratorio, tipo descriptivo, con enfoque cualitativo, sobre la adherencia al tratamiento de tuberculosis en personas
que presentan la coinfección tuberculosis/virus de la inmunodeficiencia humana. El escenario de estudio fue un centro de referencia del virus de la
inmunodeficiencia humana/sÃndrome de inmunodeficiencia adquirida del estado de São Paulo, ubicado en la capital. El instrumento de recopilación de datos
contenÃa preguntas relacionadas con el perfil sociodemográfico y de salud. Para analizar el material empÃrico se utilizó el método de análisis de discurso que
permitió extraer frases temáticas.
Resultados: Se entrevistaron 16 personas, de las cuales la mayorÃa era de sexo masculino, de color pardo, del grupo de edad entre 30 y 39 años, con 9 a
12 años de estudios, que vivÃan solos, solteros y que se declararon homosexuales. Del análisis de los relatos surgieron tres categorÃas de análisis: Proceso
de salud y enfermedad: el impacto del diagnóstico y los significados de vivir la coinfección; Tratamiento farmacológico: motivos para el acompañamiento,
facilidades y dificultades relacionadas, y Cuidado en el servicio sanitario: contención y redes de apoyo que favorecen la adherencia al tratamiento.
Conclusión: La adherencia al tratamiento de la coinfección tuberculosis/virus de la inmunodeficiencia humana demostró estar relacionada con la forma
como la persona está insertada en la sociedad, su condición de vida y trabajo. También se observó que el cuidado en los servicios de salud interfiere en la
adherencia, debido a la importancia del vÃnculo entre los profesionales de la salud y los usuarios.
Acta Paul Enferm. 2022; 35:eAPE03661. 3
Silva AR, Hino P, Bertolozzi MR, Oliveira JC, Carvalho MV, Fernandes H, et al
is continuous throughout life. In this perspective,
it is assumed that PLWHA who undergo TB treatment may represent a group of greater vulnerability to not following treatment, mainly due to the
potential adverse effects of antituberculosis drugs
and antiretroviral therapy (ART). The intolerance,
in addition to other aspects related to the evolution
of coinfection, can lead to treatment abandonment
and impact the patients’ QoL.(4,8)
Recognizing the importance of adherence to
treatment in people living with TB/HIV coinfection, the present investigation was guided by the
following question: According to the perception of
PLWHA undergoing TB treatment, what are the
aspects involved in adherence to treatment? Thus,
the objective of the study was to analyze the aspects
related to adherence to tuberculosis treatment in
people living with tuberculosis/HIV coinfection.
Methods
This is an exploratory, descriptive, qualitative study on
adherence to TB treatment among people with TB/
HIV coinfection. The study took place at CRT DST
Aids, a Brazilian HIV/AIDS treatment reference center in the capital of São Paulo state. This is a normative
reference unit for evaluation and coordination of the
State Program for the Prevention, Control, Diagnosis
and Treatment of Sexually Transmitted Infections
and Acquired Immunodeficiency Syndrome (AIDS)
that attends users residing in the municipality and
surroundings. The service is an outpatient and hospital complex with approximately 800 employees,
including doctors of different specialties, nurses,
dentists, pharmacists, nutritionists, psychologists, social workers, laboratory and nursing technicians and
administrative officers
The study inclusion criteria were people aged 18
years or over, regardless of sex, who had an HIVpositive serology result, were prescribed TB treatment and antiretrovirals (ART) for at least a month,
and with cognitive and physical conditions to participate in the study.
During the data collection period, there were 18
people with TB/HIV coinfection on TB treatment.
Convenience sampling was used, and all patients
were invited to participate in the study at the moment of the medical appointment or when receiving directly observed treatment at the reference center. Data collection took place from April to August
2019 and was performed by an undergraduate
Nursing student duly trained to interview the study
participants. The interviews were performed individually in a private environment on the premises
of the health service in order to guarantee privacy.
The data collection instrument contained socio-demographic and health related questions and the
following guiding questions: 1) “Tell me about the
start of your TB event. 2) Has the TB and HIV treatment brought needs that you did not have before? and
3) What are the easy and difficult issues in your treatment? Each interview lasted an average of 25 minutes;
the testimonies were recorded and fully transcribed by
the same interviewer. Then, testimonies were identified by a letter (I) followed by an Arabic number in order to guarantee anonymity. In-depth and exhaustive
reading of the interviews was performed to apprehend
the meanings of adherence to treatment of people who
experience TB/HIV coinfection.
In this study, a concept of adherence involving
three plans was used: 1) the health-disease concept of the person being treated, which can mean
greater passivity or proactivity in coping with the
health-disease process; 2) the social place occupied
by the sick person, understanding that insertion in
society determines access to life with dignity and
the potential for coping with the processes that lead
to strain while conducting life; and 3) the plan that
addresses the health production process, that is, the
way health services are organized to offer and provide health care. These constituent elements of the
concept of adherence contribute to broaden the understanding of the health-disease process.(9)
For the analysis of empirical material, the discourse analysis method was used, allowing the
comprehension of thematic phrases. Ideas and
speeches are expressions of real life, containing people’s worldviews that materialize in representations
of elements of objective reality.(10) The analysis of
speeches was performed in the light of the social
determination of the health-disease process.
4 Acta Paul Enferm. 2022; 35:eAPE03661.
Perceptions of people with tuberculosis/HIV regarding treatment adherence
The project was approved by the Research Ethics
Committee (opinion number: 3.732.087) (CAAE:
91820618.0.0000.5505) and by the Research
Ethics Committee of the health service where interviews were held (opinion number: 3.806.049)
(CAAE: 91820618.0.3001.5375). Respondents
who participated in the study signed the Informed
Consent form.
Results
Two out of the 18 people invited to participate in
the study refused, which was justified by the impossibility of remaining in the service for a longer period of time. Sixteen people were interviewed, most
were male (n=12), mixed race (n=9), predominant
age group was 30-39 years (n=6), with 9-12 years of
study (n=10), living alone (n=7), single (n=14) and
declared themselves as men who have sex with men
(n=10). Table 1 presents the description of work,
life and health-disease process conditions.
The analysis of testimonies showed that adherence to treatment is perceived as something complex that involves aspects transcending those related
to disease clinical aspects, involving social issues.
Three analysis categories emerged from the analysis process: Health-disease process, Drug treatment
and Care in health services. Chart 1 presents the
analytical categories and their respective constituent
elements.
Table 1. Sociodemographic and health characteristics of people
living with HIV/AIDS undergoing tuberculosis treatment
Variables n(%)
Characteristics of working conditions
Works
Does not work
Retired
5(31.3)
9(56.2)
2(12.5)
Characteristics of living conditions
Income (minimum wage)
Up to 1
2 to 3
>3
6(37.5)
5(31.3)
5(31.3)
HIV exposure
Sexual
Other
14(87.5)
2(12.5)
HIV diagnosis time (years)
>10
1 to 9
<1
9(56.3)
2(12.5)
5(31.2)
Viral load (copies/mL)
<50 (undetectable)
50 to 20.000
7(43.7)
9(56.3)
CD4+ T cell count
>350
200 to 350
<200
3(18.8)
6(37.5)
7(43.7)
Clinical form of tuberculosis
Pulmonary
Extrapulmonary
Extrapulmonary + pulmonary
12(75)
1(6.2)
3(18.8)
Tuberculosis treatment time (days)
31 to 90
91 to 360
>360
10(62.5)
5(31.2)
1*(6.2)
*User on second treatment attempt in the same year
Chart 1. Categories of analysis and constituent elements of
adherence to tuberculosis treatment among people living with
HIV/AIDS
Health-disease process:
the impact of the diagnosis
and the meanings of living
with coinfection
Drug treatment: reasons
for follow-up, facilities and
difficulties involved
Care in the health service:
embracement and support
networks that favor
treatment adherence
– Impact of diagnosis
– Meanings of living with TB/
HIV coinfection
– Health conditions
– Reasons to undertake
treatment
– Facilities and difficulties in
treatment
– Care offered
– User embracement
– Support network
Regarding the category Health-disease process,
the analysis of testimonies showed that experiencing TB/HIV coinfection is a multifaceted process.
For some interviewees, TB represented an alert to
resume HIV treatment, demystifying the false feeling of “I have nothing†(I2). For others, the search
for care was motivated by a flu-like condition that
intensified with “fever and a lot of lung pain†(I12),
which led to the diagnosis of both TB and HIV. As
a result, changes in daily life occurred as a way of
adapting to the diseases. The most cited were not
being able to go out as often, having to prioritize
health care, in addition to the search for knowledge
about HIV, TB and other opportunistic diseases.
Feelings of surprise and fear were common when
receiving the diagnosis of TB and HIV, as illustrated by the following statement: “when I discovered
HIV, it was a shock, I wanted to kill myself, because I
did not know the disease†(I6). With the diagnosis of
TB, feelings of fear and panic were mentioned, in
addition to the intensification of symptoms of the
disease: “I couldn’t sleep at night, I sweated a lot, and
had a cough that would not go away†(I10), “a lot of
fever, that sweating, lack of appetite†(I11).
Some participants who had not undergone ART
reported that their health condition became compromised with HIV infection: “I was weakenedâ€
Acta Paul Enferm. 2022; 35:eAPE03661. 5
Silva AR, Hino P, Bertolozzi MR, Oliveira JC, Carvalho MV, Fernandes H, et al
(I11), “I did not feel the movements of my legs†(I3),
“I had a headache, drowsiness†(I10).
Regarding changes in life, one of the interviewees reported that because he was infected with HIV
while still in adolescence (I2), he did not remember his life before that period. Furthermore, some
interviewees (I4, I5) who reported having been diagnosed with HIV at a time when ART were not
available, considered that, as they were asymptomatic, they worried about the disease only after experiencing the death of close people. Others also mentioned that TB or HIV diagnosis had implications
on mental health, such as suicidal ideation (I6, I8).
Social issues arising from the diagnosis of TB/
HIV coinfection were also mentioned. Respondents
reported that disclosing treatment and serological
status directly affected daily life and interpersonal
relationships: “I think I have a lot of difficulty in socializing, in my social life, you know†(I2). “I am no
longer able to have relationships with anyone†(I10).
In relation to the category Drug treatment,
the search for quality of life and the fear of dying
were mentioned among the reasons for taking the
treatment. Experiencing TB/HIV coinfection was
reflected in the commitment to undertake drug
treatment. According to an interviewee, the TB
diagnosis determined that he should try to resume
ART: “it is a good time, because this panic makes me
stick to treatment†(I2).
On the other hand, the treatment goes beyond
taking medications and involves moral, religious and
sexual issues: “it goes a little beyond that, these situations I am dealing with now, I was abused as a child,
sexual hyperstimulation, religious repression†(I2).
Family support revealed itself in different ways
that directly interfere in the continuation of therapy. Family’s acceptance of sexual orientation and
serological status were perceived as positive and
strengthened the continuation of treatment “She
[mother] is my support for everything, she is my life,
my everything, nowadays, she is the one who makes
me live†(I11). The opposite occurs when family
members showed attitudes of denial or even exclusion, such as: “yesterday my father told me to leave the
house, I don’t know if because of TB too, he no longer
accepts me†(I1).
TB/HIV coinfection seemed to be an incentive for treatment adherence. Some users reported
that the state of physical weakness made them feel
obliged to continue treatment: “I put it in my head:
there is only one way, either to die or to be treatedâ€
(I6); “Ah, I set a goal in my mind that I want it to
come out of me, then, I think about taking the medicine every day†(I3).
Regarding to the incentives to stick to the
therapeutic scheme, participants reported that the
bond established with the health service favored
treatment adherence, mainly because they felt embraced and free from prejudice “I felt embraced, was
well treated, in four days I got out of bed, I have the
confidence to get here and open myself up†(I11). The
provision of medicines and food incentives by the
public service, free of charge, the easy access to the
health unit and the bond with the health care team
were also mentioned as facilitators for the continuation of treatment.
On the other hand, social stigma has a negative impact on the lives of people who experience
TB/HIV coinfection, making treatment adherence
difficult: “I spent a year in retreat, I didn’t want to
see nor talk to anyone, I only knew how to keep my
distance, I isolated myself for a year, either because of
my prejudice in relation to the disease, or because of the
prejudice of others†(I9).
In addition, some reports mentioned that health
care makes the treatment routine stressful: “my life
is only doctor†(I10), which leads the user to reflect:
“I will have to take the medicines every day for the rest
of my life, it’s something I didn’t want for myself†(I7).
Finally, the category “Care in the health serviceâ€, revealed that user embracement represents
one of the main pillars for adherence to treatment
of TB/HIV coinfection (“the staff is highl 7y concerned about the person as a whole, aren’t they?†(I8),
since it constitutes a support network. The bond
with the health team and the provision of food assistance (monthly food parcel) is highlighted. Most
interviewees reported that the availability of free
medicines and food supplements, the possibility of
carrying out laboratory tests and multidisciplinary
follow-up in the service were essential to continue
the clinical management of coinfection. Due to the
6 Acta Paul Enferm. 2022; 35:eAPE03661.
Perceptions of people with tuberculosis/HIV regarding treatment adherence
above mentioned, despite the fact of living far from
CRT DST Aids, users chose to be treated there.
Discussion
The testimonies showed that adherence is not limited to an act of personal volition and individual
nature exclusively, but is associated with other dimensions, such as user embracement in the health
unit and family support.(11) Adherence to treatment
is not reduced to the acceptance of drug therapy,
but a multi-faceted process involving the multidisciplinary team and co-responsibility of the user.
A study conducted in the city of Campinas with
people on TB treatment showed the importance of
health education when offering information and
guidance on the disease and treatment as a way to
improve treatment adherence.(12)
The testimonies were explicit in showing that
adherence to treatment is strongly related to the
way the health service receives the user by offering
quality and humanized care
The importance of the bond between the multidisciplinary team and the user was highlighted in
the testimonies and constitutes a facilitator of treatment adherence, especially if the care is centered in
the user, with attention to individual health needs.
Shared decisions when making the therapeutic plan
brings users closer to the healthcare team, and encourages the patient to reach for help when in need.
This finding corroborates a study that brings user-centered care and based on monitoring and counseling that encourage self-management of health care
as elements of success to the treatment.(13)
Likewise, testimonies reported that the incentives received contributed to strengthen treatment
adherence, especially for the more socially vulnerable. Some authors advocate that even if not being
the solution to health problems and needs, incentives minimize the suffering of the affected ones,
and more than that, social protection must be an
structural part of society.(11)
A study was conducted in Ukraine to identify TB
treatment adherence challenges from the patients’
perspective showed that the time and cost of the
journey to reach treatment was an obstacle to adherence, as well as the lack of qualified listening and user
embracement.(14) The analysis of testimonies of the
present study showed that despite the time spent in
the journey, the cost and the waiting time at the service, users chose to continue treatment in this health
unit, because of the quality of care and the bond established with the healthcare team. This service was
understood by participants as a place that meets the
health needs in both HIV and TB treatment.
In another line, social stigma resulting from HIV
and TB can affect treatment adherence. When prejudice occurs within the family and social spheres,
the odds of non-adherence seem to be higher. The
present study findings corroborate the ones of an
investigation performed in two South African provinces, in which simultaneous adherence to treatment for TB and ART was evaluated to identify the
risk factors for non-adherence to both treatments.
The results showed better adherence and health care
in those who disclosed their serological status to
family and friends and could count on their support
to remind them to take the medications.(15)
The findings of this study are in line with a national study in which the desire to live of people
with TB/HIV coinfection was essential for treatment adherence, because it allows overcoming barriers imposed by health conditions.(16) In fact, interviewees reported that the search for quality of life
and the fear of dying were reasons for seeking health
services and adhering to treatment.
The testimonies revealed that quality of care is
decisive for the continuity of treatment, and also
mentioned accessibility, a good relationship with
the multidisciplinary team, as well as availability of
medications and food incentives. It is known that
dissatisfaction with the health service and long wait
for care can negatively influence adherence to treatment, discouraging treatment. Therefore, when the
health promotion process involves the individual,
treatment commitment is enhanced.(17)
In the context of therapeutic management of
coinfection treatment, participants reported that falling ill with TB brought up the need to resume ART
and health care, representing one of the reasons for
treatment adherence. A study conducted in Rio de
Acta Paul Enferm. 2022; 35:eAPE03661. 7
Silva AR, Hino P, Bertolozzi MR, Oliveira JC, Carvalho MV, Fernandes H, et al
Janeiro showed that the impact of TB diagnosis is
directly associated with acceptance of the serological
condition, since the diagnosis of coinfection was a
result of deficient care with one´s health, with TB
being a coinfection that worsens life with HIV. (18)
The user’s behavior may not be the same for each
therapeutic regimen, given the specific intrinsic complexity. Like the reports observed in interviews, this
study revealed that adverse effects, social isolation, and
stigmatization of coinfection negatively influenced adherence to treatment. Therefore, the need for a care
model focused on the therapeutic management of
coinfection and its particularities is confirmed.(19)
A study conducted in Ceará state aimed to
evaluate ART adherence in TB treatment found
that adherence to treatment was lower in patients
coinfected with TB/HIV.(20) The population of the
present study is similar to interviewees of the Ceará
study, since most were male and in the 30-39 age
group, which represents economically active individuals. This particular aspect may suggest that the
therapeutic plan may demand adjustments to accommodate this need.
Since TB/HIV coinfection remains a challenge
for the control of both TB and HIV, the results of
this study reinforce the need to implement collaborative actions between both diseases coordinating
the health care networks in order to offer comprehensive and qualified care to adequately fulfil the
needs of PLWHA on TB treatment.
A possible limitation of this study was the fact
it was restricted to only one reference service for the
care of PLWHA. However, given the richness of testimonies, , we believe the information enables a reflection with regard to adherence to treatment in the
perception of PLWHA undergoing TB treatment.
Conclusion
The present study investigated issues related to adherence to treatment of TB/HIV coinfection, including the health-disease process, drug treatment
and care in health services. In this sense, we highlight that the establishment of a bond between the
user and the healthcare team favors adherence, as
well as the support networks and incentives provision. On the other hand, social stigma and prejudice involving both conditions may negatively interfere with treatment adherence. The findings of
this study corroborate WHO End of TB Strategy
pillars, since they demonstrate the importance of
patient-centered, integrated care, in close connection with bold policies that promote access to treatment at good quality healthcare services, where a
stable bond with the user can be maintained.
Acknowledgements
To the São Paulo Research Support Foundation
(FAPESP) for granting a Scientific Initiation scholarship (Process 2018/02915-0).
Collaborations
Silva ARS, Hino P, Bertolozzi MR, Oliveira JC,
Carvalho MVF, Fernandes H and Sakabe S declare
that they contributed to the design of the project,
analysis and interpretation of data, writing of the
article, critical review of the intellectual content and
final approval of the version to be published.
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