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  • 1
    Online Resource
    Online Resource
    The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions
    FapUNIFESP (SciELO) ; 2019
    In:  Revista Brasileira de Epidemiologia Vol. 22, No. suppl 1 ( 2019)
    Details
    In: Revista Brasileira de Epidemiologia, FapUNIFESP (SciELO), Vol. 22, No. suppl 1 ( 2019)
    Abstract: RESUMO Introdução: Modelos de cuidado contínuo baseiam recentes estratégias em HIV, infecções sexualmente transmissíveis e hepatite C (HCV). Métodos: Desenvolveram-se modelos de contínuo do cuidado em HIV, HCV e sífilis congênita incluindo todas as etapas da atenção, desde a promoção e a prevenção até o controle clínico/cura. O modelo baseou a intervenção QualiRede, desenvolvida em parceria entre universidade e Sistema Único de Saúde (SUS), direcionada a gestores e demais profissionais de 6 regiões de saúde prioritárias em São Paulo e Santa Catarina. Selecionaram-se indicadores para cada etapa do contínuo do cuidado, provenientes dos sistemas de informação do SUS e dos questionários de avaliação de processo Qualiaids e QualiAB. Os indicadores formaram a base técnica de duas oficinas com profissionais e gestores de cada região: a primeira para identificar problemas e formar um Grupo Técnico Regional; e a segunda para construir planos de ação e metas a fim de melhorar o desempenho regional. Resultados: Os indicadores estão disponíveis no website www.qualirede.org. As oficinas ocorreram em quatro regiões de São Paulo (Alto Tietê, Baixada Santista, Grande ABC e Registro) e uma região de Santa Catarina (Foz do Rio Itajaí), resultando em planos regionais em São Paulo, mas não em Santa Catarina. Observou-se domínio limitado dos novos protocolos para HIV e HCV e uso incipiente de indicadores na rotina dos serviços. Conclusão: Melhorar o desempenho do contínuo do cuidado exige apropriação dos indicadores de desempenho e coordenação integrada dos fluxos de atenção em todos os níveis de gestão.
    Type of Medium: Online Resource
    ISSN: 1980-5497 , 1415-790X
    URL: Article
    DOI: 10.1590/1980-549720190010.supl.1
    Language: English
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2019
    detail.hit.zdb_id: 2183366-7
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  • 2
    Online Resource
    Online Resource
    Avaliação dos serviços ambulatoriais de assistência a pessoas vivendo com HIV no Sistema Único de Saúde: estudo comparativo 2007/2010
    FapUNIFESP (SciELO) ; 2018
    In:  Cadernos de Saúde Pública Vol. 34, No. 2 ( 2018-02-19)
    Details
    In: Cadernos de Saúde Pública, FapUNIFESP (SciELO), Vol. 34, No. 2 ( 2018-02-19)
    Abstract: Health services play a crucial role in reaching the 90-90-90 target of controlling the HIV epidemic. This study evaluates the organization of Brazilian health services in improving, monitoring, and retention in HIV care and adherence support. Percentage variation (PV) was used to compare the responses by services to an evaluation questionnaire on organizational quality (Qualiaids) in 2007 and 2010. The study analyzed the 419 services that completed the questionnaire in 2007 (83.1% of respondents) and 2010 (63.6%). Management actions of retention and support although increased in the period, but remained at low rates, for example: systematic meetings for case discussion (32.7% in 2010; PV = 19.8%) and recording of missed medical appointments (35.3%; PV = 36.8%). Patient care actions related to adherence to ART remained largely exclusive to the attending physician. The supply of funds and resources from the Federal Government (medicines and specific HIV tests) remained high for the vast majority of the services (~90%). It will not be possible to achieve a significant decrease in HIV transmission as long as retention in treatment is not a priority in all the health services.
    Type of Medium: Online Resource
    ISSN: 1678-4464 , 0102-311X
    URL: Article
    DOI: 10.1590/0102-311x00047217
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2018
    detail.hit.zdb_id: 2027139-6
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  • 3
    Online Resource
    Online Resource
    Avaliação de serviços de assistência ambulatorial em aids, Brasil: estudo comparativo 2001/2007
    FapUNIFESP (SciELO) ; 2013
    In:  Revista de Saúde Pública Vol. 47, No. 1 ( 2013-02), p. 137-146
    Details
    In: Revista de Saúde Pública, FapUNIFESP (SciELO), Vol. 47, No. 1 ( 2013-02), p. 137-146
    Abstract: OBJECTIVE: To assess Brazilian Unified Health System outpatient services delivering care to adults living with AIDS in 2007 and to compare with the assessment conducted in 2001. METHODS: The 636 health services registered in the Ministry of Health in 2007 were invited to respond to a previously validated questionnaire (Qualiaids Questionnaire) with 107 multiple-choice questions about the organization of care delivery. It analyzed the frequencies of responses to the 2007 questionnaire compared with those found in that of 2001 through percent variation (PV). RESULTS: 504 (79.2%) of the services responded to the questionnaire. Almost 100.0% of the respondents reported having essential resources for outpatient care: having at least one doctor, sufficient supplies of antiretroviral drugs, CD4 and viral load tests. Many aspects displayed improvement in 2007 compared to 2001: registry of missed medical appointments (from 18.3 to 27.0%, PV: 47.5%), follow-up appointment within 15 days of starting antiretroviral treatment (from 55.3 to 66.2%, PV: 19.7%) and user's organized participation (from 5.9 to 16.7%, PV: 183.1%). However, some difficulties remained: little change in the availability of specialized exams, such as endoscopy, within 15 days, (31.9 to 34.5%, PV: 8.1%) and decreases in indicators such as optimal time access to specialized appointments (55.9 to 34.5% in cardiology, negative PV: 38.3%). Mean time spent in follow-up medical appointments remained low: about 15 minutes (52.5 to 49.5%, negative PV: 5.8%). CONCLUSIONS: The 2007 assessment revealed that services have essential resources for ambulatory assistance. There was some improvement in many aspects compared to 2001, although some challenges still remain. Little time dedicated to medical appointments may be linked to insufficient number of doctors and/or due to reduced capacity of listening and dialogue. Impaired access to specialized appointments reveals the difficulty local Brazilian Unified Health System facilities have regarding infrastructure.
    Type of Medium: Online Resource
    ISSN: 0034-8910
    URL: Article
    DOI: 10.1590/S0034-89102013000100018
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2013
    detail.hit.zdb_id: 2031055-9
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  • 4
    Online Resource
    Online Resource
    Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil
    FapUNIFESP (SciELO) ; 2006
    In:  Revista de Saúde Pública Vol. 40, No. 1 ( 2006-02), p. 143-151
    Details
    In: Revista de Saúde Pública, FapUNIFESP (SciELO), Vol. 40, No. 1 ( 2006-02), p. 143-151
    Abstract: OBJECTIVE: In the context of universal access to antiretroviral treatment, the results of the Brazilian AIDS Program will depend on the quality of the care provided. The aim of the present study was to evaluate the healthcare provided by outpatient services for the treatment of AIDS patients. METHODS: The present study was carried out in seven Brazilian States between 2001 and 2002. We evaluated the quality of the care provided to AIDS patients from the standpoint of resource availability and care process organization. A questionnaire comprising 112 structured questions addressing these aspects was sent to 336 services. RESULTS: Response rate was 95.8% (322). Greater adequacy is seen for indicators of resource availability than for those of work organization. The supply of antiretroviral medication is sufficient in 95.5% of services. CD4 and viral load tests are available at adequate amounts in 59 and 41% of services, respectively. In 90.4% of services there is at least one non-medical professional (psychologist, nurse, or social worker). As to work organization, 80% scheduled the date but not the time of medical appointments; 40.4% scheduled more than 10 appointments per period; 17% did not have exclusive managers; and 68.6% did not hold systematic staff meetings. CONCLUSIONS: The results indicate that, in addition to ensuring the more homogeneous distribution of resources, the program must invest in the training and dissemination of care management skills, as confirmed by the results of care process organization.
    Type of Medium: Online Resource
    ISSN: 0034-8910
    URL: Article
    DOI: 10.1590/S0034-89102006000100022
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2006
    detail.hit.zdb_id: 2031055-9
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  • 5
    Online Resource
    Online Resource
    Development and validation of the WebAd-Q Questionnaire to monitor adherence to HIV therapy
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2018
    In:  Revista de Saúde Pública Vol. 52 ( 2018-05-22), p. 62-
    Details
    In: Revista de Saúde Pública, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 52 ( 2018-05-22), p. 62-
    Abstract: OBJECTIVE: To present the development and validation of the WebAd-Q Questionnaire, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/AIDS centers in Brazil. METHODS: The WebAd-Q is an electronic questionnaire that has three questions about the use of antiretrovirals in the last week. It was constructed from interviews and focus groups with 38 patients. Its validity was tested in a study with a sample of 90 adult patients on antiretroviral therapy for at least three months. We used electronic monitoring bottles, pill counting, and self-report interview to compare adherence. The WebAd-Q was answered on the sixtieth day, twice, with at least one hour of interval. The viral load of the patients was obtained from the service records. We have analyzed the agreement between the answers to the WebAd-Q, the associations, and the correlations with viral load and performance compared to other measures of adherence. RESULTS: Among the invited patients, 74 (82.2%) answered the WebAd-Q. No difficulties were reported to answer the questionnaire. The average answer time was 5 min 47 sec. The set of three questions of the WebAd-Q obtained agreement of 89.8%, with Kappa of 0.77 (95%CI 0.61–0.94). The non-adherence answers of the WebAd-Q were associated with detectable viral load. We obtained moderate viral load correlations with the non-adherence scale according to the WebAd-Q. For the three questions of the WebAd-Q, patients with non-adherence answers were also reported as less adherent according to the other measures of adherence. CONCLUSIONS: The WebAd-Q answered all the issues considered relevant in the validation of questionnaires, was well understood by patients, was associated with viral load, and obtained good agreement and good performance compared to the other measures. The feasibility analysis of its implementation still depends on a national study on its applicability.
    Type of Medium: Online Resource
    ISSN: 1518-8787 , 0034-8910
    URL: Article
    DOI: 10.11606/S1518-8787.2018052000337
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2018
    detail.hit.zdb_id: 2031055-9
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  • 6
    Online Resource
    Online Resource
    Pessoas vivendo com HIV/Aids no cárcere: regularidade no uso da terapia antirretroviral
    FapUNIFESP (SciELO) ; 2019
    In:  Acta Paulista de Enfermagem Vol. 32, No. 5 ( 2019-10), p. 521-529
    Details
    In: Acta Paulista de Enfermagem, FapUNIFESP (SciELO), Vol. 32, No. 5 ( 2019-10), p. 521-529
    Abstract: Resumen Objetivo analizar los desafíos relacionados con la regularidad del uso del tratamiento antirretroviral por personas privadas de la libertad que viven con el VIH. Métodos se trata de un estudio exploratorio, con enfoque cuantitativo, realizado en seis unidades penitenciarias de dos municipios del estado de São Paulo. La recolección de datos se llevó a cabo en el período de agosto a noviembre de 2015 mediante entrevistas, con apoyo de instrumento específico. Los datos fueron analizados a partir de técnicas descriptivas, análisis univariado (prueba χ2 de Pearson y prueba exacta de Fisher) y prueba no paramétrica U de Mann-Whitney. Resultados participaron de la investigación 67 individuos en tratamiento antirretroviral. Se identificó que, en los últimos siete días, el 80,6% de los individuos no dejó de tomar los medicamentos antirretrovirales y un 91% negó haber tomado la cantidad equivocada de comprimidos, de acuerdo con la prescripción médica. Con relación a las acciones de monitoreo del tratamiento antirretroviral, el cuestionamiento sobre el uso continuo de los medicamentos por el equipo de salud de las unidades penitenciarias fue considerado regular. El tratamiento antirretroviral irregular presentó una relación estadísticamente significativa con el uso de drogas lícitas antes del encarcelamiento (p=0,006) y la interrupción del seguimiento médico (p=0,014). Conclusión tales descubrimientos demuestran la necesidad de estrategias de intervención que favorezcan el seguimiento y monitoreo del uso del tratamiento antirretroviral en el contexto penitenciario.
    Type of Medium: Online Resource
    ISSN: 1982-0194 , 0103-2100
    URL: Article
    DOI: 10.1590/1982-0194201900073
    Language: Portuguese
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2019
    detail.hit.zdb_id: 2506970-6
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  • 7
    Online Resource
    Online Resource
    Atividades para melhoria da adesão à TARV em serviços de saúde do SUS no estado de São Paulo, 2007
    FapUNIFESP (SciELO) ; 2009
    In:  Saúde e Sociedade Vol. 18, No. suppl 2 ( 2009-06), p. 79-83
    Details
    In: Saúde e Sociedade, FapUNIFESP (SciELO), Vol. 18, No. suppl 2 ( 2009-06), p. 79-83
    Abstract: The success of antiretroviral therapy for AIDS treatment depends on the maintenance of high rates of adherence to drug therapy. Despite the emphasis given to the question by the Brazilian STD / AIDS Program, the adherence technologies that are in course on outpatient services are not known. Based on the analysis of a semi-structured questionnaire distributed to all outpatient services of the State of São Paulo, this study describes the types of interventions that have been implemented. In the State of São Paulo, adherence to HAART is incorporated into the activities of outpatient services. Almost all services inform interventions administered to individuals, and the majority, at least one group intervention to improve adherence. However, in many outpatient services, adherence interventions, as well as the assessment of patient's adherence, take place during nursing and medical consultations. This indicates that the adherence technology approach consists predominantly of questioning and discussions with the patient, meaning that the professionals decide when and how they address adherence. The larger and more specialized services tend to have more qualified and more specific activities.
    Type of Medium: Online Resource
    ISSN: 0104-1290
    URL: Article
    DOI: 10.1590/S0104-12902009000600013
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2009
    detail.hit.zdb_id: 2424415-6
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  • 8
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    Online Resource
    The variability and predictors of quality of AIDS care services in Brazil
    Springer Science and Business Media LLC ; 2009
    In:  BMC Health Services Research Vol. 9, No. 1 ( 2009-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2009-12)
    Abstract: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery. Methods The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality. Results The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities. Conclusion The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/1472-6963-9-51
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2009
    detail.hit.zdb_id: 2050434-2
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  • 9
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    Avaliação da qualidade da assistência no programa de AIDS: questões para a investigação em serviços de saúde no Brasil
    FapUNIFESP (SciELO) ; 2004
    In:  Cadernos de Saúde Pública Vol. 20, No. suppl 2 ( 2004), p. S310-S321
    Details
    In: Cadernos de Saúde Pública, FapUNIFESP (SciELO), Vol. 20, No. suppl 2 ( 2004), p. S310-S321
    Abstract: This article discusses a study focused on quality care in health services under the Brazilian AIDS Program. Research in 2001-2003 involved three different projects: an in-depth analysis of the predominant health care pattern in five services, a qualitative evaluation of 27 services, and a structured evaluation of 322 services from seven Brazilian states. Through a description of the projects' stages, the authors discuss issues on theoretical and methodological approaches to evaluation of care in health programs. The discussion also focuses on key problems with the applicability and impact of health services evaluation.
    Type of Medium: Online Resource
    ISSN: 0102-311X
    URL: Article
    DOI: 10.1590/S0102-311X2004000800024
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2004
    detail.hit.zdb_id: 2027139-6
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  • 10
    Online Resource
    Online Resource
    Desafios da adesão ao tratamento de pessoas vivendo com HIV/Aids no Brasil
    FapUNIFESP (SciELO) ; 2007
    In:  Revista de Saúde Pública Vol. 41, No. suppl 2 ( 2007-12), p. 87-93
    Details
    In: Revista de Saúde Pública, FapUNIFESP (SciELO), Vol. 41, No. suppl 2 ( 2007-12), p. 87-93
    Abstract: OBJECTIVE: To analyze the difficulties related to treatment adherence by patients living with HIV/AIDS in highly active antiretroviral therapy. METHODS: Qualitative research based on 34 interviews with patients under treatment in several outpatient services in the state of São Paulo, in 1998-1999. The group was comprised of people from different socioeconomic levels, gender, length of treatment and varied adherence levels, according to healthcare staff perception. The interviews focused on the patient's narrative about his/her disease. The content analysis classified the difficulties as follows: related to social factors and life styles, including the stigma; related to beliefs about the use of medication; and directly related to the use of medication. RESULTS: All the interviewees reported having difficulties concerning the stigma of living with HIV/AIDS. The difficulties related to the use of medication were the most important among patients with the best adherence level. Patients with average adherence level presented all three types of difficulties. CONCLUSIONS: Social and cultural factors are more difficult to be overcome in order to achieve treatment adherence than those related to taking medication, thus making the role played by the health sector important, supported by clear public social policies. These dimensions must be faced not only in the health sector, but also on social and political levels.
    Type of Medium: Online Resource
    ISSN: 0034-8910
    URL: Article
    DOI: 10.1590/S0034-89102007000900014
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2007
    detail.hit.zdb_id: 2031055-9
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