Can the absence of drug dispensing units in municipalities influence the abandonment of treatment by people living with HIV/AIDS?

Abstract

Objective: to verify the existence of an association between abandonment to antiretroviral therapy (ART) by PLWHA and the lack of dispensing service in municipalities located in southern Brazil. Methods: an exploratory and analytical study was carried out based on records of People Living with HIV/AIDS (PLWHA) abandoning antiretroviral therapy (ART) in the South region of Brazil. We included the record of individuals who had not taken their medications for at least one hundred days. Data were collected through the Drugs Management System (SICLOM), Clinical Monitoring System of People Living with HIV/AIDS (SIMC) and Laboratory Test Control System (SISCEL), from october to november 2022, referring to records of users dated between 1986 and 2022. Results: the records of 21,861 users were checked. The mean abandonment rate was 814±831.7 days, ranging from 101 to 4,276 days. Most PLWHA on ART lived in Rio Grande do Sul (n=10,951; 50.1%), one of the states with the highest incidence of AIDS. Regarding the other socio-demographic characteristics, it was revealed that most were male (n=12,300; 56.4%), living in the countryside (n=15,905; 72.8%), with a mean age of 42.1±13.0, white (n=13,053; 59.7%) and with 4 to 7 years of schooling (n=6,192; 28.3%). The average time of ART use was 7.9±2.1 years, and 49.0% (n=10,718) of PLWHA before abandoning treatment had an undetectable viral load (<50 copies/mm3). In parallel to this, it was observed that the research participants who lived in cities that did not have Drug Dispensing Units (DDU) (p<0.02) had a 14.9% (CI 14.5 - 15.3) higher chance of abandoning their therapy when compared to those who lived in cities that had antiretroviral dispensing service. Conclusion: these findings pointed out that the abandonment of ART by PLWHA may be associated with the spatial distribution of DDUs. Therefore, decentralizing access to antiretroviral drugs is a strategy that can positively impact the quality of life and increase the survival time of patients in southern Brazil.