27 The incorporation of a screening instrument for drug use among caregivers may contribute to strategies aiming to improve adherence in the pediatric population, since among HIV-infected adults, the proper management of substance abuse has been associated with commitment to cART treatment.28 In fact, substance abuse has been identified
as a relevant public health problem and the WHO recommends the use of ASSIST as a screening Quizartinib manufacturer tool to be incorporated in primary health care settings and in all contexts where a significant proportion of patients may be exposed to it, such as in sexually transmitted disease clinics. According to WHO guidelines, the routine use of ASSIST increases the opportunities for early detection of drug abuse and for launching a discussion about it with both patients and their families. This study confirmed that pharmacy reports are accurate predictors of viral suppression. Similar results have been found among HIV-infected adults in Africa,29 as well as in Brazilian adults, children, and adolescents.12 and 30 GDC-0941 in vitro Pharmacy reports can provide useful information that can be easily incorporated into routine care as a monitoring tool. The Brazilian AIDS department defines pharmacy visits with intervals greater than 38 days as indicative of non-adherence, and advises
health units to utilize
mechanisms to alert professionals whenever this happens. The present results reinforce the need to trigger the alert mechanism as soon as delays occur. The limitations of this study include putative biases related to patient selection at the sites (probably comprising intra- as well as inter-site unmeasured heterogeneities) and the cross-sectional design, which did not allow the evaluation of adherence over time and the proper definition of the directionality of some of the observed associations (i.e., those in which bidirectional associations are plausible). Unfortunately, data regarding PLEKHM2 HIV genotyping was not available for all patients, and thus this aspect of virological failure was not evaluated. The relatively small number of patients enrolled in some sites did not allow for a statistical analysis stratified by geographical location (i.e., the respective five Brazilian macro-regions). We report the findings from a Brazilian multicenter study on cART adherence in a pediatric population. This study’s findings indicate the usefulness of pharmacy reports along with the use of an integrated package of standard instruments, such as WHOQOL-BREF and ASSIST, which should be used in an attempt to provide a more comprehensive approach and optimal management and care for families with children and adolescents living with HIV/AIDS.