The place of antiretroviral therapy in the behavioral strategies aimed at maintaining the health and quality of counseling of people living with HIV

Objective. To assess the place of antiretroviral therapy (ART) in the structure of behavioral strategies aimed at maintaining the health of people and at their retaining the amount of counseling on follow-up and treatment adherence in clinical practice.

Subjects and methods. In 2019-2020, a total of 331 HIV-infected patients were surveyed by a continuous sampling method during a planned follow-up visit. Group 1 consisted of 165 respondents who were registered at the Republican Center for Prevention and Control of AIDS and Communicable Diseases, Ministry of Health of the Republic of Tatarstan. There were 84 men and 77 women in the group; the median (Me) age was 39.0 years [34; 45]. The Me life expectancy for patients with HIV was 9 years [4; 16]. ART was prescribed to 93.13% of the respondents. Group 2 included 166 respondents, the patients (91 men and 75 women) of the Leningrad Regional Center for Prevention and Control of AIDS and Communicable Diseases. The Me age was 39.0 years [35; 45]. The Me life expectancy for patients with HIV was 8 years. 89.76% of respondents received ART.

Results. Group 1 respondents presented 280 units of content, an average of 1.7 strategies. In Group 2, there were 370 health care strategies, an average of 2.3 strategies. The share of different medical strategies for health care was 17.86% in Group 1 and 35,67% in Group 2 (p < 0,05); moreover, among this group of strategies, both patient groups showed a preponderance of ART-related ones. In Group 2, “receiving therapy” was the leading strategy (23,78% of the total content of strategies) among all types of health maintenance, whereas in Group 1, ART-related strategies (13,57%) were inferior to physical activity (18.93%) and nutrition (18.93%). Singling out ART among the health maintenance strategies indicates a high level of awareness among the respondents about the role of ART in maintaining health; such respondents were 38 (23,75%) in Group 1 and 88 (55,35%) in Group 2. In these groups, health care by maintaining a healthy lifestyle was reported by 75,36 and 54,86% of the respondents, respectively (p < 0,05). There was no significant difference between the shares of strategies related to mental health care: these strategies were reported in Groups 1 (2,86%) and 2 (5,95%) (p = 0,05). The full volume of counseling was kept in memory by 24,37% of the respondents in Group 1 and by 34,37% in Group 2. The respondents most often identify the discussion of side effects of therapy, the rules to follow when taking prescribed drugs, and the need for meeting the medical guidelines, and that for for treatment. The respondents of both groups most infrequently indicated the «causes of inappropriate medication use» and «attitude to treatment» among the other options to be discussed.

Conclusion. The majority of the respondents underestimate the role of ART in the health maintenance process; «receiving ART» is built into the health maintenance process only in one quarter of the respondents in Group 1 and in half of those in Group 2. The main counseling errors in both groups were insufficient work with the identification and prevention of the causes of noncompliant behavior. Involvement of works with the risks of non-compliance in the communication process can substantially enhance the effectiveness of counseling.