Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 2 - Apr/Jun - 2019

Review Article Imprimir 

Páginas 110 a 119


Adherence to antiretroviral treatment among adolescents living with HIV /Aids: an integrative review of the literature

Adherencia al tratamiento antirretroviral entre adolescentes que viven con VIH/SIDA: Revisión Integral de la Literatura

Adesão ao tratamento antirretroviral entre adolescentes vivendo com HIV/ Aids: Revisão Integrativa da Literatura

Autores: Mayra da Silva Marques1; Marcelo Siqueira de Oliveira2; Monica Taminato3; Dayana Fram4

1. Graduation in Nursing by the Paulista School of Nursing from the Federal University of São Paulo. São Paulo, SP, Brazil
2. Doctorate in Sciences by the Federal University of São Paulo (UNIFESP). Teacher by the Multidisciplinary Center of Cruzeiro do Sul from Federal University of Acre (UFAC). Cruzeiro do Sul - AC - Brazil
3. Doctorate in Sciences by the Federal University Federal of São Paulo (UNIFESP). Teacher of the Paulista School of Nursing from the Federal University of São Paulo (UNIFESP). São Paulo, SP, Brazil
4. Doctorate in Sciences by the Federal University of São Paulo (UNIFESP). Nurse of the Infection Control Service at the São Paulo Hospital of the Federal University of São Paulo. São Paulo, SP, Brazil

Correspondência:
Mayra da Silva Marques
Rua Napoleão de Barros, nº 754, Vila Clementino
São Paulo, SP, Brasil. CEP: 04024-002
(may-marques11@outlook.com)

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Keywords: Medication Adherence; HIV; Acquired Immunodeficiency Syndrome; Adolescent.
Palabra Clave: Adhesión a la Medicación; HIV; Síndrome de Inmunodeficiencia Adquirida; Adolescente.
Descritores: Adesão à Medicação; HIV; Síndrome de Imunodeficiência Adquirida; Adolescente.

Abstract:
OBJECTIVE: Identify in the literature the factors that interfere in adherence to drug therapy in adolescents living with HIV/Aids.
DATA SOURCE: An integrative literature review was carried out, with searches in five databases. We used the descriptors in health sciences (DeCS) and Medical Subject Headings (MeSH), namely: adherence to medication, HIV, Acquired Immunodeficiency Syndrome, adolescent and Medication Adherence, HIV, Acquired Immunodeficiency Syndrome, Adolescent, respectively. Were selected articles in Portuguese, English and Spanish from 2007 to 2017, with full texts available.
DATA SYNTHESIS: After the survey, 34 articles were found and after inclusion of the inclusion criteria, six articles were selected. Of these, five in Portuguese (83.3%), conducted in Brazil and one in English (16.7%), conducted in the United States of America. As to the type of study, four of them have qualitative data (66.6%), one have mixed methodology (16.7%) and one of literature review (16.7%). After reading the selected articles, four categories emerged in relation to adherence: factors related to drug characteristics, factors related to the effects of treatment and posology, social and economic factors, and factors related to age.
CONCLUSION: Knowledge of the factors that influence adherence is fundamental so that nurses and other health professionals can provide comprehensive care and develop strategies that favor adherence to treatment, improving the attitude of adolescents and their caregivers, enhancing their capacity to self-care.

Resumen:
OBJETIVO: Identificar en la literatura los factores que interfieren en la adhesión a la terapéutica medicamentosa en adolescentes viviendo con HIV/Sida.
FUENTE DE DATOS: Fue realizada una revisión integral de la literatura, con búsqueda en cinco bases de datos. Fueron utilizados los descriptivos en ciencias de la salud (DeCS) y el Medical Subject Headings (MeSH), siendo ellos: adhesión a la medicación, HIV, Síndrome de Inmunodeficiencia adquirida, adolescente y Medication Adherence, HIV, Acquired Immunodeficiency Syndrome, Adolescent, respectivamente. Fueron seleccionados artículos completos en lengua portuguesa, inglesa y española de 2007 a 2017.
SÍNTESIS DE LOS DATOS: Fueron encontrados 34 artículos y luego de la aplicación de los criterios de inclusión fueron seleccionados seis artículos. De esos, cinco en lengua portuguesa (83,3%), realizados en Brasil y uno en lengua inglesa (16,7%), realizado en Estados Unidos de América. Respecto al tipo de estudio, cuatro de ellos tienen datos cualitativos (66,6%), uno tiene metodología mixta (16,7%) y uno de revisión de literatura (16,7%). Luego de la lectura de los artículos seleccionados, emergieron cuatro categorías en relación a la adhesión: factores relacionados a las características de los fármacos, a los efectos del tratamiento y posología, factores sociales y económicos y la franja etaria.
CONCLUSIÓN: El conocimiento de los factores que influencian en la adhesión es fundamental para que enfermeros y demás profesionales de salud puedan ofrecer un cuidado integral y desarrollar estrategias que favorecen a la adhesión al tratamiento, mejorando la actitud de los adolescentes y de sus cuidadores, potencializando su capacidad de autocuidado.

Resumo:
OBJETIVO: Identificar na literatura os fatores que interferem na adesão à terapêutica medicamentosa em adolescentes vivendo com HIV/Aids.
FONTES DE DADOS: Foi realizada uma revisão integrativa da literatura, com buscas em cinco bases de dados. Foram utilizados os descritores em ciências da saúde (DeCS) e o Medical Subject Headings (MeSH), sendo eles: adesão à medicação, HIV, Síndrome da Imunodeficiência adquirida, adolescente e Medication Adherence, HIV, Acquired Immunodeficiency Syndrome, Adolescent, respectivamente. Foram selecionados artigos completos em língua portuguesa, inglesa e espanhola de 2007 a 2017.
SÍNTESE DOS DADOS: Foram encontrados 34 artigos e após a aplicação dos critérios de inclusão foram selecionados seis artigos. Desses, cinco em língua portuguesa (83,3%), realizados no Brasil e um em língua inglesa (16,7%), realizado nos Estados Unidos da América. Quanto ao tipo de estudo, quatro deles tem dados qualitativos (66,6%), um tem metodologia mista (16,7%) e um de revisão de literatura (16,7%). Após a leitura dos artigos selecionados, emergiram quatro categorias em relação à adesão: fatores relacionados às características dos fármacos, aos efeitos do tratamento e posologia, fatores sociais e econômicos e a faixa etária.
CONCLUSÃO: O conhecimento dos fatores que influenciam na adesão é fundamental para que enfermeiros e demais profissionais da saúde possam prestar um cuidado integral e desenvolver estratégias que favorecem à adesão ao tratamento, melhorando a atitude dos adolescentes e de seus cuidadores, potencializando sua capacidade de autocuidado.

INTRODUCTION

The human immunodeficiency virus (HIV) is the causative agent of acquired immunodeficiency syndrome (AIDS), a disease that affects the immune system of humans, and mainly affects T CD4+ lymphocytes. HIV uses the deoxyribonucleic acid (DNA) of these cells for the viral replication process, and later causes their destruction causing a reduction in the global count of these lymphocytes, which makes the body more vulnerable to infections1.

The first cases were identified in the United States of America in the early 1980s and subsequently spread throughout the world, including Brazil. The disease has become a pandemic and a serious public health problem2,3.

According to the latest national epidemiological bulletin, since the onset of the disease in Brazil (1980) until June 2017, there were 882,810 case reports of patients living with HIV/AIDS. From 2007 to June 2017, a total of 194,217 cases were notified to the national notification system (Sinan), and in 2007 there were 6,861 cases. In the first half of 2017, 16,365 new cases were notified, which shows a significant increase4.

In 2007, 104 new cases were reported among adolescents, and in the first half of 2017, 688 cases were reported, representing an increase of approximately 600% in just ten years4. Despite the increasing number of cases, mortality in this population has been decreasing in Brazil since 1996, with the creation of Law No. 9,313/96, which guarantees to all people diagnosed with the disease access to medication through the Unified Health System. health (SUS)1.

Data from the United Nations Programme on HIV/AIDS (UNAIDS) showed an increase in the total number of adolescents aged 15-19 years living with HIV/AIDS in 25 countries, the increase from approximately 800,000 in 2005 to 940,000 in 20155.

HIV infection has been considered lately as a potentially controllable chronic disease since the emergence of combined antiretroviral therapy (ART) and the availability of biomarkers such as CD4 T-lymphocyte count and viral load to monitor the disease progression. These advances greatly help people's lives6.

Upon entering the human cell, the virus causes an uncoordinated multiplication of the infected cells. The antiretroviral act in various stages of replication, slowing the development of the disease and reducing the amount of virus in the body7. However, it is known that the effectiveness of treatment depends on good adherence and correct use of medication, avoiding the emergence of resistant strains8.

The factors for adherence among children and adolescents are diverse, considering that children often depend on their caregiver for the administration of medication, so it is necessary that not only the child is responsible for adherence, but also their caregiver. Bronwyne et al.9 analyzed the barriers and facilitators of adherence within the pediatric community in South Africa, where the unpleasantness of the medication and the amount to be taken as the main factor for non-adherence were observed, given that the tablets They are large and often the child takes the pills more than once a day. In addition, administration problems were reported by the caregiver, which is not always unique, leading to drug administration failures.

In Brazil, studies10,11 show a reality not unlike South Africa when it comes to the adolescent scenario. The difficulty in administering the complex therapeutic regimen, which often requires a change in lifestyle that the caregiver and patient are unprepared for; the non-disclosure of the diagnosis by the caregiver for fear of stigma and prejudice; the difficulties related to the understanding of young people facing the need for treatment; and the palatability of drugs. Given the absence of drugs exclusively for the age group, these are conditions that interfere with the process of treatment adherence. These factors favor the clinical evolution of the disease and may lead the child or adolescent to severe outcomes and death.

Given the above, it is possible to highlight that adherence to drug therapy is a daily challenge and nursing professionals, as members of the multidisciplinary team in health services and care for people living with HIV/AIDS, have a fundamental role to develop strategies aimed at adherence to treatment in the adolescent population, to improve the attitude of adolescents and their caregivers. Thus, the aim of the present study was to identify the factors that interfere with adherence to drug therapy in adolescents living with HIV/AIDS, and thus contribute to health professionals to provide comprehensive care by strengthening and improving decision-making capacity in the health care sector regarding to the adherence to treatment of that population.


METHOD

Ethical aspects

This study was submitted and approved by the Ethics and Research Committee of the Federal University of São Paulo under protocol number 1376/2017.

An integrative literature review was conducted on the factors that interfere with adherence to drug therapy in adolescents living with HIV/AIDS. The research was conducted from September 2017 to May 2018, and the six methodological steps of the integrative review were used12,13.

In the first stage, the study's guiding question was formulated: "What are the main factors that interfere with adherence to antiretroviral treatment in adolescents?". From the elaboration of the question, the keywords were defined according to the descriptors in health sciences (DeCS) and the Medical Subject Headings (MeSH), namely: medication adherence, HIV, Acquired Immunodeficiency Syndrome, adolescent and Medication Adherence, HIV, Acquired Immunodeficiency Syndrome, Adolescent, respectively.

In the second stage the criteria for inclusion and exclusion of the studies were established and the search databases were defined. Inclusion criteria were: national and international articles, published from 2007 to 2017, in Portuguese, English and Spanish, with full texts available, related to the research question. The following exclusion criteria were adopted: theses and dissertations and articles whose theme did not refer to the central object of study of the research. The scientific databases used were: Scientific Electronic Library Online (SCIELO) and US National Library of Medicine (PUBMED), and through the Virtual Health Library (VHL) the following databases were accessed: Latin American and Caribbean Literature on Social Sciences and of Health (LILACS), Nursing Database (BDENF), Medical Literature Analysis and Retrieval System Online (MEDLINE). The selection of articles was primarily by reading their titles/abstracts, and finally the studies were analyzed in full. Figure 1 show how the search was done in each database.


Figure 1. Stages of article selection in the databases analyzed in the present study.



For the third stage, an instrument for the organization and analysis of the results was elaborated (table 1), which included: (1) authors, place and date of publication, (2) study objective, (3) type of study/method, (4) main results and (5) level of evidence, according to the Melnyk and Fineout-Overholt14 model:


Level 1- Evidence from systematic review or meta-analysis of all relevant randomized controlled trials or derived from clinical guidelines based on systematic reviews of randomized controlled trials;

Level 2- Evidence derived from at least one well-designed randomized controlled trial;

Level 3 - Evidence obtained from well-designed clinical trials without randomization;

Level 4- Evidence from well-designed cohort and case-control studies;

Level 5 - Evidence from systematic review of descriptive and qualitative studies;

Level 6 - Evidence derived from a single descriptive or qualitative study;

Level 7 - Evidence from the opinion of authorities and/or expert committee report.


In the fourth stage, the analysis of the studies that were included in the review was performed, in which the previously selected articles were read in full and the inclusion criteria were applied. In the fifth stage the results were discussed and in the sixth the descriptive report of this integrative review was built.


RESULTS

Using the methodology employed, six articles were selected, five in Portuguese (83.3%), performed in Brazil and one in English (16.7%), and conducted in the United States of America. The oldest study dates from 2009, and the most recent from 2015; and in 2013 two studies were published.

Chart 1 shows the synthesis of the articles selected for the present study, presented in ascending chronological order:




The research presented was published in journals of three areas of knowledge: four in nursing (66.6%), one in psychology (16.7%) and one in the medical field (16.7%). Regarding the education of the first author of the studies, 66.6% (n = 4) are nurses, 16.7% (n = 1) psychologists and 16.7% (n = 1) dentists.

In the design of the selected studies, four of them are qualitative (66.6%), one used mixed methodology (16.7%) and one reviewed the literature (16.7%). Regarding the classification of the level of evidence according to the selected method, it can be noted that all studies are of type VI, that is, evidence derived from a single descriptive or qualitative study.

Adherence to treatment is known to be a phenomenon that has several dimensions, not depending on a single factor for it to happen. Regarding the objective of this review, that is, to identify the factors that interfere with adherence to drug therapy in adolescents with HIV/AIDS, after reading the selected articles, four categories emerged regarding adherence, described below:

Factors related to drug characteristics

Among the six studies selected, five (83.3%) have drug-related factors as barriers to non-adherence. Factors such as the amount of pills to be taken and characteristics of the drug, such as the taste, odor and size of the pills, which are not suitable for this population are cited.

Factors related to the effects of treatment and dosage

Five studies (83.3%) bring the goal of treatment as a factor for non-adherence, due to the fact that treatment does not cure the disease, only control it, which implies taking these drugs throughout their lives.

The same studies also limit adherence to the number of times they need to take the medication, at strict times that almost always conflict with the activities of daily life of adolescents, such as going to school, for example, as well as the various collateral effects.

Social and economic factors

Human immunodeficiency virus infection still carries a great deal of stigma, prejudice and discrimination. These factors make it difficult in many aspects to cope with the disease, such as adherence to drug therapy. This fact is brought up in four studies (66.6%) that make up this review. Situations in which there is a need to take the drug in public are an obstacle to adherence, as many adolescents see that this moment may favor the discovery of the diagnosis by others. The fear of rejection, prejudice and discrimination often makes the disclosure of the diagnosis postponed, both by the caregiver to the adolescent and the adolescent to their partner, a fact that may influence the increased transmission of the disease, due to the beginning of the sexual life of adolescents.

One of the studies (16.7%) also brings the economic issue as a limiting factor for adherence. Although medicines are distributed for free in many countries, treatment goes far beyond that, including the need for routine follow-up at health facilities, which may be affected by a lack of transport money, for example. Even things that seem simple, such as maintaining good nutrition to maintain good health, can be difficult to achieve in underdeveloped countries.

Age-related factors

Difficulties in adherence are perceived more often in adolescents than in children, due to the characteristics of this age group, such as feelings of rebellion and various questions. It is possible to notice a cycle when talking about the adolescent-related factors: the adolescents' lack of autonomy to take the drug is reported in a study (16.7%), where the caregiver wants the adolescent to have self-care, aiming at your well-being. However, in order for people to perform self-care, they need to be stimulated and informed, and adolescents often have difficulty understanding the severity of the disease or treatment goals, which means they do not understand why taking their medicines, This point is addressed in 50% of the studies (n = 3). The very absence of symptoms due to the correct use of antiretroviral is reported as a barrier in one study (16.7%), considering that when there are no symptoms, adolescents understand that there is no need to continue treatment.


DISCUSSION

Adherence to antiretroviral treatment among adolescents living with HIV/AIDS is a challenge for health professionals and services, and knowing the factors and characteristics that interfere with adherence to therapy in adolescents living with HIV/AIDS represents an important instrument to identify the main needs. of this population and to propose specific coping strategies to increase adherence to therapy and reduce morbidity and mortality.

The physical and organoleptic characteristics of medications and their side effects are still one of the major barriers to adequate adherence and are reported in several studies21-25, which is in line with the results found in our research. Some strategies have been used to circumvent palatability issues, such as ingesting the tablets with food or other liquids other than water to mask taste and odor9,21.

This is an extremely important issue that should be worked out with all staff, checking the possibility of changing the scheme in use or associating other medications that can mitigate adverse effects, such as antiemetic in vomiting complaints, for example.

Hawkins et al.26 studied the factors that interfere with adherence and found a significant relationship between non-adherence and weekends. This can be explained by the fact that teenagers have a more active social life on weekends. The same study also shows that adherence is impaired when taking drugs outside the home environment, which is consistent with other studies21-23, and is related to the prejudice, discrimination and stigma that many sufferers still suffer today, and they fear the discovery of their diagnosis by taking medicines in public places.

The economic issues should be considered in adolescent care, because the absence in consultations may be due to lack of money for transportation21, or even for the purchase of medicines. Maintaining good health, essential to treatment, involves a financial issue. A study in South Africa9 shows that caregivers consider it a threat to their financial stability to keep children and adolescents healthy, either by prior spending on food or subsequent spending after appetite improvement.

Caregivers' education has been associated in some studies with the low adherence of adolescents to drugs21,22. Health professionals should be aware of the caregivers' level of education, aiming at strategies that favor their understanding of the information that will be given, given the complexity of the drug regimen.

Some authors show that caregivers' dependence to remind adolescents about medication intake21 and forgetfulness22 are important factors for noncompliance. Although the adolescent is in a phase where they seek their autonomy, this attitude is not reflected very well when it comes to adherence to their own treatment, where there is a lack of commitment on their part to assume this self-care, being almost always dependent on the caregiver to remind him of the medicine.

The use of reminders, such as alarm clocks or cell phones, has been widely used so that the doses are not forgotten, due to the large number of pills to be taken several times a day21,24.

The caregiver sometimes postpones the disclosure of the diagnosis to the adolescent, due to possible reactions of the same. However, this attitude makes it difficult for adolescents to understand the need and importance of treatment, and is also deprived of seeking support and coping networks, such as activities with other HIV-positive adolescents and educational groups.

Health education, whether with the adolescent or their caregiver, has proved to be an important factor for adherence to therapy and should be encouraged, as it improves the rapprochement and the relationship of trust between adolescents and their caregivers with health professionals, strengthening bonds21,24,25,27. Having an empathic listening, making room for the teenager to bring their doubts and questions about their condition or treatment makes them feel welcomed improving adherence.


CONCLUSION

Non-adherence to drug therapy can bring serious complications to adolescent health and may even lead to death. From this study it was possible to know what the main factors that interfere with the adherence, like a multifactorial phenomenon which needs an interdisciplinary and multi-professional approach.

It is evident that although we have made advances in the pharmaceutical area, existing antiretroviral still cause several side effects, requiring further investment in this area, as it is a chronic disease with lifelong treatment. Health education can bring more information about HIV/AIDS to the general population, reducing the stigma and prejudice that still surrounds the disease, and providing adolescents and their caregivers with important information, given the complexity of living with HIV, improving the attitude of young people and enhancing their self-care capacity.

A limiting factor in this study was the lack of studies with this population, considering that many studies do not have an approach focused on the adolescent population, working with children and adolescents or adolescents and adults, which doesn´t take into account the specificities of this study with this age group. In addition to the population studied, we highlight the level of evidence from the studies included in the review, which are derived from a single descriptive or qualitative study (VI), emphasizes the importance of strengthening studies on the subject through the publication of studies with better level of evidence.

Further studies are needed to analyze factors that can act as facilitators and strategies that can be addressed in order to obtain adequate adherence, overcoming the barriers described in this study.


NOTE

Financial Support: National Council for Scientific and Technological Development (CNPq) - Benefit process: 123707/2017-0.


REFERENCES

1. IST/AIDS: Departamento de Vigilância, Prevenção e Controle das IST [Internet]. O que é HIV. [acesso 2018 nov 18]; [about 1 screen]. Disponível em: http://www.aids.gov.br/pt-br/publico-geral/o-que-e-hiv.

2. Pinto ACS, Pinheiro PNC, Vieira NFC, Alves MDS. Understanding the aids pandemia in the last 25 years. DST-J bras Doenças Sex Transm. 2007; 19 (1): 45-50.

3. Da Silva RAR, Duarte FH da S, Nelson ARC, Holanda JRR. Aids epidemic in brazil: analysis of current profile. Revista de enfermagem UFPE on line-ISSN: 1981-8963. 2013; 7(10): 6039-6046.

4. Boletim epidemiológico - HIV e AIDS. Ministério da saúde. Secretaria de Vigilância em Saúde, Departamento de DST, Aids e Hepatites Virais. Brasília. 2017.

5. Unaids Brasil: Programa Conjunto das Nações Unidas sobre HIV/AIDS [internet]. Estatísticas; [acesso 2017 nov 21]; [about 21 screen]. Disponível em: http://unaids.org.br/estatisticas/.

6. Manual de adesão ao tratamento para pessoas vivendo com HIV e Aids. Ministério da saúde. Secretaria de Vigilância em Saúde, Programa Nacional de DST e Aids. Brasília, 2008.

7. Narciso AMS, Paulilo MAS. Accession and aids: some interventional factors. Serviço Social em Revista. 2001; 4(1): 27-43.

8. Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS. 2014; 28(13): 1945-56.

9. Coetzee B, Kagee A, Bland R. Barriers and facilitators to pediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective. AIDS care. 2015; 27(3): 315-321.

10. Feitosa AC, Lima HJA, Caetano JA, Andrade LM de, Beserra EP. Antiretroviral therapy: factors interfering in the adherence of children with HIV/AIDS. Esc Anna Nery Rev Enferm. 2008; 12(3): 515-21.

11. Martins S DA S, Martins TS de S. Adherence to antirretroviral therapy: experience with scholars. Texto & Contexto Enfermagem. 2011; 20(1): 111-118.

12. Mendes KDS, Silveira RC de CP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto-Enferm. 2008;17(4):758-764.

13. De Souza MT, Da Silva MD, De Carvalho R. Integrative Review: what is it? How do it? Einstein. 2010; 8(1 Pt 1); 102-6.

14. Galvão Mc. Níveis de evidência. Acta Paul Enferm. 2006;19(2): V.

15. Kourrouski MFC, De Lima RAG. Adesão ao tratamento: Vivências de adolescentes com HIV/AIDS. Rev Latino-am Enfermagem. 2009 Nov-Dez; 17(6).

16. Guerra CPP, Seidi EMF. Adesão em HIV/AIDS: Estudo com adolescentes e seus cuiadores primários. Psicologia em Estudo 2010 Out-Dez; 15(4): 781-789.

17. Da Motta M da G C, Pedro ENR, De Paula CC, Coelho DF, Ribeiro AC, Greff AP, et al. O silêncio no cotidiano do adolescente com HIV/AIDS. Rev Bras Enferm 2013 mai-jun; 66(3): 345-50.

18. De Paula CC, Padoin S M de M, De Albuquerque PVC, Bubadué R de M, Da Silva CB, Brum CN. Cotiadiano de Adolescentes com o Vírus da imunodeficiência Humana em Tratamento. Rev Enfermagem UFSM. 2013 Set-Dez; 3(3): 500-508.

19. Da Motta M da G C, Pedro ENR, De Paula CC, Coelho DF, Ribeiro AC, Greff AP, et al. Vivências de adolescentes com HIV/AIDS. Rev Min Enferm. 2014 Jan-Mar; 18(1): 181-187.]

20. Folayan MO, Odetoyinbo M, Harrison A, Brown B. Addressing the Socio-Development Needs of Adolescents Living with HIV/AIDS in Nigeria: A call for action. African journal of reproductive health. 2014; 18(300): 93-101.

21. De Paula CC, Padoin S M de M, Brum CN, Da Silva CB, De Albuquerque PVC, Bubadué R de M. Cotidiano medicamentoso de adolescentes vivendo com HIV/AIDS. Rev Eletr. Enf. [internet]. 2013; Out-Dez; 15(4): 1016-25. Disponível em: http://dx.doi.org/10.5216/ree.v15i4.19127.

22. Aguilar CML, López LEJ. Factores sociales relacionados con mala adherencia antirretroviral en pacientes pediátricos. Hospital Mario Catarino Rivas. Acta Pediátrica Hondureña 2016 Mar; 6(2).

23. Sehnem GD, Brondani JP, Kantorski KJC, Silva SC, Ressel LB, Pedro ENR. A saúde no adolescer com HIV/aids: caminhos para uma agenda pós-2015. Rev Gaúcha Enferm. 2015; 36(esp): 39-46.

24. Filho LF, Nogueira SA, Machado ES, Abreu TF, de Oliveira RH, Evangelista L, et al. Factors associated with lack of antiretroviral adherence among adolescents in a reference center in Rio de Janeiro, Brazil. International journal of STD & AIDS. 2008; 19(10): 685-688.

25. Galano E, Turato ER, Delmas P, Côte J, Gouvea AFTB, Succi RCM, et al. Vivências dos adolescentes soropositivos para HIV/Aids: estudo qualitativo. Rev Paul Pediatr. 2016; 34(2):171-177.

26. Hawkins A, Evangeli M, Sturgeon K, Le Prevost M, Judd A. Episodic medication adherence in adolescents and young adults with perinatally acquired HIV: a within-participants approach. AIDS Care. 2016 Mar; 28(sup1): 68-75.

27. Potrich T, De Paula CC, Padoin S M de M, Da Silva CB. Cuidado familiar na adesão à terapia antirretroviral em crianças com hiv/aids. Cogitare Enferm. 2013 Abr-Jun; 18(2): 379-86.
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