No abstract

A933system for logistic control of medicines of the Brazilian National STD/Aids Program. Despite its administrative nature, this system contains specific information about antiretroviral dispensation providing a unique data source for adherence assessment. This study aimed to assess HAART adherence among patients followed up in a public outpatient facility located in Rio de Janeiro city, Brazil, using pharmacy refill data obtained from SICLOM. Methods: All patients that initiated HAART in 2011 were included and followed up until December 2013. Data about dispensed medicines, including amounts and dates, and demographic data was obtained from SICLOM. Therapy adherence was estimated using the medication possession ratio (MPR) calculated as the ratio between the number of days covered by a refill and treatment duration in days. The number of days without medication (gaps) was also calculated. Results: The analysis included 82 patients. The average age was 36.2 ±10.1 years old and 85.4% were male. Most of the patients (65.9%) were followed up at public facilities. The medians of the gaps and MPR were 66.5 days (28.75-130) and 94.6% (87.9-97.4) respectively. MPR was lower than 95% for 54.9% of the patients. ConClusions: According to the World Health Organization, HIV patients should take more than 95% of antiretroviral prescribed doses. However, the fact that 54.9% of the patients presented a MPR lower than 95% suggests a high prevalence of HAART non-adherence. SICLOM showed to be a powerful data source for adherence studies that could provide useful information in order to improve HAART effectiveness.

Objectives: The Pan American Health Organization (PAHO) has guided countries in the region of the Americas towards increasing influenza vaccine availability. PAHO's recommendations on vaccination further encouraged national governments to subsidize vaccinations for at-risk groups. Older adults (aged ≥ 60) experience a disproportionate burden of influenza mortality, designating them an at-risk group in many PAHO countries. The purpose of this review was to identify barriers to influenza vaccination among older adults in Argentina, Brazil, and Mexico. MethOds: A review of literature from 2005-2015 was conducted in Scopus, Medline, and EconLit using search terms focused on barriers to influenza vaccination, centering on three countries in region of the Americas (Argentina, Brazil, and Mexico). Grey literature further supplemented the available data. Results: As of 2011, Argentina, Brazil and Mexico are among the countries in the Americas with vaccination policies for older adults. However, publications suggest barriers to influenza vaccine access include financial commitment to reach at-risk populations, lack of consumer education and awareness of the vaccine, and low vaccine uptake among healthcare workers (HCW). Structural financial barriers were observed in studies suggesting that individuals with lower socioeconomic level tend to have a higher likelihood of contracting infection via crowding, poor healthcare access, and fewer preventative resources. Some studies found success with additional information: targeted educational and distribution programs increased vaccine uptake within older adults. There are suggestions that HCW unwillingness to self-vaccinate could reduce the opportunities to remind consumers of seasonal vaccination. cOnclusiOns: Structural barriers, including lower education and socioeconomic status have been shown to increase the risk of influenza in older adults. Targeted educational and financial programs have been successful in increasing vaccination in Argentina, Brazil, and Mexico. However, additional work is needed to motivate future adult vaccine policy change and program implementation to ensure access to influenza vaccines among older adults.