Uso do telefone para adesão de pessoas vivendo com HIV/AIDS à terapia antirretroviral: revisão sistemática

Vanessa da Frota Santos Ana Karoline Bastos Costa Ivana Cristina Vieira de Lima Herta de Oliveira Alexandre Elucir Gir Marli Teresinha Gimeniz Galvão Sobre os autores

Resumo

O objetivo deste artigo é avaliar a eficácia do uso do telefone para adesão de pessoas com HIV/AIDS à terapia antirretroviral. Realizou-se uma revisão sistemática, nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs/Bireme), Scopus, Medical Literature Analysis and Retrieval System Online (Medline/PubMed), Web of Science; e nas bibliotecas Scientific Eletronic Library Online (SciELO) e Cochrane, com uso dos seguintes descritores: “HIV”, “Cell Phones”, “Acquired Immunodeficiency Syndrome” e “Antiretroviral Therapy, Highly Active”. Obteve-se uma amostra de 17 artigos. As intervenções com uso de telefones celulares propostas foram: uso de aplicativos de celulares, Serviço de Mensagem Curta e chamadas telefônicas. Na maioria dos estudos, o uso do telefone trouxe impacto significativo sobre a adesão ao tratamento. A avaliação dos estudos apontou boa qualidade metodológica e sigilo de alocação adequado. Acerca dos métodos de mensuração da adesão destacou-se a autorrelatada. A utilização de telefone celular foi eficaz para a melhoria da adesão à terapia antirretroviral de pessoas vivendo com HIV.

Palavras-chave
HIV; Síndrome de imunodeficiência adquirida; Telefones celulares

Introdução

Com o avanço da terapia antirretroviral (TARV) houve redução da morbidade e mortalidade associadas à infecção e o conseqüente aumento da expectativa de vida das pessoas vivendo com HIV/aids (PVHA)11 Galvão MTG, Soares LL, Pedrosa SC, Fiuza MLT, Lemos LA. Quality of life and adherence to antiretroviral medication in people with HIV. Acta Paulista de Enfermagem 2015; 28(1):48-53.. Para o alcance da efetividade da TARV, faz-se necessária uma boa adesão aos fármacos22 Silva JAG, Dourado I, Brito AMD, Silva CALD. Factors associated with non-adherence to antiretroviral therapy in adults with AIDS in the first six months of treatment in Salvador, Bahia State, Brazil. Cad Saude Publica 2015; 31(6):1188-1198., com vistas a prevenir a resistência viral, o surgimento de doenças oportunistas, o aumento da transmissão do vírus, a maior probabilidade de progressão para o estágio final da doença e a diminuição da sobrevida33 Kim J, Zhang W, Nyonyitono M, Lourenço L, Nanfuka M, Okoboi S, Birungi J, Lester RT, Kaleebu P, Munderi P, Moore DM. Feasibility and acceptability of mobile phone short message service as a support for patients receiving antiretroviral therapy in rural Uganda: a cross-sectional study. J Int SIDA Soe 2015; 18(1):20311..

Destaca-se como um desafio o alcance e manutenção de níveis ótimos de adesão à TARV, em decorrência de barreiras individuais, sociais e sistêmicas que dificultam esse processo44 Georgette, N, Siedner MJ, Petty CR, Zanoni BC, Carpenter S, Haberer JE. Impact of a clinical program using weekly Short Message Service (SMS) on antiretroviral therapy adherence support in South Africa: a retrospective cohort study. BMC Medical Informatics and Decision Making 2017; 17:18.. Estudos apontam que apesar da disponibilidade de fármacos para o tratamento antirretroviral, observam-se dificuldades na adesão à terapia e taxas de prevalência de não adesão que variam de 51,3%11 Galvão MTG, Soares LL, Pedrosa SC, Fiuza MLT, Lemos LA. Quality of life and adherence to antiretroviral medication in people with HIV. Acta Paulista de Enfermagem 2015; 28(1):48-53.,55 Harvey KM, Carrington D, Duncan J, Figueroa JP, Hirschorn L, Manning D, Jackson S. Evaluation of adherence to highly active antiretroviral therapy in adults in Jamaica. West Indian Med J 2008; 57(3):293-297. a 25%66 Srivastava S, Pant M, Abraham A, Agrawal N. The Technological Growth in e Health Services. Comput. Math Methods Med 2015; 2015:894171..

Nos últimos anos desenvolveu-se um interesse pelo uso das Tecnologias da Informação e Comunicação (TIC’s), as quais têm causado grande impacto na qualidade dos serviços e nos hábitos de vida das pessoas, e a sua implementação no setor da saúde está emergindo como uma das áreas de maior crescimento na atualidade66 Srivastava S, Pant M, Abraham A, Agrawal N. The Technological Growth in e Health Services. Comput. Math Methods Med 2015; 2015:894171.. Dentre essas tecnologias, destacam-se os dispositivos eletrônicos, como o telefone, que tem ganhado popularidade, tornando-se forte aliado no tratamento de doenças crônicas77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161..

No contexto do HIV/aids, estudos têm mostrado as vantagens do uso do telefone para melhorar os serviços de atenção a essa população, com impactos sobre a melhoria da qualidade de vida, apoio social, autocuidado88 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.,99 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834. e adesão à TARV88 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.,1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.

11 Haberer JE, Musiimenta A, Atukunda EC, Musinguzi N, Wyatt MA, Ware NC, Bangsberg DR. Short message service (SMS) reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda. AIDS 2016; 30(8):1295-1299.
-1212 Mills EJ, Lester R, Thorlund K, Lorenzi M, Muldoon K, Kanters S, Linnemayr S, Gross R, Calderone Y, Amico KR, Thirumurthy H, Pearson C, Remien RH, Mbuagbaw L, Thabane L, Chung MH, Wilson IB, Liu A, Uthman OA, Simoni J, Bangsberg D, Yaya S, Barnighausen T, Stirrat MJ, Ford N, Nachega JB. Interventions to promote adherence to antiretroviral therapy in Africa: a network meta-analysis. Lancet HIV. [Internet]. 2014[accessed 2017 Nov 30]; 1(3):e104-11. Available at: http://doi.org/10.1016/S2352-3018(14)00003-4.
http://doi.org/10.1016/S2352-3018(14)000...
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Dessa forma, observa-se que é necessário o desenvolvimento de métodos eficientes para melhorar a adesão de pessoas com HIV/aids à TARV. Nesse contexto, o uso do telefone pode ser um recurso viável para promover a adesão ao tratamento de PVHA, por ter baixo custo e ser de fácil acesso entre os pacientes e profissionais de saúde. Assim, o presente estudo objetivou avaliar a eficácia do uso do telefone para adesão de pessoas com HIV/aids à terapia antirretroviral.

Método

Realizou-se uma revisão sistemática, um tipo de estudo secundário que permite a investigação de pesquisas relevantes sobre uma determinada temática com objetivo de realizar uma revisão crítica e abrangente da literatura, proporcionando a incorporação de novas tendências na prática clínica e a conseqüente atualização do profissional a partir das evidências encontradas1313 Clarke M. Cochrane Collaboration. In: Armitage P, Colton T, editors. Encyclopedia of Biostatistics. 2(nd) edition. Chichester: John Wiley & Sons; 2005.[informar as páginas do capítulo].

Para a realização da revisão sistemática foram seguidos os sete passos recomendados pela colaboração Cochrane1414 Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration 2011. [accessed 2017 Nov 30]. Available at: www.cochrane-handbook.org
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: formulação da questão de pesquisa; localização dos estudos; avaliação crítica das pesquisas; coleta de dados; análise e apresentação das informações.

A questão de pesquisa foi delineada com base na estratégia PICO, que representa um acrônimo para Paciente (adultos que vivem com HIV), Intervenção (Uso do telefone), Comparação (cuidado padrão) e Outcomes - desfecho (adesão ao tratamento)88 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.. Dessa forma, estabeleceu-se a seguinte pergunta norteadora: “Qual a eficácia do uso do telefone para promover a adesão de PVHA à TARV?”

Foram incluídos os ensaios clínicos que investigaram intervenções com uso do telefone direcionadas à promoção da adesão de PVHA à TARV, independentemente do idioma e do ano de publicação. Os critérios de exclusão definidos foram: revisões de literatura, cartas, artigos de opinião, relatos de experiência, estudos de caso, capítulos de livros, apresentações de congressos, publicações repetidas, estudos com crianças e artigos que não responderam à questão de pesquisa.

A busca eletrônica foi realizada por dois revisores de forma simultânea no mês de outubro de 2017, em três bases de dados - Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs/Bireme), Scopus e Web of Science; um portal Medical Literature Analysis and Retrieval System Online (Medline/PubMed) e nas bibliotecas Scientific Eletronic Library Online (SciELO) e Cochrane.

Para a estratégia de busca, foram utilizados os seguintes descritores nos idiomas português, inglês e espanhol: HIV, Cell Phones, Acquired Immunodeficiency Syndrome e Antiretroviral Therapy, Highly Active, combinados com operador booleano AND nos idiomas português, inglês e espanhol. Os descritores foram selecionados através dos Descritores em Ciências da Saúde (DeCS) e do Medical Subject Heading (MESH). Os cruzamentos realizados foram: [HIV and Cell Phones]; [Acquired Immunodeficiency Syndrome and Cell Phones]; [Antiretroviral Therapy, Highly Active and Cell Phones]; [HIV and Cell Phones and Antiretroviral Therapy, Highly Active]; [Acquired Immunodeficiency Syndrome and Cell Phones and Antiretroviral Therapy, Highly Active].

A partir dos cruzamentos realizados foram encontrados 758 artigos, sendo selecionados 17. Foram excluídos 741 artigos, dentre os quais 29 estavam duplicados e 712 não atendiam a pergunta norteadora por abordarem as seguintes temáticas: aceitação das intervenções propostas, percepções dos indivíduos acerca das intervenções, reflexões sobre os avanços no uso de tecnologias para melhoria na adesão. A amostra final consistiu em 17 artigos, sendo seis retirados da Scopus, cinco da Medline/PubMed, três da Web of Science e três da Cochrane.

A Figura 1 mostra a identificação, seleção e inclusão dos artigos da pesquisa.

Figura 1
Fluxograma de identificação, seleção e inclusão dos estudos. Fortaleza, CE, Brasil, 2017.

Os critérios de avaliação da qualidade dos estudos foram realizados mediante aplicação da Escala de Qualidade por Jadad1515 Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin. Trials 1996; 17(1):1-12., cuja pontuação varia de 0 a 5, sendo considerado estudos de baixa qualidade aqueles com pontuação inferior a 3. A análise foi realizada com base nas seguintes questões: 1a. O estudo foi descrito como aleatório (uso de palavras como “randômico”, “aleatório”, “randomização”)?; 1b. O método foi adequado? 2a. O estudo foi descrito como duplo-cego? 2b. O método foi adequado? 3. Houve descrição das perdas e exclusões?

Os artigos também foram analisados e classificados quanto ao sigilo de alocação em: Categoria A - sigilo da alocação adequadamente realizado e descrito; Categoria B - o estudo foi descrito como aleatório, mas não há descrição da forma da randomização nem do sigilo da alocação; Categoria C - o sigilo de alocação foi inadequado e Categoria D - o estudo não foi aleatório1414 Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration 2011. [accessed 2017 Nov 30]. Available at: www.cochrane-handbook.org
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A análise dos dados foi realizada mediante tradução e leitura dos artigos na íntegra, por dois autores, de forma independente. As informações foram transcritas e organizadas a partir de um instrumento validado1616 Ursi ES, Galvão CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. Rev Latino-am Enfermagem 2006; 14(1):124-131., que investigou: autoria, ano, país onde o estudo foi realizado, objetivo, desenvolvimento metodológico, tecnologia proposta, resultados e conclusão. Portanto, optou-se pela revisão descritiva das informações encontradas.

Com relação às questões éticas, foram respeitadas a integridade dos artigos e os direitos autorais, não havendo modificação do conteúdo encontrado em benefício desta pesquisa.

Resultados

Todas as pesquisas eram ensaios clínicos e abrangeram um total de 2720 adultos com HIV em uso da TARV. Em relação ao ano de publicação variou de 2010 a 2017. Quanto ao local de realização, a maioria dos estudos foi desenvolvida nos Estados Unidos77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.

18 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310.

19 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.

20 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155.

21 Rana AI, Van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS 2016; 30(4):178-184.
-2222 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059., bem como em países africanos, como Quênia88 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.,99 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834., Uganda2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586., África do Sul2424 Orrell C, Cohen K, Mauff K, Bangsberg DR, Maartens G, Wood R. A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70(5):495-502. e Nigéria1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308., além de países asiáticos2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559.

26 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978.

27 Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and Validity of Daily Self-Monitoring by Smartphone Application for Health-Related Quality-of-Life, Antiretroviral Adherence, Substance Use, and Sexual Behaviors Among People Living with HIV. AIDS Behav 2015; 19(2):330-340.
-2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698. e do Brasil2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269. (Quadro 1). As intervenções propostas foram: uso de aplicativos de celular2020 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155.,2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586., Serviço de Mensagem Curta (SMS)77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.

8 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.

9 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834.
-1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.,2121 Rana AI, Van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS 2016; 30(4):178-184.,2222 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.,2424 Orrell C, Cohen K, Mauff K, Bangsberg DR, Maartens G, Wood R. A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70(5):495-502.

25 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559.

26 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978.

27 Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and Validity of Daily Self-Monitoring by Smartphone Application for Health-Related Quality-of-Life, Antiretroviral Adherence, Substance Use, and Sexual Behaviors Among People Living with HIV. AIDS Behav 2015; 19(2):330-340.

28 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698.
-2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269. e ligações telefônicas1818 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310.,1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.,2626 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698. (Quadro 1).

Quadro 1
Caracterização dos estudos. Fortaleza, CE, Brasil, 2017.

O uso de aplicativo consistia em um programa instalado no telefone móvel que apresentava diversos recursos como: um relógio com o medicamento das 24 horas diárias, exibindo o cronograma da dosagem diária da terapia do participante, tendo a função de gravar os dias e horários da ingestão dos medicamentos; representações gráficas das concentrações plasmáticas estimados de cada um dos antirretrovirais; e uma simulação da atividade imune que compreendia uma representação da contagem de linfócitos TCD4+ e da carga viral, com base nas análises de sangue mais recentes. Esse aplicativo permitia que o participante visualizasse, em tempo real, os efeitos fisiológicos da sua adesão à TARV1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269..

O SMS era composto por mensagens de texto enviadas a partir de telefones celulares. O conteúdo da mensagem era motivador e atuava como um lembrete para tomada dos antirretrovirais, além de influenciar comportamentos para a melhoria da adesão2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269.. Em um estudo, os participantes deveriam confirmar o recebimento da mensagem, caso isso não acontecesse era emitido um sinal sonoro a cada 15 minutos para o paciente77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161..

A intervenção baseada em ligações telefônicas era direcionada a aparelhos portáteis dos usuários e objetivava investigar a tomada dos medicamentos e de possíveis doses perdidas nos últimos dias, além de fornecer aconselhamento para promover a adesão1818 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310..

O tempo de seguimento dos participantes variou de 4 (um mês) a 96 (24 meses) semanas. A melhoria da adesão foi identificada em quatorze estudos77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.

8 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.

9 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834.
-1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.,2121 Rana AI, Van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS 2016; 30(4):178-184.

22 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.

23 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.
-2424 Orrell C, Cohen K, Mauff K, Bangsberg DR, Maartens G, Wood R. A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70(5):495-502.,2727 Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and Validity of Daily Self-Monitoring by Smartphone Application for Health-Related Quality-of-Life, Antiretroviral Adherence, Substance Use, and Sexual Behaviors Among People Living with HIV. AIDS Behav 2015; 19(2):330-340.

28 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698.
-2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269. e em três2020 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155.,2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559.,2626 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978. as intervenções não foram eficazes.

No que concerne a freqüência de oferecimento da intervenção, predominou a freqüência diária77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.,1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.

20 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155.

21 Rana AI, Van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS 2016; 30(4):178-184.

22 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.

23 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.

24 Orrell C, Cohen K, Mauff K, Bangsberg DR, Maartens G, Wood R. A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70(5):495-502.
-2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559.,2727 Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and Validity of Daily Self-Monitoring by Smartphone Application for Health-Related Quality-of-Life, Antiretroviral Adherence, Substance Use, and Sexual Behaviors Among People Living with HIV. AIDS Behav 2015; 19(2):330-340.. Três estudos utilizaram a freqüência em dias alternados88 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.,1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269., dois semanais2626 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698., um quinzenal1818 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310. e outro estudo comparou o uso da intervenção diária e semanal99 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834.. Quanto aos profissionais que aplicaram a intervenção, houve destaque para equipe do estudo não sendo especificada a categoria profissional (82,3%)77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,99 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834.,1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.,1818 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310.,2020 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155.,2222 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.

23 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.

24 Orrell C, Cohen K, Mauff K, Bangsberg DR, Maartens G, Wood R. A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70(5):495-502.
-2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559.,2727 Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and Validity of Daily Self-Monitoring by Smartphone Application for Health-Related Quality-of-Life, Antiretroviral Adherence, Substance Use, and Sexual Behaviors Among People Living with HIV. AIDS Behav 2015; 19(2):330-340.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269., seguido de pesquisadores que não estavam envolvidos na rotina dos pacientes (5,8%)2626 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978., além da menção de categorias da saúde de nível superior, enfermeiro (11,8%)88 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698. e médico (5,8%)2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698. (Quadro 1).

Acerca dos métodos de mensuração da adesão à TARV, destacaram-se a adesão autorrelatada77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,88 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball T, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1):a randomised trial. The Lancet 2010; 376 (9755):1838-1845.,1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.

18 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310.

19 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.
-2020 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155.,2222 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.,2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.,2626 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978.

27 Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and Validity of Daily Self-Monitoring by Smartphone Application for Health-Related Quality-of-Life, Antiretroviral Adherence, Substance Use, and Sexual Behaviors Among People Living with HIV. AIDS Behav 2015; 19(2):330-340.

28 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698.
-2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269., o sistema de monitoramento de eventos medicamentosos (MEMS)77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,99 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834.,2121 Rana AI, Van den Berg JJ, Lamy E, Beckwith CG. Using a Mobile Health Intervention to Support HIV Treatment Adherence and Retention Among Patients at Risk for Disengaging with Care. AIDS Patient Care STDS 2016; 30(4):178-184.,2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269., a contagem de comprimidos77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,1818 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269., o escore de adesão composta77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161., os registros de farmácia1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.,2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559., contagem de linfócitos T CD4+1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698. e a avaliação da carga viral1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.,2222 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.

23 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.
-2424 Orrell C, Cohen K, Mauff K, Bangsberg DR, Maartens G, Wood R. A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70(5):495-502.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698.. Houve estudos em que foi realizada a combinação de diferentes formas de mensuração da adesão77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.

18 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310.
-1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.,2222 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.,2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269. (Quadro 1).

Na adesão autorrelatada os pacientes informavam a medicação prescrita, os medicamentos ingeridos e a quantidade de doses perdidas nos últimos dias2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269.. Outros artigos analisaram a adesão mediante aplicação de instrumentos como: Escala de relatório de adesão à medicação (MARS), que consiste em perguntas específicas sobre a dose ingerida e as doses perdidas nos últimos 28 dias, organizadas em escala de Likert2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.; e Escala Visual Analógica (VAS), a qual analisa a taxa de adesão nas últimas 4 semanas numa escala de 0% a 100%, correlacionando com a contagem de comprimidos recordada nos últimos três dias e a carga viral1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51..

O MEMS foi também uma estratégia utilizada para medir a adesão e consiste em um dispositivo sem fio colocado no recipiente da medicação que registra a data e horário de cada abertura do frasco para ingestão do antirretroviral, comunicando imediatamente através de um serviço de rádio para um servidor central2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559..

Outros estudos mensuraram a adesão mediante a contagem de comprimidos, com entrega do medicamento em um encontro inicial e contagem de comprimidos ao final de um determinado período2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698.. Também houve uso do escore de adesão composta (CAS), um método baseado na união da contagem de comprimido e do MEMS77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161..

Os registros da farmácia sobre o reabastecimento foi um método adicional de avaliação da adesão, contemplando informações sobre o número de comprimidos liberados para os pacientes e cálculo em relação aos comprimidos prescritos, levando-se em conta o número de comprimidos dispensados2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.. Além desses métodos, houve a mensuração dos linfócitos T CD4+1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698. e da carga viral, mediante realização de exame laboratorial1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.,2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586..

O Quadro 2 mostra a caracterização dos estudos quanto ao autor, ano e país de publicação, amostra, intervenção utilizada, tempo de seguimento, os resultados em relação a melhora da adesão, pontuação da escala de Jadad e sigilo de alocação.

Quadro 2
Avaliação da qualidade dos estudos. Fortaleza, CE, Brasil, 2017

A avaliação da qualidade dos estudos apontou boa qualidade metodológica, com predominância da pontuação superior a 399 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834.,1010 Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013; 16(3):302-308.,1818 Kalichman SC, Kalichman MO, Cherry C, Swetzes C, Amaral CM, White D, Jones M, Grebler T, Eaton L. Brief behavioral self-regulation counseling for HIV treatment adherence delivered by cell phone: an initial test of concept trial. AIDS Patient Care STDS 2011; 25(5):303-310.

19 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.
-2020 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155.,2222 Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS and Behavior. 2016; 20(5):1049-1059.,2424 Orrell C, Cohen K, Mauff K, Bangsberg DR, Maartens G, Wood R. A randomized controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70(5):495-502.

25 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559.
-2626 Shet A, De Costa A, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V. Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India. BMJ 2014; 349:g5978.,2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269.. Com relação ao sigilo de alocação, houve destaque para a categoria A - processo de sigilo de alocação adequado, com exceção de quatro estudos cujo sigilo de alocação não foi descrito77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,99 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834.,1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.,2020 Swendeman D, Jana S, Ray P, Mindry D, Das M, Bhakta B. Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 2(19 Supl.):142-155. e dois que não foram aleatórios1717 Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res 2012; 14(2):e51.,2727 Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and Validity of Daily Self-Monitoring by Smartphone Application for Health-Related Quality-of-Life, Antiretroviral Adherence, Substance Use, and Sexual Behaviors Among People Living with HIV. AIDS Behav 2015; 19(2):330-340. (Quadro 2).

Discussão

O uso das TIC’s no contexto do HIV amplia o acesso aos serviços de saúde e promove a comunicação entre o profissional e o paciente em tempo real, oportunizando o autocuidado e a gestão da doença. A eficácia dessas tecnologias sobre a adesão à TARV está associada ao fato de proporcionarem o apoio social, a autoavaliação do paciente quanto ao seguimento terapêutico, o conhecimento sobre o HIV e o manejo dos efeitos colaterais - condições que ajudam o paciente a estabelecer uma rotina diária e a resolver problemas relacionados à tomada de comprimidos3030 Rodrigues R, Poongulali S, Balaji K, Atkins S, Ashorn P, Costa ADE. Patient perceptions of an mHealth antiretroviral treatment support intervention in the HIVIND trial in South India. BMJ Abrir 2015; 5(11):e007574..

O acompanhamento do profissional em tempo real proporcionado pelas TIC’s promove a informação e a educação para a adesão, permitindo aos pacientes relatar efeitos colaterais e ajustar rapidamente seu comportamento para melhorar a adesão. Além disso, o uso das tecnologias como lembrete para a tomada dos antirretrovirais, conforme a prescrição médica, melhora o comportamento de autogestão da dose do medicamento2525 Sabin LL, Bachman DSM, Gill CJ, Zhong L, Vian T, Xie W, Cheng F, Xu K, Lan G, Haberer JE, Bangsberg DR, Li Y, Lu H, Gifford AL. Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study. J Acquir Immune Defic Syndr 2015; 69(5):551-559..

O cuidado em saúde mediado pelas tecnologias é visto como um olhar onipresente e uma atenção permanente dos profissionais sobre o cotidiano das PVHA, motivando o comportamento de adesão ao tratamento e promovendo o suporte emocional para o combate a sentimentos de depressão relacionados ao diagnóstico3131 Ware NC, Pisarski EE, Tam M, Wyatt MA, Atukunda E, Musiimenta A, Bangsberg DR, Haberer JE. The Meanings in the messages: how SMS reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda. AIDS 2016; 30(8):1287-1293.. Dessa forma, a comunicação frequente entre profissional e paciente funciona como uma forma de aconselhamento direto, promovendo a economia de tempo e de custos financeiros3131 Ware NC, Pisarski EE, Tam M, Wyatt MA, Atukunda E, Musiimenta A, Bangsberg DR, Haberer JE. The Meanings in the messages: how SMS reminders and real-time adherence monitoring improve antiretroviral therapy adherence in rural Uganda. AIDS 2016; 30(8):1287-1293.,3232 Van der Kop ML, Karanja S, Thabane L, Marra C, Chung MH, Gelmon L, Kimani J, Lester RT. In-depth analysis of patient-clinician cell phone communication during the WelTel Kenya1 antiretroviral adherence trial. PLoS One 2012; 7(9):e46033..

Conforme evidenciado na presente revisão, o uso das tecnologias para ampliar a assistência em saúde às PVHA traz impactos benéficos em curto e longo prazos, promove a supressão viral, previne a progressão da doença, além de reduzir a resistência aos fármacos e a morbimortalidade. Ressalta-se que para o alcance de resultados positivos sobre os marcadores biológicos, é recomendado um tempo de intervenção igual ou superior a seis meses2828 Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Shahar HK, Othman N. Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PloS one 2017; 12(5):e0177698..

Apesar das vantagens associadas ao uso das tecnologias para promover a adesão à TARV, algumas dificuldades podem comprometer o uso do telefone celular na assistência em saúde, tais como: a falta de crédito, dificuldade no manuseio, manter a bateria carregada, problemas de rede, perda de acesso, mudança de número, restrição de horários no uso do telefone, quebra de sigilo e preocupação com a divulgação do estado sorológico para terceiros77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,3232 Van der Kop ML, Karanja S, Thabane L, Marra C, Chung MH, Gelmon L, Kimani J, Lester RT. In-depth analysis of patient-clinician cell phone communication during the WelTel Kenya1 antiretroviral adherence trial. PLoS One 2012; 7(9):e46033.,3333 RanaY, HabererJ, Huang H, Kambugu A , Mukasa B , Thirumurthy H, Wabukala P, Wagner GJ, Linnemayr S. Short Message Service (SMS)-Based Intervention to Improve Treatment Adherence among HIV-Positive Youth in Uganda: Focus Group Findings. PLoS One 2015; 10(4):e0125187..

Diante do exposto, faz-se necessário desenvolver estratégias de intervenção que sejam de baixo custo, eficazes e que busquem envolver o paciente com o serviço de saúde3434 Mûnene E, Ekman B. Association between patient engagement in HIV care and antiretroviral therapy medication adherence: cross-sectional evidence from a regional HIV care center in Kenya. AIDS Care 2015; 27(3):378-386.. Além disso, é importante conhecer as percepções e as necessidades dos pacientes acerca dessas tecnologias, identificando as barreiras e solucionando os problemas para se buscar o desenvolvimento de tecnologias eficazes1919 Belzer ME, Naar-King S, Olson J, Sarr M, Thornton S, Kahana SY, Gaur AH, Clark LF. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav 2014; 18(4):686-696.. É necessário, portanto, comparar as tecnologias e buscar as mais apropriadas para cada contexto.

Em relação à freqüência da intervenção, as mensagens semanais foram mais aceitas e causaram maior impacto e melhor adesão à TARV quando comparadas com os lembretes diários. Isso pode ser explicado pelo estímulo freqüente e repetido que causa desconforto nos pacientes, podendo invadir a privacidade99 Pop-eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, DeWalque D, MacKeen L, Haberer J, Kimaiyo S, Sidle J, Ngare D, Bangsberg DR. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 2011; 25(6):825-834..

No que concerne às formas de mensuração da adesão, houve destaque para a adesão autorrelatada, que é menos dispendiosa e mais fácil de ser analisada, porém é subjetiva e propensa a erros, podendo resultar em superestimação de valores3535 Gare J, Kelly-Hanku A, Ryan CE, David M, Kaima P, Imara U, Lote N, Crowe SM, Hearps AC. Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea. PLoS One 2015; 10:8.. Assim, faz-se necessário associar essas medidas autorreferidas com os marcadores clínicos, tais como carga viral, linfócitos CD4+ e outros meios mais objetivos de avaliar a adesão a exemplo da contagem de comprimido, do MEMS e dos registros da farmácia77 Hardy H, Kumar V, Doros G, Farmer E, Drainoni ML, Rybin D, Myung D, Jackson J, Backman E, Stanic A, Skolnik PR. Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy. AIDS Patient Care STDs 2011; 25(3):153-161.,2323 Perera AI, Thomas MG, Moore JO, Faasse K, Petrie KJ. Effect of a smartphone application incorporating personalized health-related imagery on adherence to antiretroviral therapy: a randomized clinical trial. AIDS Patient Care STDS 2014; 28(11):579-586.,2929 Costa TM, Barbosa BJ, Gomes E, Costa DA, Sigulem D, De Fátima MH, Filho AC, Pisa IT. Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages. Int J Med Inform 2012; 81(4):257-269.,3636 Beer L, Skarbinski J. Adherence to antiretroviral therapy among HIV-infected adults in the United States. AIDS Educ. Prev 2014; 26(6):521-537..

Quanto à qualidade dos ensaios clínicos analisados, quatro atingiram a pontuação máxima na Escala de Jadad1515 Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin. Trials 1996; 17(1):1-12., indicando que uma quantidade significante dos estudos encontrados possuía cegamento duplo. Foi evidenciado que o duplo cegamento produz resultados mais consistentes por reduzir vieses de seleção e garantir a fidedignidade das informações coletadas1515 Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin. Trials 1996; 17(1):1-12..

Conclusão

A utilização de telefone como ferramenta no apoio aos cuidados de adultos com HIV/aids foi eficaz para melhoria da adesão à terapia antirretroviral, além de melhorar a relação entre profissional e paciente. O telefone foi utilizado de diferentes formas e envolveu o uso de aplicativos no aparelho com acesso à internet, mensagens de texto e ligações. Houve destaque para as mensagens de texto pelo seu baixo custo. As limitações associadas ao uso do telefone foram a acessibilidade e o treinamento para uso dos dispositivos eletrônicos.

Para futuros estudos experimentais com uso de telefone recomenda-se: comparação de métodos de intervenção, associação de métodos de mensuração e comparação entre os métodos objetivos, realização de ensaios clínicos do tipo fatorial (múltiplas intervenções) e comparação entre a frequência de aplicação das intervenções. Além disso, deve-se considerar e desenvolver mais pesquisas que busquem identificar as percepções dos usuários sobre as intervençõe mais eficientes.

Teve-se como limitação da revisão a impossibilidade de realizar meta-análise a partir dos estudos selecionados em virtude da heterogeneidade dos ensaios clínicos em relação às diferentes medidas de mensuração da adesão à TARV, a variável desfecho distinta e a insuficiência de dados estatísticos, o que inviabilizou o cálculo das medidas-resumo.

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Datas de Publicação

  • Publicação nesta coleção
    05 Set 2019
  • Data do Fascículo
    Set 2019

Histórico

  • Recebido
    26 Set 2017
  • Revisado
    18 Fev 2018
  • Aceito
    20 Fev 2018
ABRASCO - Associação Brasileira de Saúde Coletiva Rio de Janeiro - RJ - Brazil
E-mail: revscol@fiocruz.br