Marcela Arrivillaga

Bio: Marcela Arrivillaga is an academic researcher from Pontifical Xavierian University. The author has contributed to research in topics: Health care & Population. The author has an hindex of 11, co-authored 36 publications receiving 477 citations.

Creencias sobre la salud y su relación con las prácticas de riesgo o de protección en jóvenes universitarios.

Abstract: Objetivo: Describir las creencias sobre la salud de jovenes universitarios y su relacion con las practicas o conductas de riesgo o de proteccion, en seis dimensiones del estilo de vida (condicion, actividad fisica y deporte; recreacion y manejo del tiempo libre; autocuidado y cuidado medico; habitos alimenticios; consumo de alcohol, tabaco y otras drogas y sueno). Metodo: Investigacion descriptiva, con diseno transeccional. Sujetos: 754 jovenes universitarios de Cali. Instrumentos: Cuestionario de practicas y creencias relacionadas con estilos de vida y Encuesta sobre factores del contexto relacionados con el estilo de vida. Resultados: Alta o muy alta la presencia de creencias favorables con la salud, en todas las dimensiones, excepto en el sueno. Incongruencia entre creencias y practicas en la mayoria de las dimensiones del estilo de vida. Conclusiones: El factor cognitivo no siempre actua como mediador determinante en la ejecucion de conductas prosalud. Es necesario disenar programas orientados a la promocion de estilos de vida saludables en jovenes, que contemplen distintos procesos psicosociales como el aprendizaje, la cognicion, la motivacion y la emocion.

Social position, gender role, and treatment adherence among Colombian women living with HIV/AIDS: social determinants of health approach.

Abstract: The relationship between socio-economic-political factors and health outcomes has been recognized since the beginning of the history of public health

Adherencia al tratamiento de hipertensión arterial: efectividad de un programa de intervención biopsicosocial

Abstract: La investigacion tuvo como objetivo determinar la efectividad de un programa de intervencion biopsicosocial para reducir niveles de presion arterial y mejorar la adherencia al tratamiento de personas con diagnostico de hipertension arterial. El estudio fue cuasi-experimental, diseno intra e intergrupo, pre-post intervencion. La muestra estuvo conformada por 44 participantes, con ausencia de otra enfermedad cronica y/o de trastorno psiquiatrico diagnosticado, atendidos en una Institucion de Salud de la ciudad de Cali, Colombia. Los niveles de presion arterial sistolica y diastolica fueron medidos pre-post intervencion por el personal de salud. Se encontro una disminucion estadisticamente significativa en la PAS, la PAD no presento cambios pero se mantuvo en niveles controlados. En adherencia al tratamiento los cambios post-intervencion fueron estadisticamente significativos (p = 0,000; n.c. 95%), el 86,6% termino en nivel alto de adherencia y el 11,4% finalizo en nivel medio.

A Systematic Review of Microfinance-Based Interventions for HIV/AIDS Prevention

Abstract: The aim of this study is to describe the scope of microfinance-based interventions for HIV/AIDS prevention. A systematic review was carried out of literature published between 1986 and 2012 from EBSCO, ProQuest, Science Direct, Emerald, and JSTOR. The search included original research articles that presented evaluated interventions. Books, dissertations, gray literature, and theoretical reviews were excluded. Findings revealed a total of fourteen studies focused on the evaluation of: the IMAGE project, female sex workers, life skills and risk behavior reduction, adherence to treatment, and children and their families. Most of these interventions have shown to have beneficial effects, although results depend on: the type of program, monitoring, sustainability of microcredits, and contextual conditions. The findings of this review should be complemented with interventions carried out by various NGOs and microfinance institutions in different countries that present their results in a dissimilar way.

Variables psicológicas en mujeres diagnosticadas con VIH/SIDA: un estudio correlacional

Abstract: Este articulo presenta la descripcion y correlacion de las variables psicologicas ansiedad, depresion, Percepcion de Control sobre la Salud -PCS- y Percepcion de Control sobre Eventos Estresantes de la Vida -PCEEV- en mujeres diagnosticadas con VIH/Sida. La investigacion fue de caracter no experimental, de tipo descriptivo-correlacional, con diseno transversal. La muestra estuvo compuesta por 47 mujeres atendidas en instituciones de salud de la ciudad de Cali, Colombia. Como medidas se utilizaron la entrevista de datos sociodemograficos, caracteristicas biomedicas y psicosociales en mujeres diagnosticadas con VIH/Sida (disenada por los autores) y una bateria de evaluacion de variables psicologicas adaptada para mujeres diagnosticadas con VIH/Sida. Los resultados generales muestran que el 23,4% de la muestra presenta indicadores clinicos de ansiedad, el 10,63% de depresion, el 6,38% muestra bajos niveles de PCS y el 100% de las participantes muestra niveles moderados de PCEEV. Las variables ansiedad y depresion presentaron una correlacion positiva, asi como la PCEEV con ansiedad y depresion; depresion con PCS y ansiedad con PCS presentaron correlaciones negativas.

Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis

Abstract: Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = -0.395, P = 0.001), concerns about ART (SMD = -0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = -0.305, P = 0.001), stigma about HIV (SMD = -0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = -0.196, P = 0.001), daily dosing frequency (SMD = -0.193, P = 0.001), financial constraints (SMD -0.187, P = 0.001) and pill burden (SMD = -0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.

Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review

Abstract: This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa. Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases. A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5–38.2%, Tau2 = 0.23) and 18% (95% CI 12.3–25.8%, Tau2 = 0.19) respectively. Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31–0.66, Tau2 = 0.20, P value = 0.000). Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.

Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review.

Abstract: Adolescents living in low- and middle-income countries (LMICs) are disproportionately burdened by the global HIV/AIDS pandemic. Maintaining medication adherence is vital to ensuring that adolescents living with HIV/AIDS receive the benefits of antiretroviral therapy (ART), although this group faces unique challenges to adherence. Knowledge of the factors influencing adherence among people during this unique developmental period is needed to develop more targeted and effective adherence-promoting strategies. This systematic review summarizes the literature on quantitative observational studies examining correlates, including risk and resilience-promoting factors, of ART adherence among adolescents living with HIV/AIDS in LMICs. A systematic search of major electronic databases, conference-specific databases, gray literature, and reference lists of relevant reviews and documents was conducted in May 2014. Included studies examined relationships between at least one factor and ART adherence as an outcome and were conducted in primarily an adolescent population (age 10-19) in LMICs. The search identified 7948 unique citations from which 15 studies fit the inclusion criteria. These 15 studies identified 35 factors significantly associated with ART adherence representing a total of 4363 participants across nine different LMICs. Relevant studies revealed few consistent relationships between measured factors and adherence while highlighting potentially important themes for ART adherence including the impact of (1) adolescent factors such as gender and knowledge of serostatus, (2) family structure, (3) the burdensome ART regimens, route of administration, and attitudes about medication, and (4) health care and environmental factors, such as rural versus urban location and missed clinic appointments. Rates of adherence across studies ranged from 16% to 99%. This review identifies unique factors significantly related to ART adherence among adolescents living in LMICs. More research using longitudinal designs and rigorous measures of adherence is required in order to identify the range of factors influencing ART adherence as adolescents living with HIV/AIDS in LMICs grow into adulthood.

The hidden inequity in health care

Abstract: Inequity is the presence of systematic and potentially remediable differences among population groups defined socially, economically, or geographically [1,2]. It is not the same as inequality, which is a much broader term, generally used in the human rights field to describe differences among individuals, some of which are not remediable (at least with current knowledge). Some languages do not make a distinction between the two terms, which may lead to confusion and a need to clarify exact meaning in different contexts. Some people use the term "unfairness" to define inequity, but unfairness is not measurable and therefore not a useful term for policy or evaluation. Inequity can be horizontal or vertical. Horizontal inequity indicates that people with the same needs do not have access to the same resources. Vertical inequity exists when people with greater needs are not provided with greater resources. In population surveys, similar use of services across...