Risk-factors for non-adherence to antiretroviral therapy

Cross-sectional study analyzed as case-control to identify risk factors for non-adherence to antiretroviral therapy. We studied 412 out-clinics HIV infected subjects of three public hospitals of Recife, Pernambuco. The objective was to examine the association between non-adherence to the antiretroviral therapy and biological, social-behavior and demographics and economic factors, factors related to the disease and/or treatment, factors related to life habits and depression symptoms. Variables significantly associated with non-adherence to antiretroviral therapy were: time elapsed since HIV diagnosis (p = 0.002), daily dose (p = 0.046), use of alcohol (p = 0.030) and past drug use (p = 0.048), and borderline p-values were found for educational level (p = 0.093) and family monthly income (p = 0.08). In the multivariable analysis, the factors that remained in the final model were family monthly income, time period with HIV infection and use of alcohol. No association was observed between non-adherence to antiretroviral therapy and gender, age, sexual orientation, marital status, educational level and place of residence. Based on our results and the local situation we suggest: assessment of social needs; training of partners and/or families on supporting adherence, creation of "adherence groups" to motivate and to reassure patients on the benefits of treatment; counseling and/or psychotherapy for alcohol drinkers

Strategic Public Management for Financial Condition: Focus on Fund Balances of School Districts

Scholars have emphasized the roles of strategic public management and the financial condition but little is known about the link between the two. Finding the missing link is the purpose of this study. By analyzing data from K-12 Texas school districts, this study investigates how top managers’ strategic efforts toward their superiors, subordinates, and external stakeholders affect the financial condition of school districts. The findings suggest that superintendents’ managing upward toward school boards increases fund balances, whereas managing downward toward school principals decreases fund balances. Apparently, the relationships between school boards, superintendents, and school principals contain different priorities and incentives that influence their behaviors in managing school district budgets.Accepted versio