[Treatment adherence, access and AIDS assistance quality in Brazil. ]

The patient adherence to highly active antiretroviral therapy (HAART) is a crucial matter to AIDS treatment effectiveness and its' impact. This article aims to discuss the association between adherence and quality of health service providing care to people living with AIDS (PLWA), highlighting quality of the services as a central point to adherence and access. It is based on results of our previous studies about the health care to PLWA in Brazil. Our studies point out that the groups of patients who are followed-up in health services providing care for less than 100 patients presented greater estimated risk of non-adherence than services following more than 500 patients. Also, smaller health services showed greater estimated risk to be ranged in the worst quality of services groups. This is related to the low complexity of smaller health care services, such as: lack of minimum human resources and material structures, poor organization on work process, medical-centered care and poor technical management. New studies in adherence and quality of services are needed. Nevertheless, the existent findings have already pointed out the need to review the current distribution of AIDS care services as well as to make the quality of services more homogenous thorough the country. These are high priorities in order to keep acceptable levels of adherence to HAART in Brazil.