Desenvolvimento de protocolo clínico para o planejamento familiar de pessoas vivendo com HIV/AIDS

Abstract

The high number of HIV / AIDS cases in the reproductive phase and the feminization of the epidemic generates demand for care in the area of ​​family planning, which requires health professionals with competence to deal with the specificities of this public, an aspect that can be overcome through the use of a clinical protocol . The objective was to elaborate a clinical protocol for care in family planning of people living with HIV / AIDS and to evaluate the quality of the clinical protocol. Development or technological research, carried out from March 2014 to March 2016, following the elaboration steps (establish the title of the protocol based on the theme and the focus; search in the literature of clinical protocols, addressing the theme and focus established; Justification of the development of the protocol, delimitation of content and clinical issues and listening to the user, integrative literature review, textual construction and algorithms, formatting and protocol design); Quality assessment (consultation of evaluators, inclusion of evaluators' recommendations in the protocol and return to them when necessary); And finalization (revision of the Portuguese language, final production and dissemination of the protocol). In the elaboration stage, a technical group of eight participants with experience in family planning and / or HIV / AIDS was formed, with the author as leader. Applying the form "Tool for preparation of clinical protocol with technical group" with the group, we obtained subsidies to define the title, central theme, focus, contents and clinical issues of the protocol - "What scientific evidence about the drug interaction between ART And hormonal contraceptives (combined and progestogen exclusive)? "And" What scientific evidence is the main technology used by couples living with HIV / AIDS (seroconcordant and serodiscordant) who wish to conceive? " Service users were also heard to contribute to the development of the protocol, responding to the questioning - "How would you like to be taken care of in family planning or what do you expect from that service?" The search for the scientific evidence to answer the clinical questions was carried out in the Cochrane Library, PubMed / Medline databases, using the descriptors "HIV infections" and "Family planning", integrated. These included the "Assessment of Quality of Evidence for the Oxford Center for Evidence-Based Medicine - 2009". The evaluation of quality was based on the six areas of scope and scope of the Evaluation of Guideline for Research & Evaluation (AGREE II). Purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence, with its 23 items. The quality evaluation was carried out by five evaluators with experience in family planning and / or HIV / AIDS and / or validation / evaluation of protocols in the academic and care areas. The domain editorial independence obtained maximum evaluation (100.0%); Three domains obtained 95% or more in the evaluation and two domains reached between 88 and 89%. In the overall evaluation, all evaluators recommended the use of the clinical protocol, with the exception of one evaluator who recommended it with restrictions. The Pearson coefficient of variation (CVP) identified a high agreement among the evaluators in all domains, that is, 2.6%, 18.6%, 2.7%, 5.4% and zero, respectively.