Adherence to HIV regimens: 10 vital lessons

Clinical Non-Adherence and Its Associated Factors Among HIV-Positive Pediatric Patients Attending HIV Care in South Gondar Zone Public Health Facilities, Northwest Ethiopia, 2021

Background

Poor clinical adherence is the main factor that hinders ART adherence level in children and its ultimate effect on viral load suppression and decreasing morbidity and mortality of children. Although data from different settings are necessary to tackle such types of problems, the pieces of evidence are limited in the case of clinical adherence level. Therefore, this study was intended to assess clinical non-adherence and its associated factors among HIV-infected pediatrics on highly active antiretroviral therapy.

Methods

A multi-center cross-sectional study was conducted from July 1 to August 30, 2021, among HIV-infected children receiving ART in the South Gondar Zone. Data were collected through face-to-face interviews, and reviewing patients’ documents using a structured checklist. Data were entered into Epi-data version 4.6 and exported to the Statistical Package for Social Science version 23 for analysis. Binary logistic regression was used to assess the association between the factors and the outcome variable. The significance of variables was declared when a p-value was less than 0.05.

Results

From 422 participants, 383 have involved in the study making the response rate of 90.7%. Almost half of the study participants 190 (49.6%) were girls. Two hundred ninety-one (76%) of caretakers were biological mothers, and 203 (53%) did not have adherence supporters. About 179 (46.7%) of caretakers did not disclose the status of the child about the illness. The overall prevalence of non-adherence among children on ART was 31.9% (95% CI: 27.2–36.6). Rural residency, diagnostic status non-disclosure, no adherence supporter, having no biological caretaker and co-morbid illness were significantly associated with clinical non-adherence of HIV positive children.

Conclusion

Clinical non-adherence among children among HIV-positive children attending care in south Gondar zone health facilities is unacceptably high. Attention shall be given to HIV-positive pediatrics who reside in rural areas, whose status was not disclosed, had no adherence supporter, had a non-biological caretaker, and had comorbidity to have good clinical adherence on ART service.

Lack of congruence between patients' and health professionals' perspectives of adherence to imatinib therapy in treatment of chronic myeloid leukemia: A qualitative study

OBJECTIVE

Consistent use of imatinib is critical for treatment success in chronic myeloid leukemia, yet perfect adherence to the prescribed clinical regimen is reported to be as low as 14%. This study aimed to understand patients' experiences of chronic myeloid leukemia with a qualitative approach, including identified facilitators and barriers to adherence, drawing on patients' and health professionals' perspectives, recording comments made by patients and health professionals involved with the same treatment team.

METHOD

We recruited patients with chronic myeloid leukemia prescribed imatinib therapy and health professionals involved in their treatment from a specialized cancer center. Semi-structured qualitative interviews were recorded, transcribed, and manually analyzed using interpretive phenomenological analysis. Recruitment ceased upon saturation, with 16 patients and 10 health professionals (hematologists n = 4, nurses n = 3, pharmacists n = 3).

RESULTS

Twelve patients reported at least one instance of nonadherence. Reasons for unintentional nonadherence included forgetfulness related to variations of routine and doctor-patient communication issues. Reasons for intentional nonadherence included desires to reduce dose-dependent side effects and insufficient support. Patients who reported higher nonadherence rates felt complacent following periods of sustained disease control or had received conflicting advice regarding nonadherence. Health professionals had difficulty in accurately evaluating medication adherence due to a lack of reliable measures, utilizing patient self-report and manifestations of suboptimal disease control to guide assessments.

SIGNIFICANCE OF RESULTS

Adherence issues persist throughout the course of treatment. While high patient-reported nonadherence rates were recorded, health professionals were often unaware of the complex causes, compounded by an inadequacy of adherence assessment tools. Some patients reported nonadherence events because of insufficient education or lack of access to prompt medical guidance. These issues should be addressed to improve clinical practice.

Which patient-related factors determine self-perceived patient adherence to prescribed dyspepsia medication?

Patient adherence to medical treatment for dyspepsia is disappointing, whereas adherence is crucial for a proper evaluation of treatment. This prospective study used elements of the Integrated Change Model and Weiner's Attribution Theory to describe patients' important cognitions and their interrelationships regarding self-perceived adherence to short-term medical treatment for dyspepsia. Patient questionnaires measured the predictors before treatment and self-perceived adherence after treatment. Approximately one-quarter of the patients indicated that they were non-adherent (n = 347). Univariate and multiple linear regression analyses revealed several significant predictors that explained 44% of the variance in self-perceived adherence. Patients with a low educational level, patients who claimed to regularly forget their medication in general, patients with a low self-efficacy or a low intention were less likely to be adherent. These results may indicate targets for interventions designed to improve adherence to medical treatment for dyspepsia. For instance, asking about expected difficulties in taking acid suppressants (e.g. forgetfulness or medication use at weekends) and making action plans to overcome these difficulties (e.g. using reminders) may result in improved adherence rates. Such an approach may reach a substantial number of patients since one in five patients in our study experienced some difficulties in taking medication.

Do psychological attributes matter for adherence to antihypertensive medication? The Finnish Public Sector Cohort Study

OBJECTIVE

Psychological factors may be important determinants of adherence to antihypertensive medication, as they have been repeatedly found to be associated with an increased risk of hypertension, coronary heart disease, and health-damaging behaviours. We examined the importance of several psychological attributes (sense of coherence, optimism, pessimism, hostility, anxiety) with regard to antihypertensive medication adherence assessed by pharmacy refill records.

METHODS

A total of 1021 hypertensive participants, aged 26-63 years, who were employees in eight towns and 12 hospitals in Finland were included in the analyses.

RESULTS

We found 60% of patients to be totally adherent, 36% partially adherent, and 4% totally nonadherent. Multinomial regression analyses revealed high sense of coherence to be associated with lower odds of being totally nonadherent in contrast of being totally adherent (odds ratio=0.55; 95% confidence interval: 0.31-0.96). This association was independent of factors that influenced adherence to antihypertensive medication, such as sociodemographic characteristics, health-related behaviours, self-reported medical history of doctor-diagnosed comorbidity, and anteriority of hypertension status. The association was not specific to certain types of antihypertensive drugs.

CONCLUSION

High sense of coherence may influence antihypertensive medication-adherence behaviour. Aspects characterizing this psychological attribute, such as knowledge (comprehensibility), capacity (manageability), and motivation (meaningfulness) may be important determinants of adherence behaviour for asymptomatic illnesses, such as hypertension, in which patients often do not feel or perceive the immediate consequences of skipping medication doses.

Becoming Adherent: Experiences of Persons Living With HIV/AIDS

Interviews were conducted with HIV-infected persons who had been taking antiretroviral medications for 6 months, reported high levels of adherence, and had low or stable viral loads consistent with adherence. Analysis of the qualitative data revealed five themes related to adherence. "Choosing life" was reflected in decisions about initiating treatment, changing one's lifestyle, and pursuing goals. "Riding it out" emerged from descriptions of adjusting to side effects and overcoming barriers to adherence. "Figuring it out" encompassed individual strategies for incorporating pill-taking into one's life, such as use of pillboxes and making a schedule. "Sticking to it" was overcoming internal resistance to maintaining adherence. "Realizing the benefits," the final theme, revealed successful adherers who had improved clinical outcomes and for whom pill-taking had become routine.

Dealing With the Obstacles in Adhering to Highly Active Antiretroviral Therapy

Improving patient adherence to highly active antiretroviral therapy (HAART) is essential to effective treatment and represents a major challenge confronting healthcare providers. Because of their holistic perspective, nurses are uniquely qualified to identify the psychosocial and practical obstacles to full adherence and help patients deal with these problems. Studies have shown that many factors related to the disease, the patient, the provider, and the treatment regimen all play important roles in adopting and maintaining adherent behavior. Therefore, any attempt toward improving adherence should include adherence assessment and an approach that targets the patient, the provider, and the regimen. The availability of antiretroviral agents that are administered once daily and/or are associated with lower toxicity can help to simplify treatment regimens and avoid certain side effects, thereby facilitating greater adherence to highly active antiretroviral therapy.

Enquête sur la mise en place d’une consultation pharmaceutique pour les patients sous antirétroviraux

OBJECTIVE

Highly active anti-retroviral therapies (HAART) in HIV treatment can result in complex treatment regimens. We surveyed HIV patients followed in the infectious disease department of Saint-Germain-en-Laye Hospital to assess the interest of offering patients a consultation with a pharmacist.

METHODS

The 3-part questionnaire enabled us to assess the medical and pharmaceutical information given to the patient, adherence, and risk factors for poor observance. The questionnaire was distributed to all patients, regardless of whether they were receiving treatment. A simple adherence score was computed as well as a score for the risk of poor adherence.

RESULTS

Ninety patients returned analyzable questionnaires: 65 (72.2%) thought a pharmaceutical consultation would be useful. They felt it should cover in priority the following subjects: drug interactions (51%), secondary effects (49%), and what to do after forgetting a dose (44%). Treatment was perceived as positive by 82 patients (91%) and tolerated well by 57 (65%). Sixty patients (66.3%) reported that they occasionally forgot a dose, 37 (41.3%) that they regularly did. The results showed good adherence by 61.3% and poor adherence by 38.5%. Risk of non-adherence was significantly associated with three factors: the number of pills to take, the number of daily doses, and the length of the treatment.

CONCLUSION

Our survey shows the interest of consultations with pharmacists as a clinical service. By reinforcing the patient's understanding, these can complete and supplement the physician's explanation and instructions on pharmaceutical topics, especially those that could not be addressed during the clinical visit. The main aim of this process is to improve adherence, which is a key element in treatment efficacy.

Factors affecting adherence to antiretroviral therapy in people living with HIV/AIDS

Antiretroviral treatments have given hope to people living with HIV/AIDS and play a role in improving their quality of life. However, the effectiveness of these treatments is directly related to the level of adherence and commitment to them. Researchers have demonstrated that there are many factors that play an important role in adopting and maintaining adherence behavior. In this article, the authors present an indepth review of the literature and from this, enumerate the factors that link adherence behavior to the individual, the treatment, the illness, and the relationship with the health professional. An understanding of these factors is essential to develop interventions that will improve adherence to therapeutic regimens among people with HIV/AIDS.

Adherence to antiretroviral therapy among women with HIV infection

OBJECTIVE

The overall objective of this secondary analysis was to examine self-reported adherence to antiretroviral therapy in a sample of women with HIV.

DESIGN

The primary study used survey methodology.

SETTING

The setting included a university-based HIV/AIDS clinic in southwestern Pennsylvania and a community-based HIV/AIDS clinic in eastern Pennsylvania.

PARTICIPANTS

Sixty-one women infected with HIV who were taking protease inhibitors.

MAIN OUTCOME MEASURE

Self-reported adherence was based on responses to two questions: whether the person had missed a dose of her medications within the past 24 hours, and how many pills the person had taken on time as scheduled (none, very few, a few, about half, most, nearly all, all of them).

RESULTS

Adherence ranged from 60% to 75%. Two thirds (65.6%) of the sample thought that their medications were helping them; three fifths (57.4%) thought that it was dangerous to miss a dose of their medications.

CONCLUSIONS

Adherence in this sample was less than perfect, suggesting the need to develop, implement, and test interventions to promote better adherence to antiretroviral medication regimens among women with HIV.