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Zahra AN, Waluyo A, Yona S, Pakasi TA. Resilience in Relation to Adherence to Antiretroviral Therapy in People Living With HIV: A Qualitative Study. Glob Qual Nurs Res 2024; 11:23333936241233449. [PMID: 38666086 PMCID: PMC11044794 DOI: 10.1177/23333936241233449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 04/28/2024] Open
Abstract
Antiretroviral therapy (ART) adherence significantly impacts the survival and quality of life of people living with HIV (PLWH). Despite the challenges faced by PLWH, adherence remains crucial. Thus, cultivating resilience in ART is essential for optimal treatment outcomes. This qualitative study explored the experience of resilience in relation to ART adherence among PLWH. Semi-structured interviews with 10 participants were conducted and inductively analyzed. Participants' resilience in ART adherence was reflected in their achievements related to cultivating the habit of taking medication and in their convictions that the medication was a daily necessity. PLWH developed resilience through strategies encompassing finding purpose through faith and motivation, fostering wellness by obtaining adequate information, enjoying life, managing disease therapy, and adopting a healthy lifestyle, and building connections by finding adequate support and involving in the community. Nurses are crucial in HIV management, fostering resilience for successful ART adherence and ensuring effective treatment outcomes.
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Affiliation(s)
| | - Agung Waluyo
- Universitas Indonesia, Depok, West Java, Indonesia
| | - Sri Yona
- Universitas Indonesia, Depok, West Java, Indonesia
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Smith R, Villanueva G, Probyn K, Sguassero Y, Ford N, Orrell C, Cohen K, Chaplin M, Leeflang MM, Hine P. Accuracy of measures for antiretroviral adherence in people living with HIV. Cochrane Database Syst Rev 2022; 7:CD013080. [PMID: 35871531 PMCID: PMC9309033 DOI: 10.1002/14651858.cd013080.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Good patient adherence to antiretroviral (ART) medication determines effective HIV viral suppression, and thus reduces the risk of progression and transmission of HIV. With accurate methods to monitor treatment adherence, we could use simple triage to target adherence support interventions that could help in the community or at health centres in resource-limited settings. OBJECTIVES To determine the accuracy of simple measures of ART adherence (including patient self-report, tablet counts, pharmacy records, electronic monitoring, or composite methods) for detecting non-suppressed viral load in people living with HIV and receiving ART treatment. SEARCH METHODS The Cochrane Infectious Diseases Group Information Specialists searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, African-Wide information, and Web of Science up to 22 April 2021. They also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included studies of all designs that evaluated a simple measure of adherence (index test) such as self-report, tablet counts, pharmacy records or secondary database analysis, or both, electronic monitoring or composite measures of any of those tests, in people living with HIV and receiving ART treatment. We used a viral load assay with a limit of detection ranging from 10 copies/mL to 400 copies/mL as the reference standard. We created 2 × 2 tables to calculate sensitivity and specificity. DATA COLLECTION AND ANALYSIS We screened studies, extracted data, and assessed risk of bias using QUADAS-2 independently and in duplicate. We assessed the certainty of evidence using the GRADE method. The results of estimated sensitivity and specificity were presented using paired forest plots and tabulated summaries. We encountered a high level of variation among studies which precluded a meaningful meta-analysis or comparison of adherence measures. We explored heterogeneity using pre-defined subgroup analysis. MAIN RESULTS We included 51 studies involving children and adults with HIV, mostly living in low- and middle-income settings, conducted between 2003 and 2021. Several studies assessed more than one index test, and the most common measure of adherence to ART was self-report. - Self-report questionnaires (25 studies, 9211 participants; very low-certainty): sensitivity ranged from 10% to 85% and specificity ranged from 10% to 99%. - Self-report using a visual analogue scale (VAS) (11 studies, 4235 participants; very low-certainty): sensitivity ranged from 0% to 58% and specificity ranged from 55% to 100%. - Tablet counts (12 studies, 3466 participants; very low-certainty): sensitivity ranged from 0% to 100% and specificity ranged from 5% to 99%. - Electronic monitoring devices (3 studies, 186 participants; very low-certainty): sensitivity ranged from 60% to 88% and the specificity ranged from 27% to 67%. - Pharmacy records or secondary databases (6 studies, 2254 participants; very low-certainty): sensitivity ranged from 17% to 88% and the specificity ranged from 9% to 95%. - Composite measures (9 studies, 1513 participants; very low-certainty): sensitivity ranged from 10% to 100% and specificity ranged from 49% to 100%. Across all included studies, the ability of adherence measures to detect viral non-suppression showed a large variation in both sensitivity and specificity that could not be explained by subgroup analysis. We assessed the overall certainty of the evidence as very low due to risk of bias, indirectness, inconsistency, and imprecision. The risk of bias and the applicability concerns for patient selection, index test, and reference standard domains were generally low or unclear due to unclear reporting. The main methodological issues identified were related to flow and timing due to high numbers of missing data. For all index tests, we assessed the certainty of the evidence as very low due to limitations in the design and conduct of the studies, applicability concerns and inconsistency of results. AUTHORS' CONCLUSIONS We encountered high variability for all index tests, and the overall certainty of evidence in all areas was very low. No measure consistently offered either a sufficiently high sensitivity or specificity to detect viral non-suppression. These concerns limit their value in triaging patients for viral load monitoring or enhanced adherence support interventions.
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Affiliation(s)
- Rhodine Smith
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Nathan Ford
- Department of HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Catherine Orrell
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Marty Chaplin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Hine
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Abdulrahman A, Richards D, Bilgin AA. Exploring the influence of a user-specific explainable virtual advisor on health behaviour change intentions. AUTONOMOUS AGENTS AND MULTI-AGENT SYSTEMS 2022; 36:25. [PMID: 35401031 PMCID: PMC8977831 DOI: 10.1007/s10458-022-09553-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
Virtual advisors (VAs) are being utilised almost in every service nowadays from entertainment to healthcare. To increase the user's trust in these VAs and encourage the users to follow their advice, they should have the capability of explaining their decisions, particularly, when the decision is vital such as health advice. However, the role of an explainable VA in health behaviour change is understudied. There is evidence that people tend to change their intentions towards health behaviour when the persuasion message is linked to their mental state. Thus, this study explores this link by introducing an explainable VA that provides explanation according to the user's mental state (beliefs and goals) rather than the agent's mental state as commonly utilised in explainable agents. It further explores the influence of different explanation patterns that refer to beliefs, goals, or beliefs&goals on the user's behaviour change. An explainable VA was designed to advise undergraduate students how to manage their study-related stress by motivating them to change certain behaviours. With 91 participants, the VA was evaluated and the results revealed that user-specific explanation could significantly encourage behaviour change intentions and build good user-agent relationship. Small differences were found between the three types of explanation patterns.
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Affiliation(s)
- Amal Abdulrahman
- School of Computing, Macquarie University, Balaclava Road, Sydney, 2109 NSW Australia
| | - Deborah Richards
- School of Computing, Macquarie University, Balaclava Road, Sydney, 2109 NSW Australia
| | - Ayse Aysin Bilgin
- School of Mathematical and Physical Sciences, Macquarie University, Balaclava Road, Sydney, 2109 NSW Australia
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Limbada M, Bwalya C, Macleod D, Shibwela O, Floyd S, Nzara D, Situmbeko V, Hayes R, Fidler S, Ayles H. Acceptability and Preferences of Two Different Community Models of ART Delivery in a High Prevalence Urban Setting in Zambia: Cluster-Randomized Trial, Nested in the HPTN 071 (PopART) Study. AIDS Behav 2022; 26:328-338. [PMID: 34304330 PMCID: PMC8813709 DOI: 10.1007/s10461-021-03385-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Abstract
Community delivery of Antiretroviral therapy (ART) is a novel innovation to increase sustainable ART coverage for People living with HIV (PLHIV) in resource limited settings. Within a nested cluster-randomised sub-study in two urban communities that participated in the HPTN 071 (PopART) trial in Zambia we investigated individual acceptability and preferences for ART delivery models. Stable PLHIV were enrolled in a cluster-randomized trial of three different models of ART: Facility-based delivery (SoC), Home-based delivery (HBD) and Adherence clubs (AC). Consenting individuals were asked to express their stated preference for ART delivery options. Those assigned to the community models of ART delivery arms could choose ("revealed preference") between the assigned arm and facility-based delivery. In total 2489 (99.6%) eligible individuals consented to the study and 95.6% chose community models of ART delivery rather than facility-based delivery when offered a choice. When asked to state their preference of model of ART delivery, 67.6% did not state a preference of one model over another, 22.8% stated a preference for HBD, 5.0% and 4.6% stated a preference for AC and SoC, respectively. Offering PLHIV choices of community models of ART delivery is feasible and acceptable with majority expressing HBD as their stated preferred option.
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Affiliation(s)
- Mohammed Limbada
- Zambart House, School of Medicine, University of Zambia, Ridgeway Campus, Off Nationalist Road, P.O. Box 50697, Lusaka, Zambia
| | - Chiti Bwalya
- Zambart House, School of Medicine, University of Zambia, Ridgeway Campus, Off Nationalist Road, P.O. Box 50697, Lusaka, Zambia
| | - David Macleod
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Osborn Shibwela
- Zambart House, School of Medicine, University of Zambia, Ridgeway Campus, Off Nationalist Road, P.O. Box 50697, Lusaka, Zambia
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Diana Nzara
- Zambart House, School of Medicine, University of Zambia, Ridgeway Campus, Off Nationalist Road, P.O. Box 50697, Lusaka, Zambia
| | - Vasty Situmbeko
- Zambart House, School of Medicine, University of Zambia, Ridgeway Campus, Off Nationalist Road, P.O. Box 50697, Lusaka, Zambia
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Fidler
- Imperial College, United Kingdom and Imperial College NIHR BRC, London, UK
| | - Helen Ayles
- Zambart House, School of Medicine, University of Zambia, Ridgeway Campus, Off Nationalist Road, P.O. Box 50697, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - the HPTN 071 (PopART) Study Team
- Zambart House, School of Medicine, University of Zambia, Ridgeway Campus, Off Nationalist Road, P.O. Box 50697, Lusaka, Zambia
- Imperial College, United Kingdom and Imperial College NIHR BRC, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Pill Counting as an Intervention to Enhance Compliance and Reduce Adverse Outcomes with Analgesics Prescribed for Chronic Pain Conditions: A Systematic Review. Curr Pain Headache Rep 2022; 26:883-887. [PMID: 36459370 PMCID: PMC9716148 DOI: 10.1007/s11916-022-01091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW Appropriate use of opioid analgesics is a key concern within the field of pain medicine. Several methods exist to discourage abuse and facilitate effective treatment regimens. Pill counting is often cited as one such method and frequently employed in varying fashions within clinical practice. However, to date, there is no published review of the evidence to support this practice. This was a comprehensive review of the available literature that was conducted with analysis of the efficacy and practical application of pill counting during treatment of chronic pain conditions. RECENT FINDINGS There is paucity in data regarding pill count importance in pain management. Pill count is a very important tool to monitor compliance of opioids use which in turn can prevent several complications associated with opioid misuse. Pill counting may be used in conjunction with other abuse deterrents, although increased support for this practice requires standardized methods of pill counting and further analysis of its effectiveness.
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In Search of Embodied Conversational and Explainable Agents for Health Behaviour Change and Adherence. MULTIMODAL TECHNOLOGIES AND INTERACTION 2021. [DOI: 10.3390/mti5090056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Conversational agents offer promise to provide an alternative to costly and scarce access to human health providers. Particularly in the context of adherence to treatment advice and health behavior change, they can provide an ongoing coaching role to motivate and keep the health consumer on track. Due to the recognized importance of face-to-face communication and establishment of a therapist-patient working alliance as the biggest single predictor of adherence, our review focuses on embodied conversational agents (ECAs) and their use in health and well-being interventions. The article also introduces ECAs who provide explanations of their recommendations, known as explainable agents (XAs), as a way to build trust and enhance the working alliance towards improved behavior change. Of particular promise, is work in which XAs are able to engage in conversation to learn about their user and personalize their recommendations based on their knowledge of the user and then tailor their explanations to the beliefs and goals of the user to increase relevancy and motivation and address possible barriers to increase intention to perform the healthy behavior.
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Villars H, Cantet C, de Peretti E, Perrin A, Soto-Martin M, Gardette V. Impact of an educational programme on Alzheimer's disease patients' quality of life: results of the randomized controlled trial THERAD. ALZHEIMERS RESEARCH & THERAPY 2021; 13:152. [PMID: 34511121 PMCID: PMC8436545 DOI: 10.1186/s13195-021-00896-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although educational interventions are recommended in Alzheimer's disease (AD), studies assessing the impact of interventions such as "therapeutic patient education" are scarce. Indeed, the intrinsic nature of the disease is considered a barrier to patients' involvement in such approaches. We aimed to evaluate an intervention by using a "dyadic" approach (patient and caregiver) in both intervention and assessment. METHODS THERAD is a monocentric, randomized, controlled trial assessing the effects of a 2-month educational programme in mild to moderately severe AD patients among 98 dyads (caregiver/patient) on caregiver-reported patient quality of life (QOL) at 2 months. Community-dwelling patients and their caregivers were recruited in ambulatory units of the French Toulouse University Hospital. Self-reported patient QOL, autonomy, behavioural and psychological symptoms and caregiver QOL and burden were collected at 2, 6 and 12 months. Linear mixed models were used in modified intention-to-treat populations. We also performed sensitivity analysis. RESULTS A total of 196 dyads were included, 98 in each group. The mean age of the patients was 82 years, 67.7% were women, diagnosed with AD (+/- cerebrovascular component) (mean MMSE =17.6), and 56.9% lived with a partner. The mean age of the caregivers was 65.7 years, and 64.6% were women (52.3% offspring/42.6% spouses), with a moderate burden (mean Zarit score = 30.9). The mean caregiver-reported patient QOL was lower than the self-reported QOL (28.61 vs. 33.96). We did not identify any significant difference in caregiver-reported patients' QOL (p = 0.297) at 2 months, but there was a significant difference in self-reported patients' QOL at 2 months (p = 0.0483) or 6 months (p = 0.0154). No significant difference was found for the secondary outcomes. The results were stable in the sensitivity analyses. CONCLUSIONS This randomized controlled trial assessing an educational intervention in 196 dyads (Alzheimer's disease affected patient/caregiver) highlights the need to better consider the patient's point of view, since only the self-reported QOL was improved. Additional studies using this dyadic approach are necessary in targeted subpopulations of caregivers (spouse vs. child, gender) and of patients (severity of cognitive impairment or behavioural disturbances) TRIAL REGISTRATION: THERAD study NCT01796314 . Registered on February 19, 2013.
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Affiliation(s)
- Hélène Villars
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France.
| | - Christelle Cantet
- Inserm UMR 1295: Center for Research in Population Health (CERPOP) - Department of Epidemiology and Public Health, University of Toulouse, II F-31073, 37, allées Jules Guesde, 31073, Toulouse cedex, France
| | - Eva de Peretti
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Amelie Perrin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Maria Soto-Martin
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
| | - Virginie Gardette
- Geriatric Department, Toulouse University Hospital, Hopital La Grave- Cité de la Santé Place Lange TSA 60 033, 31059, Toulouse Cedex 9, France
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Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Zani B, Thabane L. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1. BMJ Open 2020; 10:e034793. [PMID: 32967868 PMCID: PMC7513605 DOI: 10.1136/bmjopen-2019-034793] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care. METHODS We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis. RESULTS We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care. CONCLUSIONS Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women's College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Women's College Research Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Ghayda RA, Hong SH, Yang JW, Jeong GH, Lee KH, Kronbichler A, Solmi M, Stubbs B, Koyanagi A, Jacob L, Oh H, Kim JY, Shin JI, Smith L. A Review of Pre-Exposure Prophylaxis Adherence among Female Sex Workers. Yonsei Med J 2020; 61:349-358. [PMID: 32390358 PMCID: PMC7214109 DOI: 10.3349/ymj.2020.61.5.349] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 12/27/2022] Open
Abstract
Globally and in Africa specifically, female sex workers (FSWs) are at an extraordinarily high risk of contracting human immunodeficiency virus (HIV). Pre-exposure prophylaxis (PrEP) has emerged as an effective and ethical method with which to prevent HIV infection among FSWs. PrEP efficacy is, however, closely linked to adherence, and adherence to PrEP among FSWs is a complex and interrelated process that has been shown to be of importance to public health policies and HIV control and intervention programs. This comprehensive review categorizes barriers to and facilitators of adherence to HIV PrEP for FSWs, and describes five strategies for promoting PrEP adherence among FSWs. These strategies encompass 1) a long-term educational effort to decrease the stigma associated with sex work and PrEP use, 2) education on how PrEP works, 3) lifestyle modification, 4) research on next-generation PrEP products to address the inconvenience of taking daily pills, and 5) integration of PrEP into existing services, such as social services and routine primary care visits, to reduce the economic burden of seeking the medication. Our review is expected to be useful for the design of future PrEP intervention programs. Multidisciplinary intervention should be considered to promote PrEP adherence among FSWs in order to help control the HIV epidemic.
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Affiliation(s)
- Ramy Abou Ghayda
- Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sung Hwi Hong
- Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jae Won Yang
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Gwang Hun Jeong
- College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - Marco Solmi
- Department of Neuroscience, Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Hans Oh
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | | | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Wijnen BFM, Oberjé EJM, Evers SMAA, Prins JM, Nobel HE, van Nieuwkoop C, Veenstra J, Pijnappel FJ, Kroon FP, van Zonneveld L, van Hulzen AGW, van Broekhuizen M, de Bruin M. Cost-effectiveness and Cost-utility of the Adherence Improving Self-management Strategy in Human Immunodeficiency Virus Care: A Trial-based Economic Evaluation. Clin Infect Dis 2020; 68:658-667. [PMID: 30239629 DOI: 10.1093/cid/ciy553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/03/2018] [Indexed: 01/02/2023] Open
Abstract
Background Several promising human immunodeficiency virus (HIV) treatment adherence interventions have been identified, but data about their cost-effectiveness are lacking. This study examines the trial-based cost-effectiveness and cost-utility of the proven-effective Adherence Improving Self-Management Strategy (AIMS), from a societal perspective, with a 15-month time horizon. Methods Treatment-naive and treatment-experienced patients at risk for viral rebound were randomized to treatment as usual (TAU) or AIMS in a multicenter randomized controlled trial in the Netherlands. AIMS is a nurse-led, 1-on-1 self-management intervention incorporating feedback from electronic medication monitors, delivered during routine clinical visits. Main outcomes were costs per reduction in log10 viral load, treatment failure (2 consecutive detectable viral loads), and quality-adjusted life-years (QALYs). Results Two hundred twenty-three patients were randomized. From a societal perspective, AIMS was slightly more expensive than TAU but also more effective, resulting in an incremental cost-effectiveness ratio (ICER) of €549 per reduction in log10 viral load and €1659 per percentage decrease in treatment failure. In terms of QALYs, AIMS resulted in higher costs but more QALYs compared to TAU, which resulted in an ICER of €27759 per QALY gained. From a healthcare perspective, AIMS dominated TAU. Additional sensitivity analyses addressing key limitations of the base case analyses also suggested that AIMS dominates TAU. Conclusions Base case analyses suggests that over a period of 15 months, AIMS may be costlier, but also more effective than TAU. All additional analyses suggest that AIMS is cheaper and more effective than TAU. This trial-based economic evaluation confirms and complements a model-based economic evaluation with a lifetime horizon showing that AIMS is cost-effective. Clinical Trials Registration NCT01429142.
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Affiliation(s)
- Ben F M Wijnen
- Department of Health Services Research, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Center of Economic Evaluations, Utrecht
| | - Edwin J M Oberjé
- Amsterdam School of Communication Research, University of Amsterdam.,Zuyd University of Applied Sciences, Faculty of Healthcare, Heerlen
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute, School for Public Health and Primary Care, Maastricht University.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Center of Economic Evaluations, Utrecht
| | - Jan M Prins
- Department of Internal Medicine, Academic Medical Center, Amsterdam
| | - Hans-Erik Nobel
- Department of Internal Medicine, Academic Medical Center, Amsterdam
| | | | - Jan Veenstra
- Department of Internal Medicine, Sint Lucas Andreas Hospital, Amsterdam
| | | | - Frank P Kroon
- Department of Infectious Diseases, Leiden University Medical Center
| | | | | | | | - Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, United Kingdom
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11
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Rooks-Peck CR, Wichser ME, Adegbite AH, DeLuca JB, Barham T, Ross LW, Higa DH, Sipe TA. Analysis of Systematic Reviews of Medication Adherence Interventions for Persons with HIV, 1996-2017. AIDS Patient Care STDS 2019; 33:528-537. [PMID: 31750731 PMCID: PMC8237207 DOI: 10.1089/apc.2019.0125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This overview of reviews summarizes the evidence from systematic reviews (SR) on the effectiveness of antiretroviral therapy (ART) adherence interventions for people with HIV (PWH) and descriptively compares adherence interventions among key populations. Relevant articles published during 1996-2017 were identified by comprehensive searches of CDC's HIV/acquired immunodeficiency syndrome (AIDS) Prevention Research Synthesis Database and manual searches. Included SRs examined primary interventions intended to improve ART adherence, focused on PWH, and assessed medication adherence or biologic outcomes (e.g., viral load). We synthesized the qualitative data and used the Assessment of Multiple Systematic Reviews (AMSTAR) for quality assessment. Forty-one SRs met inclusion criteria. Average quality was high. SRs that evaluated text-messaging interventions (n = 9) consistently reported statistically significant improvements in adherence and biologic outcomes. Other ART adherence strategies [e.g., behavioral, directly administered antiretroviral therapy (DAART)] reported improvements, but did not report significant effects for both outcomes, or intervention effects that did not persist postintervention. In the review focused on people who inject drugs (n = 1), DAART alone or in combination with medication-assisted therapy improved both outcomes. In SRs focused on children or adolescents aged <18 years (n = 5), regimen-related and hospital-based DAART improved biologic outcomes. ART adherence interventions (e.g., text-messaging) improved adherence and biologic outcomes; however, results differed for other intervention strategies, populations, and outcomes. Because few SRs reported evidence for populations at high risk (e.g., men who have sex with men), the results are not generalizable to all PWH. Future implementation studies are needed to examine medication adherence interventions in specific populations and address the identified gaps.
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Affiliation(s)
- Cherie R. Rooks-Peck
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Julia B. DeLuca
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Terrika Barham
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leslie W. Ross
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Darrel H. Higa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Prevention Research Synthesis Project
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Moosa A, Gengiah TN, Lewis L, Naidoo K. Long-term adherence to antiretroviral therapy in a South African adult patient cohort: a retrospective study. BMC Infect Dis 2019; 19:775. [PMID: 31488063 PMCID: PMC6727323 DOI: 10.1186/s12879-019-4410-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background South Africa has the highest HIV prevalence and supports the largest antiretroviral therapy (ART) programme globally. With the introduction of a test and treat policy, ensuring long term optimal adherence to ART (≥95%) is essential for successful patient and public health outcomes. The aim of this study was to assess long-term ART adherence to inform best practices for chronic HIV care. Method Long-term ART adherence was retrospectively analysed over a median duration of 5 years (interquartile range [IQR]: 5.3–6.5) in patients initially enrolled in a randomised controlled trial assessing tuberculosis and HIV treatment integration and subsequently followed post-trial in an observational cohort study in Durban, South Africa. The association between baseline patient characteristics and adherence over time was estimated using generalized estimating equations (GEE). Adherence was assessed using pharmacy pill counts conducted at each study visit and compared to 6 monthly viral load measurements. A Kaplan Meier survival analysis was used to estimate time to treatment failure. The McNemar test (with exact p-values) was used to determine the effect of pill burden and concurrent ART and tuberculosis treatment on adherence. Results Of the 270 patients included in the analysis; 54.8% were female, median age was 34 years (IQR:29–40) and median time on ART was 70 months (IQR = 64–78). Mean adherence was ≥95% for each year on ART. Stable patients provided with an extended 3-month ART supply maintained adherence > 99%. At study end, 96 and 94% of patients were optimally adherent and virologically suppressed, respectively. Time since ART initiation, female gender and primary breadwinner status were significantly associated with ≥95% adherence to ART. The cumulative probability of treatment failure was 10.7% at 5 years after ART initiation. Concurrent ART and tuberculosis treatment, or switching to a second line ART regimen with higher pill burden, did not impair ART adherence. Conclusion Optimal long-term adherence with successful treatment outcomes are possible within a structured ART programme with close adherence monitoring. This adherence support approach is relevant to a resource limited setting adopting a test and treat strategy.
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Affiliation(s)
- Atika Moosa
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.
| | - Tanuja N Gengiah
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Lara Lewis
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa
| | - Kogieleum Naidoo
- CAPRISA-Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa.,MRC-CAPRISA HIV-TB Pathogenesis and Treatment, Research Unit, Nelson R Mandela School of Medicine, Doris Duke Medical Research Institute (2nd floor), University of KwaZulu-Natal, 719 Umbilo Road, Private Bag X7, Congella, Durban, 4013, South Africa
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13
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Siwingwa M, Nzala SH, Sikateyo B, Mutale W. Perceptions on the feasibility of decentralizing phlebotomy services in community anti-retroviral therapy group model in Lusaka, Zambia. BMC Health Serv Res 2019; 19:570. [PMID: 31412849 PMCID: PMC6694622 DOI: 10.1186/s12913-019-4386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in this model, and stable patient still have to go to the clinic for blood draws after drugs refills from the community. Due to the introduction of new ART drugs, the guidelines now recommend the use of viral loads to guide decision in switching all patients from NNRTI to dolutegravir based first line ART regimens. But the national viral load testing coverage stands at 37% and and falls short of meeting the global UNAIDS and phlebotomy delivery system is congested. The purpose of this study was to identify the perceptions in decentralizing phlebotomy services into the community anti-retroviral therapy Group model. METHOD A qualitative case study design was used. Data were collected through ten Focused group discussions among community anti-retroviral therapy Group members, community and health care workers at anti-retroviral therapy clinics and in-depth interviews with five key informants. Data were managed with the help of Nvivo version 10 and analyzed using thematic method. RESULTS Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing phlebotomy appointments, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative access to laboratory services and encouraged patient's accountability. The negative perceptions were compromised sample integrity, inability to perform prevention control and patients less contact with clinicians. CONCLUSION The study has demonstrated that decentralizing phlebotomy services within the CAG model has greater potential to improve the quality of services delivery for patients. In addition, it has perceived threats on the quality of specimen collected, patient's safety, and health care.
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Affiliation(s)
- Mpanji Siwingwa
- Department of health policy and management, University of Zambia, School of public health, P.O BOX 50110 Lusaka, Zambia
| | - Selestine H. Nzala
- Department of medical education development, University of Zambia, School of Medicine, P.O BOX 50110 Lusaka, Zambia
| | - Bornwell Sikateyo
- Department of bioethics, University of Zambia, School of medicine, P.O BOX 50110 Lusaka, Zambia
| | - Wilbroad Mutale
- Department of health policy and management, University of Zambia, School of public health, P.O BOX 50110 Lusaka, Zambia
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14
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Ibrahim IM, Bade AN, Lin Z, Soni D, Wojtkiewicz M, Dyavar Shetty BL, Gautam N, McMillan JM, Alnouti Y, Edagwa BJ, Gendelman HE. Synthesis and characterization of a long-acting emtricitabine prodrug nanoformulation. Int J Nanomedicine 2019; 14:6231-6247. [PMID: 31496683 PMCID: PMC6689761 DOI: 10.2147/ijn.s215447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose A palmitoylated prodrug of emtricitabine (FTC) was synthesized to extend the drug’s half-life, antiretroviral activities and biodistribution. Methods A modified FTC prodrug (MFTC) was synthesized by palmitoyl chloride esterification. MFTC’s chemical structure was evaluated by nuclear magnetic resonance. The created hydrophobic prodrug nanocrystals were encased into a poloxamer surfactant and the pharmacokinetics (PK), biodistribution and antiretroviral activities of the nanoformulation (NMFTC) were assessed. The conversion of MFTC to FTC triphosphates was evaluated. Results MFTC coated with poloxamer formed stable nanocrystals (NMFTC). NMFTC demonstrated an average particle size, polydispersity index and zeta potential of 350 nm, 0.24 and −20 mV, respectively. Drug encapsulation efficiency was 90%. NMFTC was readily taken up by human monocyte-derived macrophages yielding readily detected intracellular FTC triphosphates and an extended PK profile. Conclusion NMFTC shows improved antiretroviral activities over native FTC. This is coordinate with its extended apparent half-life. The work represents an incremental advance in the development of a long-acting FTC formulation.
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Affiliation(s)
- Ibrahim M Ibrahim
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pharmacology, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aditya N Bade
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Zhiyi Lin
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dhruvkumar Soni
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Melinda Wojtkiewicz
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bhagya Laxmi Dyavar Shetty
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nagsen Gautam
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - JoEllyn M McMillan
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yazen Alnouti
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Benson J Edagwa
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Howard E Gendelman
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
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15
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Raberahona M, Lidamahasolo Z, Andriamamonjisoa J, Andriananja V, Andrianasolo RL, Rakotoarivelo RA, Randria MJDD. Knowledge, attitudes, perception and practices regarding antiretroviral therapy among HIV-infected adults in Antananarivo, Madagascar: a cross-sectional survey. BMC Health Serv Res 2019; 19:341. [PMID: 31138303 PMCID: PMC6537363 DOI: 10.1186/s12913-019-4173-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/20/2019] [Indexed: 01/05/2023] Open
Abstract
Background Adherence to antiretroviral therapy (ART) may be influenced by knowledge, perception and perception regarding ART. The purpose of this study was to assess knowledge, attitude/perception and practice regarding ART among people living with HIV/AIDS (PLHIV). Methods We conducted a cross-sectional survey to assess knowledge, attitudes, perception and practices ART in PLHIV. The survey was suggested to all PLHIV of at least 18 years old and who were on ART for at least 1 month. PLHIV who were unable to answer questions correctly and those who did not complete the survey for any reason were excluded. Results During the study period, 234 PLHIV were included. Participants were mostly men (75.2%). The median age was 33 years (IQR: 27–41). The median time since HIV diagnosis was 25 months (IQR: 9–56) and the median duration of ART was 18 months (IQR: 8–48). 87.6% had an overall good knowledge of ART. However, only 3.2% knew the name of their ART, 31.2% were aware that ART should be taken at a fixed time and 17.1% knew how to take ART in relation to food intake. 75.6% of participants had an overall positive attitude/perception of ART. However, 10.7% were convinced that other methods were more effective than ART for treating HIV and 42.7% thought that taking ART was shameful. The assessment of practices showed that in case of missed dose, 48.3% of participants routinely skipped this dose instead of trying to take it as soon as possible. In multivariate analysis, good knowledge of ART was independently associated with high level of education (aOR: 4.7, IC95%: 1.6–13.7, p = 0.004) and disclosure of HIV status (aOR: 2.7, IC95%: 1.1–6.6, p = 0.029). Conclusions This study showed an overall good knowledge and a predominantly positive attitude/perception of ART. However, accurate knowledge of ART intake was insufficient and the stigma associated with taking ART remained very present. Furthermore, very heterogeneous practices may reflect lack of instruction given by the physician regarding ART intake. Electronic supplementary material The online version of this article (10.1186/s12913-019-4173-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mihaja Raberahona
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
| | - Zinara Lidamahasolo
- Department of Pharmacy, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | - Volatiana Andriananja
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | | | - Mamy Jean de Dieu Randria
- Infectious Diseases Department, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.,Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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16
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Millard T, Dodson S, McDonald K, Klassen KM, Osborne RH, Battersby MW, Fairley CK, Elliott JH. The systematic development of a complex intervention: HealthMap, an online self-management support program for people with HIV. BMC Infect Dis 2018; 18:615. [PMID: 30509195 PMCID: PMC6278155 DOI: 10.1186/s12879-018-3518-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 11/15/2018] [Indexed: 12/25/2022] Open
Abstract
Background Despite persistent calls for HIV care to adopt a chronic care approach, few HIV treatment services have been able to establish service arrangements that prioritise self-management. To prevent cardiovascular and other chronic disease outcomes, the HealthMap program aims to enhance routine HIV care with opportunities for self-management support. This paper outlines the systematic process that was used to design and develop the HealthMap program, prior to its evaluation in a cluster-randomised trial. Methods Program development, planning and evaluation was informed by the PRECEDE-PROCOEDE Model and an Intervention Mapping approach and involved four steps: (1) a multifaceted needs assessment; (2) the identification of intervention priorities; (3) exploration and identification of the antecedents and reinforcing factors required to initiate and sustain desired change of risk behaviours; and finally (4) the development of intervention goals, strategies and methods and integrating them into a comprehensive description of the intervention components. Results The logic model incorporated the program’s guiding principles, program elements, hypothesised causal processes, and intended program outcomes. Grounding the development of HealthMap on a clear conceptual base, informed by the research literature and stakeholder’s perspectives, has ensured that the HealthMap program is targeted, relevant, provides transparency, and enables effective program evaluation. Conclusions The use of a systematic process for intervention development facilitated the development of an intervention that is patient centred, accessible, and focuses on the key determinants of health-related outcomes for people with HIV in Australia. The techniques used here may offer a useful methodology for those involved in the development and implementation of complex interventions.
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Affiliation(s)
- Tanya Millard
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia. .,Cochrane Australia, School of Public Health and Preventative Medicine, Melbourne, Australia.
| | | | - Karalyn McDonald
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Karen M Klassen
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia
| | - Richard H Osborne
- Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Malcolm W Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre and Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Julian H Elliott
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia.,Cochrane Australia, School of Public Health and Preventative Medicine, Melbourne, Australia
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17
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Iguenane J, Sawadogo I, Marchand C, Beugny A. [Designing and evaluating therapeutic education tools for people living with HIV]. SANTE PUBLIQUE 2018; 30:263-271. [PMID: 30148314 DOI: 10.3917/spub.182.0263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In the context of therapeutic education for people living with HIV in Africa, educational tools must be adapted to their living environment. OBJECTIVES To describe the process of designing education tools for patients living with HIV and evaluate their use by African caregivers-educators. METHODS An eight-step participatory and formative process was carried out to design educational tools. Twenty-one caregivers-educators from nine French-speaking African countries in three focus groups were interviewed on the way in which they used these tools. RESULTS Fourteen people were trained in the process of designing the tools and training caregivers-educators in their use. Two toolkits were developed (adults and children/adolescents). The image folder was the tool most commonly used. Educators in all countries used tools to address self-care and psychosocial coping skills. The criteria for choosing the tools were linked to their attractiveness, ease of use, their adaptation to the patient's needs and characteristics, and the degree of mastery by the caregiver-educator. The tools helped to structure the education sessions. Brakes to their use were organizational and lack of experience or mastery. CONCLUSION The participatory and formative approach enabled educators working with patients living with HIV in French-speaking Africa to appropriate the tools. Training was a crucial step in enabling caregiver-educators to master and disseminate the tools, and design new tools.
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18
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Frost H, Campbell P, Maxwell M, O’Carroll RE, Dombrowski SU, Williams B, Cheyne H, Coles E, Pollock A. Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLoS One 2018; 13:e0204890. [PMID: 30335780 PMCID: PMC6193639 DOI: 10.1371/journal.pone.0204890] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 09/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The challenge of addressing unhealthy lifestyle choice is of global concern. Motivational Interviewing has been widely implemented to help people change their behaviour, but it is unclear for whom it is most beneficial. This overview aims to appraise and synthesise the review evidence for the effectiveness of Motivational Interviewing on health behaviour of adults in health and social care settings. METHODS A systematic review of reviews. Methods were pre-specified and documented in a protocol (PROSPERO-CRD42016049278). We systematically searched 7 electronic databases: CDSR; DARE; PROSPERO; MEDLINE; CINAHL; AMED and PsycINFO from 2000 to May 2018. Two reviewers applied pre-defined selection criteria, extracted data using TIDIER guidelines and assessed methodological quality using the ROBIS tool. We used GRADE criteria to rate the strength of the evidence for reviews including meta-analyses. FINDINGS Searches identified 5222 records. One hundred and four reviews, including 39 meta-analyses met the inclusion criteria. Most meta-analysis evidence was graded as low or very low (128/155). Moderate quality evidence for mainly short term (<6 months) statistically significant small beneficial effects of Motivational Interviewing were found in 11 of 155 (7%) of meta-analysis comparisons. These outcomes include reducing binge drinking, frequency and quantity of alcohol consumption, substance abuse in people with dependency or addiction, and increasing physical activity participation. CONCLUSIONS We have created a comprehensive map of reviews relating to Motivational Interviewing to signpost stakeholders to the best available evidence. More high quality research is needed to be confident about the effectiveness of Motivational Interviewing. We identified a large volume of low quality evidence and many areas of overlapping research. To avoid research waste, it is vital for researchers to be aware of existing research, and the implications arising from that research. In the case of Motivational Interviewing issues relating to monitoring and reporting fidelity of interventions need to be addressed.
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Affiliation(s)
- Helen Frost
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Pauline Campbell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
| | - Margaret Maxwell
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Ronan E. O’Carroll
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Stephan U. Dombrowski
- School of Health Sciences, Division of Psychology, University of Stirling, Stirling, Scotland, United Kingdom
| | - Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Sighthill Court, Scotland, United Kingdom
| | - Helen Cheyne
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Emma Coles
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), School of Health Sciences, University of Stirling, Stirling, Scotland, United Kingdom
| | - Alex Pollock
- Nursing, Midwifery, Allied Health Professional Research Unit (NMAHP-RU), Glasgow Caledonian University, Glasgow, United Kingdom
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Sikkema KJ, Mulawa MI, Robertson C, Watt MH, Ciya N, Stein DJ, Cherenack EM, Choi KW, Kombora M, Joska JA. Improving AIDS Care After Trauma (ImpACT): Pilot Outcomes of a Coping intervention Among HIV-Infected Women with Sexual Trauma in South Africa. AIDS Behav 2018; 22:1039-1052. [PMID: 29270789 PMCID: PMC5828984 DOI: 10.1007/s10461-017-2013-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Improving AIDS Care after Trauma (ImpACT), a coping intervention for HIV-infected women with sexual abuse histories, was evaluated for feasibility and potential efficacy in a public clinic in Cape Town, South Africa. Sixty-four participants were enrolled prior to starting antiretroviral therapy (ART). After completing baseline assessments, participants were randomly assigned to standard of care (SoC: three adherence counseling sessions) or ImpACT (SoC plus four individual and three group sessions). Participants completed assessments at 3 months (after individual sessions) and 6 months post-baseline. In exploratory analysis of primary outcomes, ImpACT participants, compared to SoC, reported greater reductions in avoidance and arousal symptoms of PTSD and greater increases in ART adherence motivation at 3 months. Clinically significant decreases in overall PTSD symptoms were also demonstrated at 3 months. These effects continued as trends at the 6-month assessment, in addition to increases in social/spiritual coping. In analysis of secondary outcomes, high levels of non-adherence to ART and poor care engagement were evident at 6 months, with no differences between study arms. A trauma-focused, culturally-adapted individual intervention delivered by a non-specialist in the HIV care setting is feasible and acceptable. Preliminary findings suggest ImpACT has potential to reduce PTSD symptoms and increase ART adherence motivation, but a more intensive intervention may be needed to improve and maintain care engagement among this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02223390.
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Affiliation(s)
- Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Box 90086, Durham, NC, 27708-0086, USA.
| | - Marta I Mulawa
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Corne Robertson
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nonceba Ciya
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Emily M Cherenack
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Karmel W Choi
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Matapelo Kombora
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Spaan P, van Luenen S, Garnefski N, Kraaij V. Psychosocial interventions enhance HIV medication adherence: A systematic review and meta-analysis. J Health Psychol 2018; 25:1326-1340. [PMID: 29417851 PMCID: PMC7480021 DOI: 10.1177/1359105318755545] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
About 40 per cent of people living with HIV do not sufficiently adhere to
their medication regimen, which adversely affects their health. The
current meta-analysis investigated the effect of psychosocial
interventions on medication adherence in people living with HIV.
Databases were systematically searched, resulting in 43 included
randomized controlled trials. Study and intervention characteristics
were investigated as moderators. The overall effect size indicates a
small to moderate positive effect (Hedges’ g = 0.37)
of psychosocial interventions on medication adherence in people living
with HIV. No evidence for publication bias was found. This
meta-analysis study concludes that various psychosocial interventions
can improve medication adherence and thereby the health of people
living with HIV.
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Affiliation(s)
- Pascalle Spaan
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sanne van Luenen
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Nadia Garnefski
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Vivian Kraaij
- Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
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21
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Lin S, Melendez-Torres GJ. Systematic review of risk factors for nonadherence to TB treatment in immigrant populations. Trans R Soc Trop Med Hyg 2017; 110:268-80. [PMID: 27198210 DOI: 10.1093/trstmh/trw025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/21/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Foreign-born populations carry a significant TB burden in low-prevalence countries, composing over half of all cases in parts of Europe and North America. This study systematically reviewed evidence of risk factors for nonadherence to TB drug therapy in this group. METHODS On 28 October 2013 MEDLINE, CINAHL, Embase, PsychINFO and ProQuest were systematically searched for studies examining adherence in foreign-born populations with TB. Grey literature and reference lists were hand-searched. Risk factor studies were selected for inclusion if they consisted of at least 95% foreign-born populations. RESULTS Of 1761 studies identified in the search, 20 were included in the risk factor review. Undocumented immigration status, older age, and social risk factors were consistently correlated with nonadherence; gender, ethnicity, immigration time, education level, adverse side effects, and HIV status were inconsistently correlated; and behavioural risk factors and marital status were consistently not correlated. CONCLUSIONS This review emphasizes documentation status as a risk factor candidate for further investigation.
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Affiliation(s)
- Stephanie Lin
- University of Oxford, Department of Social Policy and Intervention, Oxford, UK
| | - G J Melendez-Torres
- University of Oxford, Department of Social Policy and Intervention, Oxford, UK
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22
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Erb S, Letang E, Glass TR, Natamatungiro A, Mnzava D, Mapesi H, Haschke M, Duthaler U, Berger B, Muri L, Bader J, Marzolini C, Elzi L, Klimkait T, Langewitz W, Battegay M. Health care provider communication training in rural Tanzania empowers HIV-infected patients on antiretroviral therapy to discuss adherence problems. HIV Med 2017; 18:623-634. [PMID: 28296019 PMCID: PMC5599974 DOI: 10.1111/hiv.12499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Self-reported adherence assessment in HIV-infected patients on antiretroviral therapy (ART) is challenging and may overestimate adherence. The aim of this study was to improve the ability of health care providers to elicit patients' reports of nonadherence using a "patient-centred" approach in a rural sub-Saharan African setting. METHODS A prospective interventional cohort study of HIV-infected patients on ART for ≥ 6 months attending an HIV clinic in rural Tanzania was carried out. The intervention consisted of a 2-day workshop for health care providers on patient-centred communication and the provision of an adherence assessment checklist for use in the consultations. Patients' self-reports of nonadherence (≥ 1 missed ART dose/4 weeks), subtherapeutic plasma ART concentrations (< 2.5th percentile of published population-based pharmacokinetic models), and virological and immunological failure according to the World Health Organization definition were assessed before and after (1-3 and 6-9 months after) the intervention. RESULTS Before the intervention, only 3.3% of 299 patients included in the study reported nonadherence. Subtherapeutic plasma ART drug concentrations and virological and immunological failure were recorded in 6.5%, 7.7% and 14.5% of the patients, respectively. Two months after the intervention, health care providers detected significantly more patients reporting nonadherence compared with baseline (10.7 vs. 3.3%, respectively; P < 0.001), decreasing to 5.7% after 6-9 months. A time trend towards higher drug concentrations was observed for efavirenz but not for other drugs. The virological failure rate remained unchanged whereas the immunological failure rate decreased from 14.4 to 8.7% at the last visit (P = 0.002). CONCLUSIONS Patient-centred communication can successfully be implemented with a simple intervention in rural Africa. It increases the likelihood of HIV-infected patients reporting problems with adherence to ART; however, sustainability remains a challenge.
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Affiliation(s)
- S Erb
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - E Letang
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
- ISGlobal, Barcelona Centre for International Health Research (CRESIB)University Hospital Clínic de BarcelonaBarcelonaSpain
| | - TR Glass
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
| | | | - D Mnzava
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
| | - H Mapesi
- Ifakara Health InstituteIfakara BranchIfakaraTanzania
| | - M Haschke
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - U Duthaler
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - B Berger
- Division of Clinical Pharmacology and ToxicologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - L Muri
- Swiss Tropical and Public Health Institute of BaselBaselSwitzerland
| | - J Bader
- Molecular VirologyDepartment of BiomedicineUniversity of BaselBaselSwitzerland
| | - C Marzolini
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - L Elzi
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Ospedale Regionale di Bellinzona e ValliBellinzonaSwitzerland
| | - T Klimkait
- Molecular VirologyDepartment of BiomedicineUniversity of BaselBaselSwitzerland
| | - W Langewitz
- Institute of Psychosomatic MedicineUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - M Battegay
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
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Ciapponi A, Lewin S, Herrera CA, Opiyo N, Pantoja T, Paulsen E, Rada G, Wiysonge CS, Bastías G, Dudley L, Flottorp S, Gagnon M, Garcia Marti S, Glenton C, Okwundu CI, Peñaloza B, Suleman F, Oxman AD. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011083. [PMID: 28901005 PMCID: PMC5621087 DOI: 10.1002/14651858.cd011083.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. METHODS We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile phone messaging for patients with long-term illnesses, mobile phone messaging reminders for attendance at healthcare appointments, mobile phone messaging to promote adherence to antiretroviral therapy, women carrying their own case notes in pregnancy, interventions to improve childhood vaccination. Quality and safety systems: decision support with clinical information systems for people living with HIV/AIDS. Complex interventions (cutting across delivery categories and other health system arrangements): emergency obstetric referral interventions. AUTHORS' CONCLUSIONS A wide range of strategies have been evaluated for improving delivery arrangements in low-income countries, using sound systematic review methods in both Cochrane and non-Cochrane reviews. These reviews have assessed a range of outcomes. Most of the available evidence focuses on who provides care, where care is provided and coordination of care. For all the main categories of delivery arrangements, we identified gaps in primary research related to uncertainty about the applicability of the evidence to low-income countries, low- or very low-certainty evidence or a lack of studies.
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Affiliation(s)
- Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Cristian A Herrera
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Tomas Pantoja
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | | | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Gabriel Bastías
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Lilian Dudley
- Stellenbosch UniversityDivision of Community Health, Faculty of Medicine and Health SciencesFransie Van Zyl DriveTygerbergCape TownSouth Africa7505
| | - Signe Flottorp
- Norwegian Institute of Public HealthDepartment for Evidence SynthesisPO Box 4404 NydalenOsloNorway0403
| | - Marie‐Pierre Gagnon
- CHU de Québec ‐ Université Laval Research CentrePopulation Health and Optimal Health Practices Research Unit10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Charles I Okwundu
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Fatima Suleman
- University of KwaZulu‐NatalDiscipline of Pharmaceutical Sciences, School of Health SciencesPrivate Bag X54001DurbanKZNSouth Africa4000
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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Pantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS, Herrera CA, Rada G, Peñaloza B, Dudley L, Gagnon M, Garcia Marti S, Oxman AD. Implementation strategies for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9:CD011086. [PMID: 28895659 PMCID: PMC5621088 DOI: 10.1002/14651858.cd011086.pub2] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. OBJECTIVES To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. METHODS We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. MAIN RESULTS We identified 7272 systematic reviews and included 39 of them in this overview. An additional four reviews provided supplementary information. Of the 39 reviews, 32 had only minor limitations and 7 had important methodological limitations. Most studies in the reviews were from high-income countries. There were no studies from low-income countries in eight reviews.Implementation strategies addressed in the reviews were grouped into four categories - strategies targeting:1. healthcare organisations (e.g. strategies to change organisational culture; 1 review);2. healthcare workers by type of intervention (e.g. printed educational materials; 14 reviews);3. healthcare workers to address a specific problem (e.g. unnecessary antibiotic prescription; 9 reviews);4. healthcare recipients (e.g. medication adherence; 15 reviews).Overall, we found the following interventions to have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects.1.Strategies targeted at healthcare workers: educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions.2.Strategies targeted at healthcare workers for specific types of problems: training healthcare workers to be more patient-centred in clinical consultations, use of birth kits, strategies such as clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings, and in-service neonatal emergency care training.3. Strategies targeted at healthcare recipients: mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, intensive disease management programmes to improve health literacy; behavioural interventions and mobile phone text messages for adherence to antiretroviral therapy; a one time incentive to start or continue tuberculosis prophylaxis; default reminders for patients being treated for active tuberculosis; use of sectioned polythene bags for adherence to malaria medication; community-based health education, and reminders and recall strategies to increase vaccination uptake; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion nurse and intensive recruitment); health insurance information and application support. AUTHORS' CONCLUSIONS Reliable systematic reviews have evaluated a wide range of strategies for implementing evidence-based interventions in low-income countries. Most of the available evidence is focused on strategies targeted at healthcare workers and healthcare recipients and relates to process-based outcomes. Evidence of the effects of strategies targeting healthcare organisations is scarce.
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Affiliation(s)
- Tomas Pantoja
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | | | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy (IECS‐CONICET)Argentine Cochrane CentreDr. Emilio Ravignani 2024Buenos AiresCapital FederalArgentinaC1414CPV
| | - Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Cristian A Herrera
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Public Health, School of MedicineMarcoleta 434SantiagoChile
| | - Gabriel Rada
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
- Pontificia Universidad Católica de ChileDepartment of Internal Medicine and Evidence‐Based Healthcare Program, Faculty of MedicineLira 44, Decanato Primer pisoSantiagoChile
| | - Blanca Peñaloza
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
- Pontificia Universidad Católica de ChileEvidence Based Health Care ProgramSantiagoChile
| | - Lilian Dudley
- Stellenbosch UniversityDivision of Community Health, Faculty of Medicine and Health SciencesFransie Van Zyl DriveTygerbergCape TownSouth Africa7505
| | - Marie‐Pierre Gagnon
- CHU de Québec ‐ Université Laval Research CentrePopulation Health and Optimal Health Practices Research Unit10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Sebastian Garcia Marti
- Institute for Clinical Effectiveness and Health PolicyBuenos AiresCapital FederalArgentinaC1056ABH
| | - Andrew D Oxman
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
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Bere T, Nyamayaro P, Magidson JF, Chibanda D, Chingono A, Munjoma R, Macpherson K, Ndhlovu CE, O’Cleirigh C, Kidia K, Safren SA, Abas M. Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva. J Health Psychol 2017; 22:1265-1276. [PMID: 26893295 PMCID: PMC4990503 DOI: 10.1177/1359105315626783] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Few evidence-based interventions to improve adherence to antiretroviral therapy have been adapted for use in Africa. We selected, culturally adapted and tested the feasibility of a cognitive-behavioural intervention for adherence and for delivery in a clinic setting in Harare, Zimbabwe. The feasibility of the intervention was evaluated using a mixed-methods assessment, including ratings of provider fidelity of intervention delivery, and qualitative assessments of feasibility using individual semi-structured interviews with counsellors (n=4) and patients (n=15). The intervention was feasible and acceptable when administered to 42 patients and resulted in improved self-reported adherence in a subset of 15 patients who were followed up after 6months.
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Affiliation(s)
- Tarisai Bere
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | | | | | - Dixon Chibanda
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Alfred Chingono
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Ronald Munjoma
- College Of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Kirsty Macpherson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London
| | | | | | | | | | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London
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Amininasab SS, Azimi Lolaty H, Moosazadeh M, Shafipour V. The relationship between human dignity and medication adherence in patients with heart failure. J Med Ethics Hist Med 2017; 10:5. [PMID: 29291038 PMCID: PMC5746662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 05/28/2017] [Indexed: 10/28/2022] Open
Abstract
Medication adherence is a behavior that is influenced by several factors, and maintaining patients' dignity is an important issue that needs to be considered in the course of treatment. The present study aimed to determine the relationship between human dignity and medication adherence in patients with heart failure. This was a cross-sectional study. A total number of 300 patients with heart failure admitted to the Mazandaran Heart Center, Iran, participated in this study by census. Samples were selected based on inclusion criteria such as an HF diagnosis by a cardiologist for a minimum of 6 months, and taking at least one cardiac medication. Data were collected through demographic, clinical, human dignity, and medication adherence questionnaires over a period of three months in 2016. This study was approved by the Ethics Committee of Mazandaran University of Medical Sciences. Consents were obtained from patients and the medical center, and necessary explanations were given about the confidentiality of information prior to completing the questionnaires. The mean score of medication adherence was 5.82 suggesting low medication adherence among the patients, and the mean score of human dignity was 81.39. There was a negative relationship between medication adherence and threat to human dignity (r = - 0.6, P < 0.001), i.e., the higher the scores of threat, the lower the medication adherence of the patients. After adjusting the effects of potential confounding variables, there still was a correlation between medication adherence and the variables of human dignity and its dimensions. Based on the findings, an increase in patients' dignity can enhance medication adherence, which can theoretically improve patients' health and reduce frequent hospitalization.
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Affiliation(s)
- Seyedeh Somayeh Amininasab
- MSc Student of Intensive Care Nursing, Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamideh Azimi Lolaty
- Assistant Professor, Department of Psychiatric Nursing, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mahmood Moosazadeh
- Assistant Professor, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Vida Shafipour
- Assistant Professor, Department of Medical-Surgical Nursing, Nasibeh Nursing & Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran.,Corresponding Author: Vida Shafipour. Address: Nasibeh Nursing & Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran. Tel/ Fax: + 98 113 336 7342
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Palchaudhuri R, Niggl M, Palmer CS. Eliminating HIV & AIDS in India: A roadmap to zero new HIV infections, zero discrimination & zero AIDS-related deaths. Indian J Med Res 2017; 144:789-792. [PMID: 28474612 PMCID: PMC5433268 DOI: 10.4103/ijmr.ijmr_1902_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Riya Palchaudhuri
- Centre for Biomedical Research, Burnet Institute; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Max Niggl
- Positive Speakers Bureau Coordinator, Living Positive Victoria, Melbourne, Victoria, Australia
| | - Clovis Steve Palmer
- Centre for Biomedical Research, Burnet Institute; Department of Infectious Diseases, Monash University; Department of Microbiology & Immunology, University of Melbourne, Melbourne, Victoria, Australia
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Gwadz MV, Collins LM, Cleland CM, Leonard NR, Wilton L, Gandhi M, Scott Braithwaite R, Perlman DC, Kutnick A, Ritchie AS. Using the multiphase optimization strategy (MOST) to optimize an HIV care continuum intervention for vulnerable populations: a study protocol. BMC Public Health 2017; 17:383. [PMID: 28472928 PMCID: PMC5418718 DOI: 10.1186/s12889-017-4279-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 12/10/2023] Open
Abstract
BACKGROUND More than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employed to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American/Black and Hispanic PLWH not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. A similar set of multi-level factors impede both HIV care and ART initiation for African American/Black and Hispanic PLWH, primary among them individual- (e.g., substance use, distrust, fear), social- (e.g., stigma), and structural-level barriers (e.g., difficulties accessing ancillary services). Guided by a multi-level social cognitive theory, and using the motivational interviewing approach, the study will evaluate five distinct culturally based intervention components (i.e., counseling sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study. METHODS/DESIGN Study aims are: 1) using a highly efficient fractional factorial experimental design, identify which of five intervention components contribute meaningfully to improvement in HIV viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of intervention component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American/Black and Hispanic PLWH (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N = 512). DISCUSSION This is the first study to apply the MOST framework in the field of HIV prevention and treatment. This innovative study will produce a culturally based HIV care continuum intervention for the nation's most vulnerable PLWH, optimized for cost-effectiveness, and with exceptional levels of efficacy, efficiency, and scalability. TRIAL REGISTRATION ClinicalTrials.gov, NCT02801747 , Registered June 8, 2016.
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Affiliation(s)
- Marya Viorst Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, Pennsylvania, PA, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - David C Perlman
- Department of Infectious Diseases, Mount Sinai Beth Israel, New York, NY, USA
| | - Alexandra Kutnick
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Amanda S Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY, USA
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Ruan Y, Xiao X, Chen J, Li X, Williams AB, Wang H. Acceptability and efficacy of interactive short message service intervention in improving HIV medication adherence in Chinese antiretroviral treatment-naïve individuals. Patient Prefer Adherence 2017; 11:221-228. [PMID: 28228652 PMCID: PMC5312688 DOI: 10.2147/ppa.s120003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM The aim of this study was to examine the acceptability and efficacy of interactive short message service (SMS) in improving medication adherence in antiretroviral treatment (ART)-naïve individuals living with HIV/AIDS in Hengyang, Hunan, China. BACKGROUND SMS via mobile phone has emerged as a potential tool for improving ART adherence. However, most studies used SMS only as a medication reminder, with few studies exploring the effect of comprehensive, interactive SMS. PATIENTS AND METHODS In a randomized controlled trial, 100 HIV-positive patients on ART for <3 months were randomized into control or intervention arm. Participants in the control group received routine standard instruction for ART medication in the HIV clinics, while the intervention group received 6 months of an SMS intervention in addition to the standard care. A total of 124 text messages within 6 modules were edited, preinstalled, and sent to participants according to personalized schedules. Knowledge (of HIV and HIV medications), self-reported antiretroviral adherence (Visual Analog Scale [VAS] and Community Programs for Clinical Research on AIDS [CPCRA] Antiretroviral Medication Self-Report), and CD4 count were assessed at baseline and immediate post-intervention. Intervention participants were interviewed after completion of the study about their satisfaction with and acceptability of the SMS intervention. RESULTS Baseline assessments were comparable between arms. Repeated-measures analysis showed that both HIV-related and ART medication knowledge of the intervention group showed better improvement over time than those of the control group after the intervention (P<0.0001). For the adherence measures, compared with the control group, participants in the intervention group had significantly higher VAS mean score (Z=2.735, P=0.006) and lower suboptimal adherence rate (Z=2.208, P=0.027) at the end of the study. The intervention had no effect on CD4 cell count. Almost all (96%) intervention participants reported satisfaction or high satisfaction with the SMS intervention, with 74% desiring to continue to receive the SMS intervention. The preferred frequency of messages was 1-2 messages per week. CONCLUSION An interactive SMS intervention with comprehensive content shows promising efficacy in promoting medication adherence in ART-naïve individuals. Future work might further refine its ability to optimally tailor the intervention for individual preferences.
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Affiliation(s)
- Ye Ruan
- Nursing Department, Second Xiangya Hospital
| | - Xueling Xiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jia Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | | | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
- Correspondence: Honghong Wang, Xiangya School of Nursing, Central South University, 172 Tong Zi Po Road, Changsha 410013, Hunan, People’s Republic of China, Tel +86 731 8265 0270, Fax +86 731 8265 0266, Email
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Mahlich J, Groß M, Kuhlmann A, Bogner J, Heiken H, Stoll M. The choice between a ritonavir-boosted protease inhibitor- and a non-nucleoside reverse transcriptase inhibitor-based regimen for initiation of antiretroviral treatment - results from an observational study in Germany. J Pharm Policy Pract 2016; 9:39. [PMID: 28050254 PMCID: PMC5203724 DOI: 10.1186/s40545-016-0092-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This study aims at identifying predictors of the treatment decision of German physicians with regard to a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) -based initial treatment regimen. METHODS The study is based on a sub analysis of a nation-wide multi-centre, non-interventional, prospective cohort study. 133 patients were identified, who received antiretroviral first-line therapy. By means of a logistic regression, factors that determine the treatment strategy for treatment-naïve patients were analysed. RESULTS Compared to patients receiving a NNRTI-based initial regimen, patients treated with PI/r are slightly younger, less educated, in a later stage of HIV and have more concomitant diseases. Regression analysis revealed that being in a later stage of HIV (CDC-C) is significantly associated with a PI/r-based treatment decision. CONCLUSIONS Our analysis is the first study in Germany investigating sociodemographic and disease-specific parameters associated with a NNRTI- or a PI/r-based initial treatment decision. The results confirm that the treatment decision for a PI/r strategy is associated with disease severity.
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Affiliation(s)
- Jörg Mahlich
- Janssen KK, Health Economics, Tokyo, Japan ; Heinrich-Heine University of Düsseldorf, Düsseldorf Institute for Competition Economics (DICE), Düsseldorf, Germany
| | - Mona Groß
- Heinrich-Heine University of Düsseldorf, Düsseldorf Institute for Competition Economics (DICE), Düsseldorf, Germany
| | - Alexander Kuhlmann
- University of Hanover, Centre for Health Economics Research, Hanover, Germany
| | - Johannes Bogner
- Division of Infectious Diseases, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Matthias Stoll
- Hannover Medical School (MHH), Centre for Internal Medicine, Hanover, Germany
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van Driel ML, Morledge MD, Ulep R, Shaffer JP, Davies P, Deichmann R. Interventions to improve adherence to lipid-lowering medication. Cochrane Database Syst Rev 2016; 12:CD004371. [PMID: 28000212 PMCID: PMC6464006 DOI: 10.1002/14651858.cd004371.pub4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lipid-lowering drugs are widely underused, despite strong evidence indicating they improve cardiovascular end points. Poor patient adherence to a medication regimen can affect the success of lipid-lowering treatment. OBJECTIVES To assess the effects of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and CINAHL up to 3 February 2016, and clinical trials registers (ANZCTR and ClinicalTrials.gov) up to 27 July 2016. We applied no language restrictions. SELECTION CRITERIA We evaluated randomised controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with a variety of measurable outcomes, such as adherence to treatment and changes to serum lipid levels. Two teams of review authors independently selected the studies. DATA COLLECTION AND ANALYSIS Three review authors extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the quality of the evidence using GRADEPro. MAIN RESULTS For this updated review, we added 24 new studies meeting the eligibility criteria to the 11 studies from prior updates. We have therefore included 35 studies, randomising 925,171 participants. Seven studies including 11,204 individuals compared adherence rates of those in an intensification of a patient care intervention (e.g. electronic reminders, pharmacist-led interventions, healthcare professional education of patients) versus usual care over the short term (six months or less), and were pooled in a meta-analysis. Participants in the intervention group had better adherence than those receiving usual care (odds ratio (OR) 1.93, 95% confidence interval (CI) 1.29 to 2.88; 7 studies; 11,204 participants; moderate-quality evidence). A separate analysis also showed improvements in long-term adherence rates (more than six months) using intensification of care (OR 2.87, 95% CI 1.91 to 4.29; 3 studies; 663 participants; high-quality evidence). Analyses of the effect on total cholesterol and LDL-cholesterol levels also showed a positive effect of intensified interventions over both short- and long-term follow-up. Over the short term, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17 to 33.14; 4 studies; 430 participants; low-quality evidence) and LDL-cholesterol decreased by a mean of 19.51 mg/dL (95% CI 8.51 to 30.51; 3 studies; 333 participants; moderate-quality evidence). Over the long term (more than six months) total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95 to 20.19; 2 studies; 127 participants; high-quality evidence). Included studies did not report usable data for health outcome indications, adverse effects or costs/resource use, so we could not pool these outcomes. We assessed each included study for bias using methods described in the Cochrane Handbook for Systematic Reviews of Interventions. In general, the risk of bias assessment revealed a low risk of selection bias, attrition bias, and reporting bias. There was unclear risk of bias relating to blinding for most studies. AUTHORS' CONCLUSIONS The evidence in our review demonstrates that intensification of patient care interventions improves short- and long-term medication adherence, as well as total cholesterol and LDL-cholesterol levels. Healthcare systems which can implement team-based intensification of patient care interventions may be successful in improving patient adherence rates to lipid-lowering medicines.
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Affiliation(s)
- Mieke L van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia, 4029
- Department of Family Medicine and Primary Health Care, Ghent University, 1K3, De Pintelaan 185, Ghent, Belgium, 9000
| | - Michael D Morledge
- Ochsner Clinical School, School of Medicine, The University of Queensland, New Orleans, USA
| | - Robin Ulep
- Ochsner Clinical School, School of Medicine, The University of Queensland, New Orleans, USA
| | - Johnathon P Shaffer
- Ochsner Clinical School, School of Medicine, The University of Queensland, New Orleans, USA
| | - Philippa Davies
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, UK, BS8 2PS
| | - Richard Deichmann
- Department of Internal Medicine, Ochsner Health System, 1514 Jefferson Hwy, New Orleans, USA, 70121
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KHUMALO PG, CHOU YJ, PU C. Antiretroviral treatment attrition in Swaziland: a population-based study. Epidemiol Infect 2016; 144:3474-3482. [PMID: 27545693 PMCID: PMC9150204 DOI: 10.1017/s0950268816001813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 11/07/2022] Open
Abstract
Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world. Attrition (loss to follow-up and mortality) in people living with HIV/AIDS (PLWHA) already on treatment is a major challenge, undermining achievements of the antiretroviral treatment (ART) programme in Swaziland. The contributing factors to attrition in the Swazi context are unclear. This study aims to (1) estimate attrition from the ART programme 12 months after ART initiation in Swaziland, and (2) determine the predictors of attrition in PLWHA treated with ART in Swaziland. A retrospective cohort study using national baseline data was conducted. A competing-risk Cox proportional hazard regression was used to determine the predictors of attrition. We estimated 10·3% (95% confidence interval 10·1-10·6) attrition in 16 423 participants that initiated ART in 2012. Attrition was significantly associated with sex, age, district, treatment supporter at initiation, co-infection of HIV and TB, functional status, WHO clinical stage, and ownership of facility. Our study can form a base of policies, plans, and service delivery strategies for preventing and controlling attrition in Swaziland.
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Affiliation(s)
- P. G. KHUMALO
- Antiretroviral Treatment Unit, Mbabane Government Hospital, Mbabane, Swaziland
| | - Y. J. CHOU
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - C. PU
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Use of peers to improve adherence to antiretroviral therapy: a global network meta-analysis. J Int AIDS Soc 2016; 19:21141. [PMID: 27914185 PMCID: PMC5134746 DOI: 10.7448/ias.19.1.21141] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 10/06/2016] [Accepted: 10/24/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION It is unclear whether using peers can improve adherence to antiretroviral therapy (ART). To construct the World Health Organization's global guidance on adherence interventions, we conducted a systematic review and network meta-analysis to determine the effectiveness of using peers for achieving adequate adherence and viral suppression. METHODS We searched for randomized clinical trials of peer-based interventions to promote adherence to ART in HIV populations. We searched six electronic databases from inception to July 2015 and major conference abstracts within the last three years. We examined the outcomes of adherence and viral suppression among trials done worldwide and those specific to low- and middle-income countries (LMIC) using pairwise and network meta-analyses. RESULTS AND DISCUSSION Twenty-two trials met the inclusion criteria. We found similar results between pairwise and network meta-analyses, and between the global and LMIC settings. Peer supporter+Telephone was superior in improving adherence than standard-of-care in both the global network (odds-ratio [OR]=4.79, 95% credible intervals [CrI]: 1.02, 23.57) and the LMIC settings (OR=4.83, 95% CrI: 1.88, 13.55). Peer support alone, however, did not lead to improvement in ART adherence in both settings. For viral suppression, we found no difference of effects among interventions due to limited trials. CONCLUSIONS Our analysis showed that peer support leads to modest improvement in adherence. These modest effects may be due to the fact that in many settings, particularly in LMICs, programmes already include peer supporters, adherence clubs and family disclosures for treatment support. Rather than introducing new interventions, a focus on improving the quality in the delivery of existing services may be a more practical and effective way to improve adherence to ART.
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Cowan FM, Delany-Moretlwe S, Sanders EJ, Mugo NR, Guedou FA, Alary M, Behanzin L, Mugurungi O, Bekker LG. PrEP implementation research in Africa: what is new? J Int AIDS Soc 2016; 19:21101. [PMID: 27760680 PMCID: PMC5071780 DOI: 10.7448/ias.19.7.21101] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/11/2016] [Accepted: 07/16/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Of the two million new HIV infections in adults in 2014, 70% occurred in sub-Saharan Africa. Several African countries have already approved guidelines for pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV as part of combination HIV prevention but key questions remain about how to identify and deliver PrEP to those at greatest need. Throughout the continent, individuals in sero-discordant relationships, and members of key populations (sex workers, men who have sex with men (MSM), transgender women and injection drug users) are likely to benefit from the availability of PrEP. In addition, adolescent girls and young women (AGYW) are at substantial risk in some parts of the continent. It has been estimated that at least three million individuals in Africa are likely to be eligible for PrEP according to WHO's criteria. Tens of demonstration projects are planned or underway across the continent among a range of countries, populations and delivery settings. DISCUSSION In each of the target populations, there are overarching issues related to (i) creating demand for PrEP, (ii) addressing supply-side issues and (iii) providing appropriate and tailored adherence support. Critical for creating demand for PrEP is the normalization of HIV prevention. Community-level interventions which engage opinion leaders as well as empowerment interventions for those at highest risk will be key. Critical to supply of PrEP is that services are accessible for all, including for stigmatized populations. Establishing accessible integrated services provides the opportunity to address other public health priorities including the unmet need for HIV testing, contraception and sexually transmitted infections treatment. National policies need to include minimum standards for training and quality assurance for PrEP implementation and to address supply chain issues. Adherence support needs to recognize that social and structural factors are likely to have an important influence. Combining interventions that build self-efficacy, empowerment and social cohesion, with evidence-based individualized adherence support for PrEP, are most likely to be effective. CONCLUSIONS Efficacy of tenfovir-based PrEP is proven but many issues related to implementation remain unclear. Here, we have summarized some of the important implementation questions that need to be assessed as PrEP is rolled out across Africa.
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Affiliation(s)
- Frances M Cowan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe;
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Eduard J Sanders
- Kenya Medical Research Institute, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nelly R Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
- Partners in Health Research and Development, Thika, Kenya
| | | | - Michel Alary
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
| | | | | | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Crane HM, Fredericksen RJ, Church A, Harrington A, Ciechanowski P, Magnani J, Nasby K, Brown T, Dhanireddy S, Harrington RD, Lober WB, Simoni J, Safren SA, Edwards TC, Patrick DL, Saag MS, Crane PK, Kitahata MM. A Randomized Controlled Trial Protocol to Evaluate the Effectiveness of an Integrated Care Management Approach to Improve Adherence Among HIV-Infected Patients in Routine Clinical Care: Rationale and Design. JMIR Res Protoc 2016; 5:e156. [PMID: 27707688 PMCID: PMC5071617 DOI: 10.2196/resprot.5492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adherence to antiretroviral medications is a key determinant of clinical outcomes. Many adherence intervention trials investigated the effects of time-intensive or costly interventions that are not feasible in most clinical care settings. OBJECTIVE We set out to evaluate a collaborative care approach as a feasible intervention applicable to patients in clinical care including those with mental illness and/or substance use issues. METHODS We developed a randomized controlled trial (RCT) investigating an integrated, clinic-based care management approach to improve clinical outcomes that could be integrated into the clinical care setting. This is based on the routine integration and systematic follow-up of a clinical assessment of patient-reported outcomes targeting adherence, depression, and substance use, and adapts previously developed and tested care management approaches. The primary health coach or care management role is provided by clinic case managers allowing the intervention to be generalized to other human immunodeficiency virus (HIV) clinics that have case managers. We used a stepped-care approach to target interventions to those at greatest need who are most likely to benefit rather than to everyone to maintain feasibility in a busy clinical care setting. RESULTS The National Institutes of Health funded this study and had no role in study design, data collection, or decisions regarding whether or not to submit manuscripts for publication. This trial is currently underway, enrollment was completed in 2015, and follow-up time still accruing. First results are expected to be ready for publication in early 2017. DISCUSSION This paper describes the protocol for an ongoing clinical trial including the design and the rationale for key methodological decisions. There is a need to identify best practices for implementing evidence-based collaborative care models that are effective and feasible in clinical care. Adherence efficacy trials have not led to sufficient improvements, and there remains little guidance regarding how adherence interventions should be implemented into clinical care. By focusing on improving adherence within care settings using existing staff, routine assessment of key domains, such as depression, adherence, and substance use, and feasible interventions, we propose to evaluate this innovative way to improve clinical outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT01505660; http://clinicaltrials.gov/ct2/show/NCT01505660 (Archived by WebCite at http://www.webcitation/ 6ktOq6Xj7).
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, United States.
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Sara C, Elsa H, Baijayanti M, Lennartsdotter EM. Clinical Correlates and Drug Resistance in HIV-Infected and -Uninfected Pulmonary Tuberculosis Patients in South India. ACTA ACUST UNITED AC 2016; 6:87-100. [PMID: 27708985 PMCID: PMC5047007 DOI: 10.4236/wja.2016.63013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine demographics, clinical correlates, sputum AFB (acid fast bacilli) smear grading DOTS (Directly Observed Therapy Short Course) uptake, and drug resistance in a cohort of newly-diagnosed, smear positive pulmonary tuberculosis (TB) patients with respect to HIV status at baseline, and compare smear conversion rates, side effects and mortality after two months. DESIGN A prospective study among 54 HIV positive and 41 HIV negative pulmonary TB patients. Data were collected via face-to-face interviews, review of medical records, and lab tests. RESULTS HIVTB co-infected patients, though more symptomatic at baseline, showed more improvement in their symptoms compared to HIV-uninfected TB patients at follow-up. The HIV co-infected group had more prevalent perceived side effects, and sputum smear positivity was marginally higher compared to the HIV negative group at follow-up. Mortality was higher among the HIV-infected group. Both groups had high rates of resistance to first-line anti-tubercular drugs, particularly isoniazid. There was no significant difference in the drug resistance patterns between the groups. CONCLUSIONS Prompt initiation and provision of daily regimens of ATT (Anti-Tubercular treatment) along with ART (Anti-Retroviral treatment) via ART centers is urgently needed in India. As resistance to ART and/or ATT is directly linked to medication non-adherence, the use of counseling, regular reinforcement, early detection and appropriate intervention strategies to tackle this complex issue could help prevent premature mortality and development of resistance in HIV-TB co-infected patients. The high rate of isoniazid resistance might preclude its use in India as prophylaxis for latent TB in HIV infected persons as per the World Health Organization (WHO) guideline.
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Affiliation(s)
- Chandy Sara
- Department of Medicine, St John's Medical College, Bangalore, India
| | - Heylen Elsa
- Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Mishra Baijayanti
- Department of Microbiology, St John's Medical College, Bangalore, India
| | - Ekstrand Maria Lennartsdotter
- Center for AIDS Prevention Studies, University of California, San Francisco, USA; St John's Research Institute, Bangalore, India
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Kurth AE, Chhun N, Cleland CM, Crespo-Fierro M, Parés-Avila JA, Lizcano JA, Norman RG, Shedlin MG, Johnston BE, Sharp VL. Linguistic and Cultural Adaptation of a Computer-Based Counseling Program (CARE+ Spanish) to Support HIV Treatment Adherence and Risk Reduction for People Living With HIV/AIDS: A Randomized Controlled Trial. J Med Internet Res 2016; 18:e195. [PMID: 27417531 PMCID: PMC4963608 DOI: 10.2196/jmir.5830] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) disease in the United States disproportionately affects minorities, including Latinos. Barriers including language are associated with lower antiretroviral therapy (ART) adherence seen among Latinos, yet ART and interventions for clinic visit adherence are rarely developed or delivered in Spanish. OBJECTIVE The aim was to adapt a computer-based counseling tool, demonstrated to reduce HIV-1 viral load and sexual risk transmission in a population of English-speaking adults, for use during routine clinical visits for an HIV-positive Spanish-speaking population (CARE+ Spanish); the Technology Acceptance Model (TAM) was the theoretical framework guiding program development. METHODS A longitudinal randomized controlled trial was conducted from June 4, 2010 to March 29, 2012. Participants were recruited from a comprehensive HIV treatment center comprising three clinics in New York City. Eligibility criteria were (1) adults (age ≥18 years), (2) Latino birth or ancestry, (3) speaks Spanish (mono- or multilingual), and (4) on antiretrovirals. Linear and generalized mixed linear effects models were used to analyze primary outcomes, which included ART adherence, sexual transmission risk behaviors, and HIV-1 viral loads. Exit interviews were offered to purposively selected intervention participants to explore cultural acceptability of the tool among participants, and focus groups explored the acceptability and system efficiency issues among clinic providers, using the TAM framework. RESULTS A total of 494 Spanish-speaking HIV clinic attendees were enrolled and randomly assigned to the intervention (arm A: n=253) or risk assessment-only control (arm B, n=241) group and followed up at 3-month intervals for one year. Gender distribution was 296 (68.4%) male, 110 (25.4%) female, and 10 (2.3%) transgender. By study end, 433 of 494 (87.7%) participants were retained. Although intervention participants had reduced viral loads, increased ART adherence and decreased sexual transmission risk behaviors over time, these findings were not statistically significant. We also conducted 61 qualitative exit interviews with participants and two focus groups with a total of 16 providers. CONCLUSIONS A computer-based counseling tool grounded in the TAM theoretical model and delivered in Spanish was acceptable and feasible to implement in a high-volume HIV clinic setting. It was able to provide evidence-based, linguistically appropriate ART adherence support without requiring additional staff time, bilingual status, or translation services. We found that language preferences and cultural acceptability of a computer-based counseling tool exist on a continuum in our urban Spanish-speaking population. Theoretical frameworks of technology's usefulness for behavioral modification need further exploration in other languages and cultures. TRIAL REGISTRATION ClinicalTrials.gov NCT01013935; https://clinicaltrials.gov/ct2/show/NCT01013935 (Archived by WebCite at http://www.webcitation.org/6ikaD3MT7).
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Affiliation(s)
- Ann E Kurth
- Yale University School of Nursing, Orange, CT, United States.
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Abdull MM, Chandler C, Gilbert C. Glaucoma, "the silent thief of sight": patients' perspectives and health seeking behaviour in Bauchi, northern Nigeria. BMC Ophthalmol 2016; 16:44. [PMID: 27102524 PMCID: PMC4839108 DOI: 10.1186/s12886-016-0220-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/13/2016] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND In Nigeria, glaucoma has a high prevalence and is the second cause of blindness among adults after cataract. People with glaucoma frequently present very late with advanced disease, and acceptance of and adherence to treatment is low. The purpose of the study was to explore how patients' understand and respond to glaucoma in order develop an intervention to improve adherence to treatment. METHOD Hospital based qualitative study. Six focus group discussions were held with patients with advanced disease and who had either undergone glaucoma surgery, were receiving medical treatment, or had neither surgery nor medical treatment. Two traditional healers who treat eye conditions were interviewed. Audio files were transcribed, translated into English and recurring themes coded and categorized as the impact of vision loss, and understandings of the disease and its management. RESULTS Visual loss impacted significantly on the lives of people with glaucoma in many ways. Many heard the term "glaucoma" for the first time during the study. Local terms to describe the symptoms included Hawan jinin ido ("hypertension of the eye"). Patients sought treatment in pharmacies, or with traditional healers who had different interpretations of glaucoma and its treatment to biomedical understandings. Cost and forgetfulness were the main reasons for low adherence to treatment while fear was a reason for not accepting surgery. Lack of money and negative staff attitudes were reasons for low follow up. CONCLUSION Halting the progression of glaucoma is possible with treatment but the condition will remain a "silent thief of sight" in West Africa unless awareness, uptake of services and adherence to treatment improve. Understanding how glaucoma is locally conceptualised, lived with and responded to by patients is essential to aid the design of interventions to prevent glaucoma blindness in Africa. Findings have been used to adapt a motivational interviewing intervention, which is being evaluated in a clinical trial.
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Affiliation(s)
- Mohammed Mahdi Abdull
- />Ophthalmology Department, Abubakar Tafawa Balewa University Teaching Hospital, PMB 0117, Bauchi, Bauchi State Nigeria
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Chandler
- />Department of Global Health and Development London School of Hygiene & Tropical Medicine, London, UK
| | - Clare Gilbert
- />International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Read G, Ingersoll KS. Which Patient Characteristics Among Cocaine Users with HIV Relate to Drug Use and Adherence Outcomes Following a Dual-Focused Intervention? AIDS Behav 2016; 20:633-45. [PMID: 26142103 DOI: 10.1007/s10461-015-1119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This is a secondary analysis of data from a randomized trial of dually-focused interventions for nonadherent HIV patients with cocaine use disorders (Ingersoll et al. in Drug Alcohol Depend 116(1-3):177-187, 2011). We examined the relationships among baseline demographic, psychological, psychiatric, and behavioral characteristics and 6-months post-study ART adherence, log viral load (VL), ASI Drug Composite Score, and days using cocaine. We used the SAS GLMSELECT procedure to build multivariate models of each post-study outcome. Post-study ART adherence was related to 2 psychological variables; while logVL was related to 2 drug-related behaviors. ASI Drug Composite score was related to 2 psychiatric disorders, 1 demographic, and 1 psychological variable; in contrast, days using cocaine related to 1 behavioral and 3 psychological variables. Analyses show clear, robust relationships among behavioral, psychological and psychiatric diagnosis factors with post-study ART adherence and cocaine use outcomes. Future ART adherence interventions for cocaine users should consider tailoring to these patient characteristics.
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Prevalence and correlates of probable common mental disorders in a population with high prevalence of HIV in Zimbabwe. BMC Psychiatry 2016; 16:55. [PMID: 26926690 PMCID: PMC4772683 DOI: 10.1186/s12888-016-0764-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/24/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In 2014 close to 10 million people living with HIV (PLWH) in sub-Saharan Africa were on highly active anti-retroviral therapy (HAART). The incidence of non-communicable diseases has increased markedly in PLWH as mortality is reduced due to use of HAART. Common mental disorders (CMD) are highly prevalent in PLWH. We aimed to determine factors associated with probable CMD and depression, assessed by 2 locally validated screening tools in a population with high prevalence of HIV in Harare, Zimbabwe. METHODS We carried out a cross-sectional survey of a systematic random sample of patients utilizing the largest primary health care facility in Harare. Adults aged ≥18 years attending over a 2-week period were eligible, excluding those who were critically ill or unable to give written informed consent. Two locally validated screening tools the Shona symptom questionnaire (SSQ-14) and the Patient Health Questionnaire (PHQ-9) were administered by trained research assistants to identify probable CMD and depression. RESULTS Of the 264 participants, 165 (62.5 %) were PLWH, and 92 % of these were on HAART. The prevalence of probable CMD (SSQ14 > = 9) and depression (PHQ9 > = 11) were higher among people living with HIV than among those without HIV (67.9 and 68.5 % vs 51.4 and 47.2 % respectively). Multivariable analysis showed female gender and recent negative life events to be associated with probable CMD and depression among PLWH (gender: OR = 2.32 95 % CI:1.07-5.05; negative life events: OR = 4.14; 95 % CI 1.17-14.49) and with depression (gender: OR = 1.84 95 % CI:0.85-4.02; negative life events: OR = 4.93.; 95 % CI 1.31-18.50) CONCLUSION: Elevated scores on self-report measures for CMD and depression are highly prevalent in this high HIV prevalence population. There is need to integrate packages of care for CMD and depression in existing primary health care programs for HIV/AIDS.
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Antenatal care and uptake of HIV testing among pregnant women in sub-Saharan Africa: a cross-sectional study. J Int AIDS Soc 2016; 19:20605. [PMID: 26787516 PMCID: PMC4718968 DOI: 10.7448/ias.19.1.20605] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/20/2015] [Accepted: 12/14/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Current guidelines recommend inclusion of HIV testing in routine screening tests for all pregnant women. For this reason, antenatal care (ANC) represents a vital component of efforts to prevent mother-to-child transmission (PMTCT) of HIV. To elucidate the relationship between ANC services and HIV testing among pregnant women in sub-Saharan Africa, we undertook an analysis of data from four countries. METHODS Four countries (Congo, Mozambique, Nigeria and Uganda) were purposively selected to represent unique geographical regions of sub-Saharan Africa. Using Demographic and Health Survey datasets, weighted crude and adjusted logistic regression models were used to explore factors that influenced HIV testing as part of ANC services. The study was approved by the Institutional Review Board of the University of Arizona. RESULTS Pooled results showed that 60.7% of women received HIV testing as part of ANC. Ugandan women had the highest rate of HIV testing as part of ANC (81.5%) compared with women in Mozambique (69.4%), Nigeria (54.4%) and Congo (45.4%). Difficulty reaching a health facility was a barrier in Congo and Mozambique but not Nigeria or Uganda. HIV testing rates were lower in rural areas, among the poorest women, the least educated and those with limited knowledge of HIV. In every country, crude regression analyses showed higher odds of being tested for HIV if women received their ANC services from a skilled attendant compared with an unskilled attendant. After adjusting for confounders, women in the total sample had 1.78 (99% CI: 1.45-2.18) times the odds of having an HIV test as part of their ANC if they went to a skilled attendant compared with an unskilled attendant. CONCLUSIONS There is a need for integration of HIV testing into routine ANC service to increase opportunities for PMTCT programmes to reach HIV-positive pregnant women. Attention should be paid to the expansion of outreach services for women in rural settings, and to the training, supervision and integration of unskilled attendants into formal maternal and child health programmes. Education of pregnant women and their communities is needed to increase HIV knowledge and reduce HIV stigma.
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Maclachlan EW, Shepard-Perry MG, Ingo P, Uusiku J, Mushimba R, Simwanza R, Likoro J, Brandt LJ, Thomas KK, Kasonka C, Hamunime N, O'Malley G. Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia. AIDS Care 2015; 28:620-7. [PMID: 26695005 PMCID: PMC4841015 DOI: 10.1080/09540121.2015.1124975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022]
Abstract
In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.
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Affiliation(s)
- Ellen W Maclachlan
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Mark G Shepard-Perry
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Paulina Ingo
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - James Uusiku
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - Ruusa Mushimba
- c International Organization for Migration (IOM) , Windhoek , Namibia
| | - Ricky Simwanza
- d Ministry of Health and Social Services (MoHSS) , Katima Mulilo , Namibia
| | - Joseph Likoro
- e The Global Fund to Fight AIDS, Tuberculosis and Malaria , Windhoek , Namibia
| | - Laura J Brandt
- f International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health , Windhoek , Namibia
| | - Katherine K Thomas
- g International Clinical Research Center (ICRC), University of Washington Department of Global Health , Seattle , WA , USA
| | - Claude Kasonka
- h Monitoring and Evaluation Unit , Millennium Challenge Account , Lusaka , Zambia
| | - Ndapewa Hamunime
- i Namibia Ministry of Health and Social Services , Directorate of Special Programs (MoHSS/DSP, Windhoek, Namibia)
| | - Gabrielle O'Malley
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
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Impact of Patient-Selected Care Buddies on Adherence to HIV Care, Disease Progression, and Conduct of Daily Life Among Pre-antiretroviral HIV-Infected Patients in Rakai, Uganda: A Randomized Controlled Trial. J Acquir Immune Defic Syndr 2015; 70:75-82. [PMID: 26039929 DOI: 10.1097/qai.0000000000000710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data are limited on effects of household or community support persons ("care buddies") on enrollment into and adherence to pre-antiretroviral HIV care. We assessed the impact of care buddies on adherence to HIV clinic appointments, HIV progression, and conduct of daily life among pre-antiretroviral therapy (pre-ART) HIV-infected individuals in Rakai, Uganda. METHODS A total of 1209 HIV-infected pre-ART patients aged ≥15 years were randomized to standard of care (SOC) (n = 604) or patient-selected care buddy (PSCB) (n = 605) and followed at 6 and 12 months. Outcomes were adherence to clinic visits, HIV disease progression, and self-reported conduct of daily life. Incidence and prevalence rate ratios and 95% confidence intervals (CIs) were used to assess outcomes in the intent-to-treat and as-treated analyses. RESULTS Baseline characteristics were comparable. In the intent to treat analysis, both arms were comparable with respect to adherence to CD4 monitoring visits [adjusted prevalence risk ratio (adjPRR), 0.98; 95% CI: 0.93 to 1.04; P = 0.529], and ART eligibility (adjPRR, 1.00; 95% CI: 0.77 to 1.31; P = 0.946). Good conduct of daily life was significantly higher in the PSCB than the SOC arm (adjPRR, 1.08; 95% CI: 1.03 to 1.13; P = 0.001). More men (61%) compared with women (30%) selected spouses/partners as buddies (P < 0.0001). Twenty-two percent of PSCB arm participants discontinued use of buddies. CONCLUSIONS In pre-ART persons, having care buddies improved the conduct of daily life of the HIV-infected patients but had no effect on HIV disease progression and only limited effect on clinic appointment adherence.
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Spoelstra SL, Burhenn PS, DeKoekkoek T, Schueller M. A trial examining an advanced practice nurse intervention to promote medication adherence and symptom management in adult cancer patients prescribed oral anti-cancer agents: study protocol. J Adv Nurs 2015; 72:409-20. [DOI: 10.1111/jan.12828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra L. Spoelstra
- Grand Valley State University; Kirkhof College of Nursing; Grand Rapids; Michigan USA
| | | | - Tracy DeKoekkoek
- Michigan State University; College of Nursing; East Lansing Michigan USA
| | - Monica Schueller
- Michigan State University; College of Nursing; East Lansing Michigan USA
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Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review. J Int AIDS Soc 2015; 18:20049. [PMID: 26385853 PMCID: PMC4575412 DOI: 10.7448/ias.18.1.20049] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/10/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. Conclusions Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.
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Development and Pilot Testing of Daily Interactive Voice Response (IVR) Calls to Support Antiretroviral Adherence in India: A Mixed-Methods Pilot Study. AIDS Behav 2015; 19 Suppl 2:142-55. [PMID: 25638037 DOI: 10.1007/s10461-014-0983-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This two-phase pilot study aimed to design, pilot, and refine an automated interactive voice response (IVR) intervention to support antiretroviral adherence for people living with HIV (PLH), in Kolkata, India. Mixed-methods formative research included a community advisory board for IVR message development, 1-month pre-post pilot, post-pilot focus groups, and further message development. Two IVR calls are made daily, timed to patients' dosing schedules, with brief messages (<1-min) on strategies for self-management of three domains: medical (adherence, symptoms, co-infections), mental health (social support, stress, positive cognitions), and nutrition and hygiene (per PLH preferences). Three ART appointment reminders are also sent each month. One-month pilot results (n = 46, 80 % women, 60 % sex workers) found significant increases in self-reported ART adherence, both within past three days (p = 0.05) and time since missed last dose (p = 0.015). Depression was common. Messaging content and assessment domains were expanded for testing in a randomized trial currently underway.
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Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000–2010). Int J Clin Pharm 2015; 37:687-97. [DOI: 10.1007/s11096-015-0137-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 05/12/2015] [Indexed: 01/08/2023]
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Ryan RE, Weir M, Leslie B, Worswick J, Lowe DB, Hill SJ. Evidence on Optimal Prescribing and Medicines Use for Decision Makers: Scope and Application of the
Rx for Change
Database. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00107.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, Australian Institute for Primary Care and AgeingLa Trobe University
| | | | - Bill Leslie
- Canadian Agency for Drugs and Technologies in Health
| | | | | | - Sophie J Hill
- Centre for Health Communication and Participation, Australian Institute for Primary Care and AgeingLa Trobe University Bundoora Victoria
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Lindhardt CL, Rubak S, Mogensen O, Hansen HP, Goldstein H, Lamont RF, Joergensen JS. Healthcare professionals experience with motivational interviewing in their encounter with obese pregnant women. Midwifery 2015; 31:678-84. [PMID: 25931276 DOI: 10.1016/j.midw.2015.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 01/28/2015] [Accepted: 03/26/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE to explore and describe how healthcare professionals in the Southern Region of Denmark experienced motivational interviewing as a communication method when working with pregnant women with obesity. DESIGN a qualitative, descriptive study based on face-to-face interviews with 11 obstetric healthcare professionals working in a perinatal setting. METHODS a thematic descriptive method was applied to semi-structured interviews. The healthcare professional's experiences were recorded verbatim during individual semi-structured qualitative interviews, transcribed, and analysed using a descriptive analysis methodology. FINDINGS motivational interviewing was found to be a useful method when communicating with obese pregnant women. The method made the healthcare professionals more aware of their own communication style both when encountering pregnant women and in their interaction with colleagues. However, most of the healthcare professionals emphasised that time was crucial and they had to be dedicated to the motivational interviewing method. The healthcare professionals further stated that it enabled them to become more professional in their daily work and made some of them feel less 'burned out', 'powerless' and 'stressed' as they felt they had a communication method in handling difficult workloads. CONCLUSION healthcare professionals experienced motivational interviewing to be a useful method when working perinatally. The motivational interviewing method permitted heightened awareness of the healthcare professionals communication method with the patients and increased their ability to handle a difficult workload. Overall, lack of time restricted the use of the motivational interviewing method on a daily basis.
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Affiliation(s)
- Christina Louise Lindhardt
- Department of Gynaecology and Obstetrics, Clinical Institute, University of Southern Denmark, Odense University Hospital, Odense 5000, Denmark.
| | - Sune Rubak
- Department of Paediatrics, Aarhus University Hospital, Centre of Medical Education, University of Aarhus, Aarhus, Denmark
| | - Ole Mogensen
- Department of Gynaecology and Obstetrics, Clinical Institute, University of Southern Denmark, Odense University Hospital, Odense 5000, Denmark
| | - Helle Ploug Hansen
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Ronald F Lamont
- Department of Gynaecology and Obstetrics, Clinical Institute, University of Southern Denmark, Odense University Hospital, Odense 5000, Denmark; Division of Surgery, University College, London, Northwick Park Institute of Medical Research Campus, London, UK
| | - Jan Stener Joergensen
- Department of Gynaecology and Obstetrics, Clinical Institute, University of Southern Denmark, Odense University Hospital, Odense 5000, Denmark
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Mehari D, Mache T, Hailemariam L. Predictors of lost to follow up to antiretroviral therapy in primary public hospital of Wukro, Tigray, Ethiopia: A case control study. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/jahr2014.0315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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