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Msosa TC, Swai I, Aarnoutse R, Rinke de Wit TF, Ngowi K, Msefula C, Nliwasa M, Boer MSD. The Effect of Real-Time Medication Monitoring-Based Digital Adherence Tools on Adherence to Antiretroviral Therapy and Viral Suppression in People Living With HIV: A Systematic Literature Review and Meta-Analysis. J Acquir Immune Defic Syndr 2024; 96:411-420. [PMID: 38985562 PMCID: PMC11236270 DOI: 10.1097/qai.0000000000003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/19/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Universal antiretroviral therapy (ART) has led to improved treatment outcomes in persons living with HIV. Adherence to ART is required to achieve viral suppression. Real-time medication monitoring (RTMM)-based digital adherence tools (DATs) could be effective in improving ART adherence and viral suppression in persons living with HIV. OBJECTIVES The primary and secondary objectives of this review were to assess the effect of RTMM-based DATs on improving ART adherence and viral load suppression. METHODS We searched MEDLINE, Embase, and Global Health for publications published through October 11, 2022. Narrative synthesis and random effects meta-analyses were conducted to synthesize the results. RESULTS Of 638 papers identified, 8 were included. Six studies were randomized controlled trials (RCTs), and 2 were cohort studies. Two studies, an RCT in China (mean adherence: 96.2% vs 89.1%) and a crossover cohort study in Uganda (mean adherence: 84% vs 93%), demonstrated improved ART adherence. No studies demonstrated improved viral suppression. In the meta-analyses, we estimated that RTMM-based digital adherence tools had a statistically insignificant small positive effect on ART adherence and viral suppression with a standardized mean difference of 0.1922 [95% CI: -0.0268 to 0.4112, P-value: 0.0854] and viral suppression with an odds ratio of 1.3148 [95% CI: 0.9199 to 1.8791, P-value: 0.1331]. CONCLUSIONS Our meta-analyses found that RTMM-based DATs did not have a significant effect on ART adherence and viral suppression. However, due to few published studies available, heterogeneity of target populations, intervention designs, and adherence measurement instruments, more data are required to provide conclusive evidence.
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Affiliation(s)
- Takondwa Charles Msosa
- Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Iraseni Swai
- Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Rob Aarnoutse
- Radboud University Medical Center, Department of Pharmacy, Research Institute for Medical Innovation, Nijmegen, the Netherlands; and
| | - Tobias F. Rinke de Wit
- Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Chisomo Msefula
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Marriott Nliwasa
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Marion Sumari-de Boer
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Kidman R, Hossain S, Hou W, Violari A. Pathways between adverse childhood experiences and viral suppression among male HIV-infected adolescents in South Africa. AIDS Care 2024; 36:36-44. [PMID: 38555604 PMCID: PMC11283965 DOI: 10.1080/09540121.2024.2332451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
Fewer adolescents achieve viral suppression compared to adults. One impediment may be a history of adverse childhood experiences (ACEs). To better develop targets and timeframes for intervention, this study created more robust estimates of the impact of cumulative adversity on viral suppression, tested whether the association is sensitive to the timing of adversity, and simultaneously tested several potential mechanisms. We focus on males, who have lower viral suppression than females and who may contribute to disproportionate incidence among young women. We recruited 251 male perinatally HIV-infected adolescents aged 15-19 from HIV clinics in Soweto, South Africa. Adversity was captured using the Adverse Childhood Experience - International Questionnaire (ACE-IQ). Viral load was measured using blood samples; viral suppression was defined as <20 copies/mL. Indicators of medication adherence, depression, post-traumatic stress disorder (, and substance misuse were captured. A series of pathway analysis were performed. Our sample experienced a median of 7 lifetime and 4 past-year adversities. Less than half (44%) exhibited viral suppression. Adversity demonstrated a significant association with suppression; depression mediated the association. Primary prevention of adversity among children living with HIV is paramount, as is addressing the subsequent mental and behavioral health challenges that impede viral suppression among adolescents.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Sabera Hossain
- State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Wei Hou
- Work completed while with the Department of Family, Population and Preventive Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Avy Violari
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nice J, Saltzman L, Thurman TR, Zani B. Latent class analysis of ART barriers among adolescents and young adults living with HIV in South Africa. AIDS Care 2024; 36:45-53. [PMID: 38422434 DOI: 10.1080/09540121.2024.2307389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024]
Abstract
This study examined adherence to antiretroviral therapy (ART) among adolescents and young adults living with HIV in South Africa. Using survey data from 857 youth on ART, the study employed latent class analysis to identify subgroups based on self-reported reasons for missed ART doses. Three distinct classes emerged: the largest class (85%) occasionally forgot to take their medication or missed a dose because others were around, the second class (9%) missed doses only due to feeling sick, and the third class (6%) faced multiple barriers such as forgetting, feeling sick, worrying about side effects, or doubting the effectiveness of ART. Youth who reported multiple barriers to adherence had significantly lower adjusted odds (AOR = 0.35, 95% CI = 0.16-0.78) of reporting 90% past month adherence compared to those who occasionally forgot their medication. Additionally, contextual factors such as food security, being treated well at the clinic, and being accompanied to the clinic were associated with higher odds of adherence. The findings highlight the importance of considering co-occurring barriers to adherence and tailoring interventions accordingly. Addressing contextual factors, such as ensuring food security and providing supportive clinic environments, is also crucial for promoting optimal adherence among adolescents and young adults living with HIV.
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Affiliation(s)
- Johanna Nice
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- International Health and Sustainable Development department, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Leia Saltzman
- Tulane University School of Social Work, New Orleans, LA, USA
| | - Tonya R Thurman
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- International Health and Sustainable Development department, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane International LLC, Cape Town, South Africa
| | - Babalwa Zani
- Highly Vulnerable Children Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane International LLC, Cape Town, South Africa
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Ashaba S, Baguma C, Tushemereirwe P, Nansera D, Maling S, Tsai AC, Zanoni BC. A qualitative analysis of self-management needs of adolescents and young adults living with perinatally acquired HIV in rural, southwestern Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003037. [PMID: 38498515 PMCID: PMC10947701 DOI: 10.1371/journal.pgph.0003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
The number of adolescents living with HIV remains high in sub-Saharan Africa with poorer HIV treatment outcomes among adolescents and young adults compared to individuals in other age groups. For adolescents and young adults living with perinatally acquired HIV (AYLPHIV), the transition from pediatric to adult HIV care is a particularly high-risk period. We conducted a qualitative study to understand self-management needs of AYLPHIV in rural, southwestern Uganda as they prepare to transition to adult HIV care in order to inform relevant interventions that can enable AYLPHIV acquire the necessary skills to manage their illness as they age into adulthood. We conducted 60 in-depth interviews with AYLPHIV (n = 30), caregivers (n = 20) and health care providers (n = 10) from the HIV clinic at Mbarara Regional Referral Hospital. We used an interview guide that focused on perceptions about transition to adult HIV care, challenges with transitioning, navigating HIV care, and self-management needs for AYLPHIV (from the perspectives of AYLPHIV, their caregivers, and health care providers). We used thematic analysis to identify themes related to AYLPHIV's self-management skills. We identified several self-management needs that we grouped under two major themes; social support and empowerment for AYLPHIV to assume responsibility for their own health and to navigate adult HIV care independently. The sub-themes under social support were information support, instrumental support, and emotional support as the sub themes while sub-themes under empowerment included self-advocacy skills, interpersonal skills, self-care skills, and disclosure skills. Taken together, these findings indicate that AYLPHIV need to be supported and empowered to maximize their chances of successfully transitioning to adult HIV care. Support comes from peers and caregivers. AYLPHIV require knowledge about their HIV status and empowerment with different skills including: self-advocacy skills, interpersonal skills, self-care skills, and HIV status disclosure skills, in order to assume responsibilities related to independent HIV care.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry Mbarara University of Science and Technology, Mbarara, Uganda
| | - Charles Baguma
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Tushemereirwe
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Denis Nansera
- Department of Pediatrics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C. Tsai
- Department of Psychiatry Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brian C. Zanoni
- Division of Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Pediatric Infectious Diseases, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
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Taiwo BO, Kuhns LM, Omigbodun O, Awolude O, Kuti KM, Adetunji A, Berzins B, Janulis P, Akanmu S, Agbaji O, David AN, Akinbami A, Adekambi AF, Johnson AK, Okonkwor O, Oladeji BD, Cervantes M, Adewumi OM, Kapogiannis B, Garofalo R. A randomized stepped wedge trial of an intensive combination approach to roll back the HIV epidemic in Nigerian adolescents: iCARE Nigeria treatment support protocol. PLoS One 2023; 18:e0274031. [PMID: 37418498 PMCID: PMC10328338 DOI: 10.1371/journal.pone.0274031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/26/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Nigeria is one of six countries with half the global burden of youth living with HIV. Interventions to date have been inadequate as AIDS-related deaths in Nigeria's youth have remained unchanged in recent years. The iCARE Nigeria HIV treatment support intervention, a combination of peer navigation and SMS text message medication reminders to promote viral suppression, demonstrated initial efficacy and feasibility in a pilot trial among youth living with HIV in Nigeria. This paper describes the study protocol for the large-scale trial of the intervention. METHODS The iCARE Nigeria-Treatment study is a randomized stepped wedge trial of a combination (peer navigation and text message reminder) intervention, delivered to youth over a period of 48 weeks to promote viral suppression. Youth receiving HIV treatment at six clinical sites in the North Central and South Western regions of Nigeria were recruited for participation. Eligibility criteria included registration as a patient at participating clinics, aged 15-24 years, on antiretroviral therapy for at least three months, ability to understand and read English, Hausa, Pidgin English, or Yoruba, and intent to remain a patient at the study site during the study period. The six clinic sites were divided into three clusters and randomized to a sequence of control and intervention periods for comparison. The primary outcome is plasma HIV-1 viral load suppression, defined as viral load ≤ 200 copies/mL, in the intervention period versus the control period at 48 weeks of intervention. DISCUSSION Evidence-based interventions to promote viral load suppression among youth in Nigeria are needed. This study will determine efficacy of a combination intervention (peer navigation and text message reminder) and collect data on potential implementation barriers and facilitators to inform scale-up if efficacy is confirmed. TRIAL REGISTRATION ClinicalTrials.gov number, NCT04950153, retrospectively registered July 6, 2021, https://clinicaltrials.gov/.
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Affiliation(s)
- Babafemi O. Taiwo
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, Unites States of America
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, Unites States of America
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
| | - Olayinka Omigbodun
- Department of Child and Adolescent Psychiatry, and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olutosin Awolude
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kehinde M. Kuti
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Staff Medical Services Department, University College Hospital, Ibadan, Nigeria
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, Unites States of America
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, Unites States of America
| | | | - Oche Agbaji
- Department of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | | | | | - Abiodun Folashade Adekambi
- Department of Paediatrics, Olabisi Onabanjo University and Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, Unites States of America
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Institute for Global Health, Northwestern University, Chicago, IL, Unites States of America
| | | | - Marbella Cervantes
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
| | - Olubusuyi M. Adewumi
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, Unites States of America
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, Unites States of America
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, Unites States of America
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Ssewamala FM, McKay MM, Sensoy Bahar O, Nabunya P, Neilands T, Kiyingi J, Namatovu P, Guo S, Nakasujja N, Mwebembezi A. Suubi4StrongerFamilies: A study protocol for a clustered randomized clinical trial addressing child behavioral health by strengthening financial stability and parenting among families in Uganda. Front Psychiatry 2022; 13:949156. [PMID: 36506418 PMCID: PMC9726732 DOI: 10.3389/fpsyt.2022.949156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Children in Sub-Saharan Africa are burdened by significant unmet mental health needs. Across the region, high rates of poverty, HIV/AIDS, food insecurity, stigma, and an inadequate health safety net system exacerbate serious child behavioral health needs and impede an effective response. Disruptive behavioral disorders are particularly concerning as they persist through adolescence and adulthood. Hence, addressing the context-specific social influences on child behavioral health is critical given that children in the region comprise more than half of the total regional population. Against this backdrop, this study protocol describes a randomized clinical trial that will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial, and context-specific drivers affect the mental health of children in Uganda. Methods The study uses an experimental, longitudinal design across 30 cluster-randomized primary schools to compare single and combination intervention options; influences of economic empowerment and family strengthening on economic, perceptual, and functioning mediators; and context-specific moderators. The study will be conducted with 900 Ugandan children in mid-upper primary school (10-14 years). The three study conditions (n = 300 each) are: (1) economic empowerment only (EE only), (2) multiple family group-based family strengthening only (MFG-based FS only), and (3) combined EE + MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24, and 36 months. Conclusion Children in Sub-Saharan Africa are burdened by significant unmet mental health needs, including disruptive behavior disorders that persist through adolescence and adulthood if left untreated. The proposed study will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial and context-specific drivers affect the mental health of children in mid-upper primary schools in Uganda. Findings from this study can inform group, community, and population approaches that are needed for scalable solutions to address the social drivers negatively impacting child behavioral health in low-resource settings, including in Sub-Saharan Africa. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT053 68714].
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Affiliation(s)
- Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Mary M. McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, MO, United States
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Torsten Neilands
- School of Medicine, University of California, San Francisco, San Francisco, LA, United States
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Phionah Namatovu
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Shenyang Guo
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Sibiya T, Ghazi T, Mohan J, Nagiah S, Chuturgoon AA. Spirulina platensis Ameliorates Oxidative Stress Associated with Antiretroviral Drugs in HepG2 Cells. PLANTS (BASEL, SWITZERLAND) 2022; 11:plants11223143. [PMID: 36432871 PMCID: PMC9694780 DOI: 10.3390/plants11223143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 06/01/2023]
Abstract
Lately, Spirulina platensis (SP), as an antioxidant, has exhibited high potency in the treatment of oxidative stress, diabetes, immune disorder, inflammatory stress, and bacterial and viral-related diseases. This study investigated the possible protective role of Spirulina platensis against ARV-induced oxidative stress in HepG2 cells. Human liver (HepG2) cells were treated with ARVs ((Lamivudine (3TC): 1.51 µg/mL, tenofovir disoproxil fumarate (TDF): 0.3 µg/mL and Emtricitabine (FTC): 1.8 µg/mL)) for 96 h and thereafter treated with 1.5 µg/mL Spirulina platensis for 24 h. After the treatments, the gene and protein expressions of the antioxidant response pathway were determined using a quantitative polymerase chain reaction (qPCR) and Western blots. The results show that Spirulina platensis decreased the gene expressions of Akt (p < 0.0001) and eNOS (↓p < 0.0001) while, on the contrary, it increased the transcript levels of NRF-2 (↑p = 0.0021), Keap1 (↑p = 0.0002), CAT (↑p < 0.0001), and NQO-1 (↑p = 0.1432) in the HepG2 cells. Furthermore, the results show that Spirulina platensis also decreased the protein expressions of NRF-2 (↓p = 0.1226) and pNRF-2 (↓p = 0.0203). Interestingly, HAART-SP induced an NRF-2 pathway response through upregulating NRF-2 (except for FTC-SP) (↑p < 0.0001), CAT (↑p < 0.0001), and NQO-1 (except for FTC-SP) (↑p < 0.0001) mRNA expression. In addition, NRF-2 (↑p = 0.0085) and pNRF-2 (↑p < 0.0001) protein expression was upregulated in the HepG2 cells post-exposure to HAART-SP. The results, therefore, allude to the fact that Spirulina platensis has the potential to mitigate HAART-adverse drug reactions (HAART toxicity) through the activation of antioxidant response in HepG2 cells. We hereby recommend further studies on Spirulina platensis and HAART synergy.
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Affiliation(s)
- Thabani Sibiya
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Terisha Ghazi
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Jivanka Mohan
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Savania Nagiah
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
- Medical Programme, Department of Human Biology, Faculty of Health Sciences, Nelson Mandela University Missionvale, Port Elizabeth 6059, South Africa
| | - Anil A. Chuturgoon
- Discipline of Medical Biochemistry and Chemical Pathology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4013, South Africa
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Sibiya T, Ghazi T, Chuturgoon A. The Potential of Spirulina platensis to Ameliorate the Adverse Effects of Highly Active Antiretroviral Therapy (HAART). Nutrients 2022; 14:nu14153076. [PMID: 35893930 PMCID: PMC9332774 DOI: 10.3390/nu14153076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
The human immunodeficiency virus (HIV) is one of the most prevalent diseases globally. It is estimated that 37.7 million people are infected with HIV globally, and 8.2 million persons are infected with the virus in South Africa. The highly active antiretroviral therapy (HAART) involves combining various types of antiretroviral drugs that are dependent on the infected person’s viral load. HAART helps regulate the viral load and prevents its associated symptoms from progressing into acquired immune deficiency syndrome (AIDS). Despite its success in prolonging HIV-infected patients’ lifespans, the use of HAART promotes metabolic syndrome (MetS) through an inflammatory pathway, excess production of reactive oxygen species (ROS), and mitochondrial dysfunction. Interestingly, Spirulina platensis (SP), a blue-green microalgae commonly used as a traditional food by Mexican and African people, has been demonstrated to mitigate MetS by regulating oxidative and inflammatory pathways. SP is also a potent antioxidant that has been shown to exhibit immunological, anticancer, anti-inflammatory, anti-aging, antidiabetic, antibacterial, and antiviral properties. This review is aimed at highlighting the biochemical mechanism of SP with a focus on studies linking SP to the inhibition of HIV, inflammation, and oxidative stress. Further, we propose SP as a potential supplement for HIV-infected persons on lifelong HAART.
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Okonji EF, Wyk BV, Mukumbang FC. Applying the biopsychosocial model to unpack a psychosocial support intervention designed to improve antiretroviral treatment outcomes for adolescents in South Africa. Pan Afr Med J 2022; 41:166. [PMID: 35655671 PMCID: PMC9120740 DOI: 10.11604/pamj.2022.41.166.31985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/22/2021] [Indexed: 12/05/2022] Open
Abstract
Adolescents (10 to 19 years) living with HIV (ALHIV) experience disproportionately poor adherence to antiretroviral treatment (ART) compared to other age groups. Several barriers, including psychosocial challenges, contribute to this observation. Psychosocial support (PSS) interventions show promising results as a strategy to deal with the biological and psychosocial challenges faced by ALHIV. However, there is dearth of information on how psychosocial support interventions designed to improve treatment adherence and retention in care among ALHIV are effective. In this commentary, we used the biopsychosocial model to formulate hypotheses on how the components of a PSS intervention could improve adherence and retention in ART care. Psychological wellbeing, coping strategies, social support, self-efficacy, and disclosure are key components in the intervention designed to improve ART adherence and retention in care. The management of ALHIV for improved ART adherence and retention requires recognising and addressing the complex biological, psychological and social issues peculiar to them.
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Affiliation(s)
- Emeka Francis Okonji
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, Cape Town 7535, South Africa
| | - Brian Van Wyk
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, Cape Town 7535, South Africa
| | - Ferdinand Che Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, Cape Town 7535, South Africa.,Department of Global Health, University of Washington, Seattle, WA, United State of America
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Amico KR, Lindsey JC, Hudgens M, Dallas R, Horvath KJ, Dunlap A, Goolsby R, Johnson MM, Heckman B, Crawford J, Secord E, Purswani M, Reirden D, Rathore M, Robinson LG, Gaur AH. Randomized Controlled Trial of a Remote Coaching mHealth Adherence Intervention in Youth Living with HIV. AIDS Behav 2022; 26:3897-3913. [PMID: 35670987 PMCID: PMC9171094 DOI: 10.1007/s10461-022-03717-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
Youth living with HIV (YLWH) in the US have low rates of viral suppression (VS). In a prospective randomized clinical trial (ATN152) that enrolled 89 YLWH on antiretroviral therapy (ART) with detectable viral load, we evaluated a 12 week triggered escalating real-time adherence (TERA) intervention with remote coaching, electronic dose monitoring (EDM), and outreach for missed/delayed doses compared to standard of care (SOC). Median [Q1, Q3] percent days with EDM opening was higher in TERA (72% (47%, 89%)) versus SOC (41% (21%, 59%); p < 0.001) and incidence of numbers of 7 day gaps between openings were lower (TERA to SOC ratio: 0.40; 95% CI 0.30, 0.53; p < 0.001). There were no differences in VS at week 12 (TERA 35%; 95% CI 21%, 51% versus SOC 36%; 95% CI 22%, 51%; p > 0.99) or later time-points. The intervention improved adherence but not VS in heavily ART-experienced YLWH. Remote coaching more closely tailored to the unique dosing patterns and duration of need for youth struggling to reach VS warrants further investigation.
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Affiliation(s)
- K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Jane C Lindsey
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael Hudgens
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronald Dallas
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Keith J Horvath
- Department of Clinical Psychology, San Diego State University, San Diego, CA, USA
| | - Amanda Dunlap
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Rachel Goolsby
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megan Mueller Johnson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Amherst, NY, USA
| | - Jessica Crawford
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | | | | | - Danial Reirden
- Children's Hospital Colorado, University of Colorado Denver, Denver, CO, USA
| | - Mobeen Rathore
- Education and Service (UF CARES), University of Florida Center for HIV/AIDS Research, Jacksonville, FL, USA
| | | | - Aditya H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
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11
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A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya. AIDS Behav 2022; 26:232-242. [PMID: 34292429 PMCID: PMC8295454 DOI: 10.1007/s10461-021-03376-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/13/2022]
Abstract
Mobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.
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12
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Taiwo BO, Kuti KM, Kuhns LM, Omigbodun O, Awolude O, Adetunji A, Berzins B, Janulis P, Johnson AK, Okonkwor O, Oladeji BD, Muldoon A, Adewumi OM, Amoo P, Atunde H, Kapogiannis B, Garofalo R. Effect of Text Messaging Plus Peer Navigation on Viral Suppression Among Youth With HIV in the iCARE Nigeria Pilot Study. J Acquir Immune Defic Syndr 2021; 87:1086-1092. [PMID: 34153015 PMCID: PMC8496997 DOI: 10.1097/qai.0000000000002694] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Consistent with the global trend, youth with HIV (YWH) in Nigeria have high rates of viral nonsuppression. Hence, novel interventions are needed. SETTING Infectious Diseases Institute, College of Medicine, University of Ibadan, Nigeria. METHODS In a single-arm trial, participants aged 15-24 years received 48 weeks of a combination intervention, comprising daily 2-way text message medication reminders plus peer navigation. The primary outcome measure was viral suppression less than 200 copies/mL. The secondary outcome measures included self-reported adherence on a visual analog scale and medication possession ratio, each dichotomized as ≥90% (good) or <90% (poor) adherence. The outcomes were analyzed using McNemar test. Retention in care, intervention feasibility and acceptability, and participants' satisfaction were also assessed. RESULTS Forty YWH (50% male participants) were enrolled: mean age 19.9 years (SD = 2.5), 55% perinatally infected, and 35% virologically suppressed at baseline. Compared with baseline, the odds of virologic suppression was higher at 24 weeks (odds ratio = 14.00, P < 0.001) and 48 weeks (odds ratio = 6.00, P = 0.013). Self-reported adherence (≥90%) increased from baseline at 24 weeks (63%, P = 0.008) and 48 weeks (68%, P = 0.031). Medication possession ratio ≥90% increased at weeks 24 and 48 (85% and 80%, respectively), achieving statistical significance at 24 weeks alone (P = 0.022). Retention in care at 48 weeks was 87.5%. All (37/37) participants at week 48 were fully or mostly satisfied with the intervention. CONCLUSION Daily 2-way text message reminders plus peer navigation is a promising combination intervention to improve viral suppression among YWH in Nigeria.
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Affiliation(s)
- Babafemi O. Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Kehinde M. Kuti
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | - Olayinka Omigbodun
- Department of Child and Adolescent Psychiatry, and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Olutosin Awolude
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
- Department of Obstetrics and Gynecology, and Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, USA
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, USA
| | - Bibilola D. Oladeji
- Department of Medical Social Sciences, Northwestern University, Chicago, USA
| | - Abigail Muldoon
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
| | | | - Paul Amoo
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Hannah Atunde
- Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, USA
- Division of Adolescent Medicine, Ann and Robert H Lurie Children’s Hospital of Chicago, USA
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13
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Dovey-Pearce G, Flannery H. Integrating psychology into paediatric healthcare: A UK perspective. Clin Child Psychol Psychiatry 2021; 26:313-322. [PMID: 33761794 DOI: 10.1177/13591045211000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, London, UK
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14
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Lake J, Lawrence KA, Martinez Alonso E, Gonzales V, LaFleur J. Quality of systematic reviews in HIV: The case of clinical outcomes associated with patient medication adherence. J Evid Based Med 2021; 14:7-16. [PMID: 33528882 DOI: 10.1111/jebm.12423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022]
Abstract
AIM Use of systematic reviews (SRs) as first-level evidence for guideline recommendations hinges on review quality. In particular, US guidelines for adherence-related recommendations in the treatment of human immunodeficiency virus (HIV) are not based on available SRs of adherence-outcome relationships; it is unclear why. No published studies report on the quality of SRs on HIV adherence and outcomes, which may be driving the lack of use. We describe the quality of this body of literature. METHODS Literature searches were conducted in Ovid MEDLINE, EMBASE, CINAHL, PubMed Central, the Cochrane Library, Science Citation Index, Web of Science, ScIELO Citation Index, and Ovid Emcare. Screening and quality assessments were performed in duplicate using AMSTAR 2. Funding sources and impact factors of publishing journals were also extracted, and correlations between quality rankings and numbers of critical weaknesses versus impact factors were assessed using Spearman's rank correlation coefficient. RESULTS Nine SRs of 1141 records met eligibility criteria. Overall confidence in the results was critically low for most (78%) SRs. Underperformance was found across all AMSTAR 2 domains. Impact factor (a surrogate or journal reputation) did not correlate with quality. CONCLUSIONS SRs do not necessarily comprise top-level evidence despite the availability of quality appraisal tools and reporting guidance, which could explain the lack of SR evidence in US HIV medication adherence-related guideline recommendations. All parties to evidence synthesis publication should require quality assessment of studies.
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Affiliation(s)
- Joanita Lake
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- Salt Lake City Veterans Affairs Health Care Center, Salt Lake City, Utah, USA
| | - Kendra A Lawrence
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
| | | | - Valerie Gonzales
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
| | - Joanne LaFleur
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- Salt Lake City Veterans Affairs Health Care Center, Salt Lake City, Utah, USA
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15
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Nakalema HS, Rajan SS, Morgan RO, Lee M, Gillespie SL, Kekitiinwa A. The effect of antiretroviral therapy guideline change on health outcomes among youth living with HIV in Uganda. AIDS Care 2020; 33:904-913. [PMID: 33021095 DOI: 10.1080/09540121.2020.1829533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTOpportunistic infections (OIs) are the primary cause of HIV-related morbidity and mortality. To reduce the risk, the ART eligibility criteria were revised to start treatment before advanced disease onset. We evaluated the effect of 2014 HIV clinical guideline changes in Uganda on opportunistic infections and survival among Youth Living with HIV (YLWH). This retrospective cohort analysis used administrative data from the District Health Information System (DHIS2) and the national referral hospital, to compare YLWH, 15-24 years old, who started ART pre-guideline (January 2012-June 2014) and post-guideline (July 2014-December 2016). We assessed the effect using multivariable logistic and Cox Proportional Hazards regression models, respectively. Post-guideline youth had 18% and 30% lower adjusted odds of having an OI at 6 (aOR: 0.82, 95%CI: 0.67, 0.99), and 12 months (aOR: 0.70, 95%CI: 0.58, 0.85) after ART initiation, compared to pre-guideline youth. No significant differences were observed in survival probabilities (Z = 2.56, P-value = 0.11) and adjusted hazard ratios (aHR: 1.55, 95%CI: 0.46, 5.28). Early ART initiation reduced the risk of OIs among YLWH. However, given the existence of geographical and clinical variations in the endemicity, morbidity and mortality associated with different OIs, additional research is still needed.
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Affiliation(s)
- Hilda Sekabira Nakalema
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda.,Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
| | - Suja S Rajan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA
| | - Minjae Lee
- Department of Epidemiology, Human Genetics & Environmental Health, University of Texas Health Science Center, Houston, TX, USA.,Department of Biostatistics & Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Susan L Gillespie
- Department of Retrovirology, Baylor College of Medicine, Houston, TX, USA
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16
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Benning L, Mantsios A, Kerrigan D, Coleman JS, Golub E, Blackstock O, Konkle-Parker D, Philbin M, Sheth A, Adimora AA, Cohen MH, Seidman D, Milam J, Kassaye SG, Taylor T, Murray M. Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy. BMC WOMENS HEALTH 2020; 20:152. [PMID: 32711509 PMCID: PMC7382076 DOI: 10.1186/s12905-020-01011-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/05/2020] [Indexed: 12/26/2022]
Abstract
Background Long-acting (LA) injectable antiretroviral therapy (ART) has been found non-inferior to daily oral ART in Phase 3 trials. LA ART may address key barriers to oral ART adherence and be preferable to daily pills for some people living with HIV. To date, women have been less represented than men in LA ART research. Using longitudinal data from the Women’s Interagency HIV Study (WIHS) cohort of women living with HIV in the United States, we examined barriers and facilitators of daily oral ART adherence that may be related to or addressed by LA ART. Methods We conducted a secondary analysis of WIHS cohort data from 1998 to 2017 among participants seen for at least 4 visits since 1998 who reported using ART at least once (n = 2601). Two dichotomous outcomes, patient-reported daily oral ART adherence and viral suppression were fit using generalized linear models, examining the role of socio-demographic and structural factors. Results At study enrollment, the median age was 40.5 years, 63% of participants were African American and 22% were Latina. The majority (82%) reported taking ART more than 75% of the time and 53% were virally suppressed. In multivariate analysis, several sub-groups of women had lower odds of reported adherence and viral suppression: 1) younger women (adherence aOR: 0.71; viral suppression aOR: 0.63); 2) women who inject drugs (adherence aOR: 0.38; viral suppression aOR: 0.50) and those with moderate (adherence aOR: 0.59; viral suppression aOR: 0.74) and heavy alcohol consumption (adherence aOR: 0.51; viral suppression aOR: 0.69); 3) those with depressive symptoms (adherence aOR: 0.61; viral suppression aOR: 0.76); and 4) those with a history of going on and off ART (adherence aOR: 0.62, viral suppression aOR: 0.38) or changing regimens (adherence aOR: 0.83, viral suppression aOR: 0.56). Conclusions Current injectable contraceptive users (vs. non-users) had greater odds of oral ART adherence (aOR: 1.87) and viral suppression (aOR: 1.28). Findings identify profiles of women who may benefit from and be interested in LA ART. Further research is warranted focused on the uptake and utility of LA ART for such key subpopulations of women at high need for innovative approaches to achieve sustained viral suppression.
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Affiliation(s)
- Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Deanna Kerrigan
- Center for Health, Risk and Society, American University, Washington, DC, USA
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oni Blackstock
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Morgan Philbin
- Columbia University Mailman School of Public Health, Sociomedical Sciences, New York, USA
| | - Anandi Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Adaora A Adimora
- Department of Medicine, School of Medicine and Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Cook County Bureau of Health Services, Chicago, IL, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Joel Milam
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Seble G Kassaye
- Division of Infectious Diseases and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Tonya Taylor
- SUNY Downstate Medical Center, Brooklyn, NY, USA
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17
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Flannery H, Jacob J. Measuring psychological outcomes in paediatric settings: Making outcomes meaningful using client-defined perspectives. Clin Child Psychol Psychiatry 2020; 25:594-603. [PMID: 32046508 DOI: 10.1177/1359104520904120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a growing drive to develop and implement patient-reported outcome measures within paediatric health services, particularly for young people living with chronic health conditions; however, there is little consensus on how best to do this in meaningful ways within psychological services working alongside medical teams. This reflective commentary considers some of the challenges of collecting psychological outcome measures in paediatric services and considers alternative approaches to making outcome measurement meaningful. All measures have their limitations; however, they become meaningless if they are not used in meaningful and considered ways with young people. Client-defined outcome measurement, such as goal-based outcome measures, alongside other types of measurement, can capture outcomes of meaning to young people living with chronic health conditions, and can enable them to feed into a shared decision-making process.
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Affiliation(s)
- Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, University College London, UK
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18
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Effectiveness of an Intervention for Improving Treatment Adherence, Service Utilization and Viral Load Among HIV-Positive Adult Alcohol Users. AIDS Behav 2020; 24:1495-1504. [PMID: 31637608 DOI: 10.1007/s10461-019-02702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study evaluates whether a group intervention that included cognitive remediation improved ART adherence, service utilization, and viral load among HIV-positive adults with a history of alcohol abuse. HIV-seropositive adults (n = 243), recruited from community-based organizations were randomized to the Holistic Health Recovery Program (HHRP-A) or a comparison condition. Both conditions included eight group sessions; outcomes (adherence, service utilization, and viral load) and processes (social support and stress) were measured. Data were collected at baseline, immediately post-intervention, 3 months, and 6 months follow-up. Participants were ≥ 18 and ≤ 60 ([Formula: see text] years old), 71% male, and 79.6% black. Participants randomized to HHRP-A were more likely to report adequate ART adherence and to report an undetectable viral load at 6 months post-intervention. Participants in the HHRP-A condition showed significantly greater improvement in social support than the comparison group. Providing comprehensive health promotion interventions that incorporate cognitive remediation strategies, could improve health outcomes for HIV-positive substance users.
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19
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Bucek A, Raymond J, Leu CS, Warne P, Abrams EJ, Dolezal C, Wiznia A, Kalichman S, Kalichman M, Mellins CA. Preliminary Validation of an Unannounced Telephone Pill Count Protocol to Measure Medication Adherence Among Young Adults With Perinatal HIV Infection. J Assoc Nurses AIDS Care 2020; 31:35-41. [PMID: 30958407 PMCID: PMC7133548 DOI: 10.1097/jnc.0000000000000082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Unannounced telephone pill counts are an objective antiretroviral therapy adherence measurement tool, but this method has not been validated in young adults (YA) living with perinatal HIV infection. Perinatally infected YA, recruited from the Child and Adolescent Self-Awareness and Health Study, agreed to unannounced telephone pill counts to measure medication adherence over 4 months and phlebotomy to measure viral load (VL). Differences in pill count adherence scores among YA with a VL of ≤20 versus >20, and demographic differences were assessed. Participants (N = 62) were, on average, 24 years old; 57% were African American, and 40% were Latino. Participants with VL of ≤20 (60%) had significantly higher adherence scores (85% versus 62%; p = .004). Associations were not significant among older YA (range, 25-28 years) or Latinos. Unannounced telephone pill counts are a valid measure of antiretroviral therapy adherence in YA with perinatal HIV infection. Studies with larger samples are needed.
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Affiliation(s)
- Amelia Bucek
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Jeannette Raymond
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, Columbia, Mailman School of Public Health, New York, New York, USA
| | - Patricia Warne
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Elaine J. Abrams
- Columbia University College of Physicians & Surgeons, and Senior Director for Research, ICAP at Columbia, Mailman School of Public Health, New York, New York, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Andrew Wiznia
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Seth Kalichman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut,, USA
| | - Claude A. Mellins
- Office of Clinical Psychology, Columbia University Medical Center, and Co-Director, HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA
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20
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Measuring Antiretroviral Adherence Among Young People Living with HIV: Observations from a Real-Time Monitoring Device Versus Self-report. AIDS Behav 2019; 23:2138-2145. [PMID: 30888573 DOI: 10.1007/s10461-019-02448-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This report compares self-report (SR) antiretroviral (ARV) adherence data to adherence data collected via Wisepill, a real-time electronic monitoring (EM) device, among young people living with HIV (YPLH) in the southern United States. Participants (n = 66; ages 16 to 26) were followed for 14 weeks. Descriptive analyses were used to compare SR to EM data. Correlations and a linear regression were conducted to explore factors possibly associated with SR-EM discrepancies. We also examined associations between various levels of SR and EM adherence and viral suppression/non-suppression at 14 weeks. Rates of SR adherence were maintained between 87% and 92% while rates of EM adherence declined from 64% to 34%. YPLH who were ARV-experienced, had lower treatment motivation, and reported more frequent recent marijuana use, had a greater discrepancy between their SR and EM adherence levels compared to other YPLH. Higher rates of SR and EM adherence were independently associated with a decline in viral load. A sensitivity analysis also revealed that SR adherence was a better predictor of viral non-suppression, whereas EM adherence was a better predictor of viral suppression. These measurement approaches are discussed in the context of providing clinical care to YPLH.
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Lower Optimal Treatment Adherence Among Youth Living With HIV in a Universal Health Care Setting Where ART Is Available at No Cost. J Adolesc Health 2019; 64:509-515. [PMID: 30545583 DOI: 10.1016/j.jadohealth.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE We assessed differences in optimal adherence between youth (aged 15-29 years) and adults (aged ≥30 years) enrolled in the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program from 2010 to 2016. METHODS Population-level clinical data were used to compare optimal antiretroviral therapy adherence (≥95%), based on pharmacy refill data, among youth and adults. Unadjusted and adjusted generalized estimating estimates were performed to examine the independent relationship between time-dependent age categories and optimal adherence, adjusting for confounders. Factors associated with optimal adherence among youth were examined. RESULTS Data for 7,485 individuals living with HIV were included. Median follow-up was 7 years (Q1-Q3: 4-7). Over the study period, the number of individuals categorized as "youth" ranged from 820 in 2010 to 291 in 2016. Multivariable models found youth living with HIV were significantly less likely to be optimally adherent than adults (adjusted odds ratio [aOR] = .55; 95% confidence interval [CI]: .49-.62), after controlling for potential confounders, although youth adherence improved significantly during the study period. Among youth, increasing time-dependent age (aOR = 1.18/year older; 95%CI: 1.11-1.25) and number of years on antiretroviral therapy (aOR = 1.15, 95%CI: 1.10-1.19) were independently associated with optimal adherence, while Hepatitis C-positive serostatus (aOR = .55; 95%CI: .33-.92) and multiple treatment regimen change (aOR = .89/regimen change; 95%CI: .81-.97) were negatively associated with optimal adherence. CONCLUSIONS Youth were less likely to be optimally adherent throughout the study period. Findings suggest implications for increased youth-centered adherence support, particularly for youth living with HIV concurrently living with Hepatitis C, newly initiating treatment, and going through medication change.
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Dunn Navarra AM, Viorst Gwadz M, Bakken S, Whittemore R, Cleland CM, D'Eramo Melkus G. Adherence Connection for Counseling, Education, and Support: Research Protocol for a Proof-of-Concept Study. JMIR Res Protoc 2019; 8:e12543. [PMID: 30920377 PMCID: PMC6458537 DOI: 10.2196/12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background The highest rates of new HIV infections are observed in African Americans and Hispanics/Latinos (ethnic minority) adolescents and young adults (youth). HIV-infected ethnic minority youth are less likely to initiate and maintain adherence to antiretroviral treatment (ART) and medical care, as compared with their adult counterparts. Objective The objective of this research protocol was to describe our proposed methods for testing a peer-led mobile health cognitive behavioral intervention, delivered via remote videoconferencing and smartphones with HIV-infected ethnic minority youth, Adherence Connection for Counseling, Education, and Support (ACCESS). Our secondary aim was to obtain initial estimates of the biobehavioral impact of ACCESS on HIV virologic outcomes and self-reported ART adherence, beliefs and knowledge about ART treatment, adherence self-efficacy, and health care utilization (retention in care). Methods An exploratory, sequential mixed-methods study design will be used with conceptual determinants of adherence behavior informed by the information-motivation-behavioral skills model. HIV-infected ethnic minority youth aged 16 to 29 years with a detectable HIV serum viral load of more than 200 copies/ml (N=25) will be recruited. Qualitative pretesting will be conducted, including semistructured, in-depth, individual interviews with a convenience sample meeting the study inclusion criteria. Preliminary analysis of qualitative data will be used to inform and tailor the ACCESS intervention. Testing and implementation will include a one-group pre-posttest pilot, delivered by a trained successful peer health coach who lives with HIV and is well-engaged in HIV care and taking ART. A total of 5 peer-led remote videoconferencing sessions will be delivered using study-funded smartphones and targeting adherence information (HIV knowledge), motivation (beliefs and perceptions), and behavioral skills (self-efficacy). Participant satisfaction will be assessed with poststudy focus groups and quantitative survey methodology. Bivariate analyses will be computed to compare pre- and postintervention changes in HIV biomarkers, self-reported ART adherence, beliefs and knowledge about ART, adherence self-efficacy, and retention in care. Results As of December 2018, we are in the data analysis phase of this pilot and anticipate completion with dissemination of final study findings by spring/summer 2019. The major outcomes will include intervention feasibility, acceptability, and preliminary evidence of impact on serum HIV RNA quantitative viral load (primary adherence outcome variable). Self-reported ART adherence and retention in care will be assessed as secondary outcomes. Findings from the qualitative pretesting will contribute to an improved understanding of adherence behavior. Conclusions Should the ACCESS intervention prove feasible and acceptable, this research protocol will contribute to a shift in existent HIV research paradigms by offering a blueprint for technology-enabled peer-led interventions and models. International Registered Report Identifier (IRRID) DERR1-10.2196/12543
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Affiliation(s)
| | - Marya Viorst Gwadz
- Silver School of Social Work, New York University, New York, NY, United States
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, NY, United States
| | - Robin Whittemore
- School of Nursing, Yale University, New Haven, CT, United States
| | - Charles M Cleland
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Gail D'Eramo Melkus
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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DeSilva M, Vu CN, Bonawitz R, Hai LT, Van Lam N, Yen LT, Gifford AL, Haberer J, Linh DT, Sabin L. The Supporting Adolescent Adherence in Vietnam (SAAV) study: study protocol for a randomized controlled trial assessing an mHealth approach to improving adherence for adolescents living with HIV in Vietnam. Trials 2019; 20:150. [PMID: 30819228 PMCID: PMC6394014 DOI: 10.1186/s13063-019-3239-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The overall goal of the Supporting Adolescent Adherence in Vietnam (SAAV) study is to improve understanding of an adherence feedback mHealth intervention designed to help adolescents living with HIV (ALHIV) maintain high adherence to antiretroviral therapy (ART), critical to effective treatment. Specifically, we aim to: (1) conduct formative research with Vietnamese ALHIV and their caregivers to better understand adherence challenges and refine the personalized mHealth intervention package; and (2) assess the feasibility, acceptability, and efficacy of the intervention to improve ART adherence by implementing a randomized controlled trial (RCT). METHODS The study will utilize mixed methods. The formative phase will include 40 in-depth interviews (IDIs) with 20 adolescent (12-17 years)/caregiver dyads and eight focus group discussions with adolescents, caregivers, and clinicians at the National Hospital for Pediatrics (NHP) in Hanoi, Vietnam. We will also conduct 20 IDIs with older adolescents (18-21 years) who have transitioned to adult care at outpatient clinics in Hanoi. We will then implement a seven-month RCT at NHP. We will recruit 80 adolescents on ART, monitor their adherence for one month to establish baseline adherence using a wireless pill container (WPC), and then randomize participants to intervention versus control within optimal (≥ 95% on-time doses) versus suboptimal (< 95% on-time doses) baseline adherence strata. Intervention participants will receive a reminder of their choice (cellphone text message/call or bottle-based flash/alarm), triggered when they miss a dose, and engage in monthly counseling informed by their adherence data. Comparison participants will receive usual care and offer of counseling at routine monthly clinic visits. After six months, we will compare ART adherence, CD4 count, and HIV viral suppression between arms, in addition to acceptability and feasibility of the intervention. DISCUSSION Findings will contribute valuable information on perceived barriers and facilitators affecting adolescents' ART adherence, mHealth approaches as adherence support tools for ALHIV, and factors affecting adolescents' ART adherence. This information will be useful to researchers, medical personnel, and policy-makers as they develop and implement adherence programs for ALHIV, with potential relevance to other chronic diseases during transition from adolescent to adult care. TRIAL REGISTRATION ClinicalTrials.gov, NCT03031197 . Registered on 21 January 2017.
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Affiliation(s)
- Mary DeSilva
- Westbrook College of Health Professions, University of New England, 716 Stevens Ave, Portland, ME 04103 USA
| | - Cong Nguyen Vu
- Institute for Population Health and Development, No.18, Lane 132, Hoa Bang Str., Cau Giay District, Hanoi, 122667 Vietnam
| | - Rachael Bonawitz
- Center for Global Health & Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA 02118 USA
| | - Le Thanh Hai
- National Hospital for Pediatrics, 18/879 La Thành, Đống Đa, Hanoi, Vietnam
| | - Nguyen Van Lam
- Department of Infectious Disease (ID), National Hospital for Pediatrics, 18/879 La Thành, Đống Đa, Hanoi, Vietnam
| | - Le Thi Yen
- Department of Infectious Disease (ID), National Hospital for Pediatrics, 18/879 La Thành, Đống Đa, Hanoi, Vietnam
| | - Allen L. Gifford
- Department of Health Law, Policy and Management, Boston University Schools of Medicine and Public Health, 725 Albany Street, Talbot T247W, Boston, MA 02118 USA
| | - Jessica Haberer
- Massachusetts General Hospital Global Health, 125 Nashua St, Suite 722, Boston, MA 02114 USA
| | - Dang Thuy Linh
- Institute for Population Health and Development, No.18, Lane 132, Hoa Bang Str., Cau Giay District, Hanoi, 122667 Vietnam
| | - Lora Sabin
- Center for Global Health & Development, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA 02118 USA
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Almeida-Brasil CC, Moodie EEM, Cardoso TS, Nascimento ED, Ceccato MDGB. Comparison of the predictive performance of adherence measures for virologic failure detection in people living with HIV: a systematic review and pairwise meta-analysis. AIDS Care 2018; 31:647-659. [PMID: 30516060 DOI: 10.1080/09540121.2018.1554241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A critical feature of an adherence assessment tool is its ability to predict virologic failure in people living with HIV (PLHIV). We, therefore, aimed to compare the predictive performance of commonly used adherence measures. We systematically searched MEDLINE, Embase and LILACS up to February 2018, to identify relevant observational studies comparing the effects of any two of the following adherence measurements on virologic outcomes: electronic monitoring, pill count, pharmacy refill, self-report and physician assessment. We analyzed data by pairwise meta-analyzes with a random-effects model. The proportion of virologic failures among non-adherent participants in each adherence measure was used to calculate the odds ratio (OR), with 95% Confidence Intervals (95%CI). Heterogeneity was assessed, with potential causes identified by sensitivity and subgroup analysis. We included 38 studies with individual patient data for 18,010 patients. All possible comparisons between pairs of the five adherence measures were considered and a total of nine comparison groups could be established. Meta-analysis suggested that self-report was a better predictor of virologic failure than pill count when the recall period was within one week (OR: 2.35, 95%CI: 1.07-5.18, p = 0.03). Physician assessment had higher odds of predicting virologic failure than did either self-report (OR: 2.63, 95%CI: 1.37-5.26, p < 0.01) or pharmacy refill (OR: 3.57, 95%CI: 1.69-7.14, p < 0.001). There was no difference in the predictive performance between any of the other measures that we were able to compare (p > 0.05). The combination of multiple measures did not increase the predictive value when compared to any of the measures alone. Low-cost and simple adherence measures such as self-report predict virologic failure better than or equally well as objective measures. Our results suggest that there is no need to use expensive or time-consuming adherence measures when the objective is to identify PLHIV at risk of treatment failure.
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Affiliation(s)
- Celline Cardoso Almeida-Brasil
- a Department of Social Pharmacy , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil.,b Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montréal , Canada
| | - Erica E M Moodie
- b Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montréal , Canada
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Yang C, Hao Z, Yu D, Xu Q, Zhang L. The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis. Epilepsy Res 2018; 142:88-99. [PMID: 29609075 DOI: 10.1016/j.eplepsyres.2018.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/13/2018] [Accepted: 03/25/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We conducted a systematic review to assess antiepileptic drug (AED) adherence rates, and to identify the characteristics associated with nonadherence in children. METHODS We searched PubMed, EMBASE, and the Cochrane Library from inception to June 2017. Observational studies addressing medication adherence or examining factors influencing AED adherence were included. RESULTS We included 22 studies, involving 3955 participants. The general quality of included studies were rated as high quality. Adherence rates were reported in 18 studies, varying between 22.1% and 96.5%. Meta analysis of 13 studies (n = 2051) revealed a pooled adherence rate assessed by objective methods of 58% (95% CI [0.46, 0.74]). Meta analysis of nine studies (n = 1217) revealed a pooled adherence rate assessed by subjective Methods of 73%, (95% CI [0.63, 0.85]). Family support, smaller family size, stable parental marriage status, support from healthcare providers and higher family socioeconomic status were associated with better medication adherence. However, contradictory results were found regarding the effects of age, the frequency of seizure, type of seizures, type of medication and the number of administered drugs. CONCLUSIONS Adherence to AEDs is challenging for pediatric patients with epilepsy. Few factors which influence adherence can be drawn because of differing variables and results. Future prospective research should be designed with longer study periods and larger samples in naturalistic settings.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Zilong Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Yu
- Department of Pediatric Neurology, West China second hospital, Sichuan University. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Qunfen Xu
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
| | - Lingli Zhang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
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Dos Santos WM, de Mello Padoin SM. Cost-Effective Analysis to Incorporate Non-Drug Interventions to Increase Adherence to Antiretroviral Therapy. Value Health Reg Issues 2018. [PMID: 29529587 DOI: 10.1016/j.vhri.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Traisathit P, Delory T, Ngo-Giang-Huong N, Somsamai R, Techakunakorn P, Theansavettrakul S, Kanjanavanit S, Mekmullica J, Ngampiyaskul C, Na-Rajsima S, Lallemant M, Cressey TR, Jourdain G, Collins IJ, Le Coeur S. Brief Report: AIDS-Defining Events and Deaths in HIV-Infected Children and Adolescents on Antiretrovirals: A 14-Year Study in Thailand. J Acquir Immune Defic Syndr 2018; 77:17-22. [PMID: 29040162 PMCID: PMC6047734 DOI: 10.1097/qai.0000000000001571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data are scarce on the long-term clinical outcomes of perinatally HIV-infected children and adolescents receiving antiretroviral therapy (ART) in low/middle-income countries. We assessed the incidence of mortality before (early) and after (late) 6 months of ART and of the composite outcome of new/recurrent AIDS-defining event or death >6 months after ART start (late AIDS/death) and their associated factors. METHODS Study population was perinatally HIV-infected children (≤18 years) initiating ART within the Program for HIV Prevention and Treatment observational cohort (NCT00433030). Factors associated with late AIDS/death were assessed using competing risk regression models accounting for lost to-follow-up and included baseline and time-updated variables. RESULTS Among 619 children, "early" mortality incidence was 99 deaths per 1000 person-years of follow-up [95% confidence interval (CI): 69 to 142] and "late" mortality 6 per 1000 person-years of follow-up (95% CI: 4 to 9). Of the 553 children alive >6 months after ART initiation, median age at ART initiation was 6.4 years, CD4% 8.2%, and HIV-RNA load 5.1 log10 copies/mL. Thirty-eight (7%) children developed late AIDS/death after median time of 3.3 years: 24 died and 24 experienced new/recurrent AIDS-defining events (10 subsequently died). Factors independently associated with late AIDS/death were current age ≥13 years (adjusted subdistribution hazard ratio 4.9; 95% CI: 2.4 to 10.1), HIV-RNA load always ≥400 copies/mL (12.3; 95% CI: 4.0 to 37.6), BMI-z-score always <-2 SD (13.7; 95% CI: 3.4 to 55.7), and hemoglobin <8 g/dL at least once (4.6; 95% CI: 2.0 to 10.5). CONCLUSIONS After the initial 6 months of ART, being an adolescent, persistent viremia, poor nutritional status, and severe anemia were associated with poor clinical outcomes. This supports the need for novel interventions that target children, particularly adolescents with poor growth and uncontrolled viremia.
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Affiliation(s)
- Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Thailand
| | - Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tim R Cressey
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Intira Jeannie Collins
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, UK
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institut national d’études démographiques (INED), F-75020 Paris, France
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Comparison of Population Pharmacokinetics Based on Steady-State Assumption Versus Electronically Monitored Adherence to Lopinavir, Atazanavir, Efavirenz, and Etravirine: A Retrospective Study. Ther Drug Monit 2017; 38:506-15. [PMID: 26937748 DOI: 10.1097/ftd.0000000000000297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Population pharmacokinetic (PopPK) analyses often rely on steady state and full adherence to prescribed dosage regimen assumptions from data gathered during therapeutic drug monitoring (TDM). Nonadherence is common in chronic diseases such as HIV. This study evaluates the impact of adherence measurement by electronic monitoring on PopPK parameter estimation and individual concentration profile predictions, and also the influence of adherence issues on the clinical interpretation of a concentration measurement. METHODS Published PopPK models for lopinavir, atazanavir, efavirenz, and etravirine were applied to estimate PK parameters and individual concentrations in 140 HIV patients taking part in a medication adherence program using 2 dosing data sets. The first set included the last dose reported by the patient with steady-state and full adherence assumptions; the second set used detailed electronic dosing history. PopPK parameter estimates and individual predictions were compared between the 2 dosing entries. RESULTS Clearance estimates and likewise predicted concentrations did not markedly differ between the 2 dosing histories. However, certain patterns of nonadherence such as sparse missed doses or consecutive missed doses lead to suboptimal drug exposure. The interpretation based on self-reported information would have concluded on a wrongly appropriate individual exposure. CONCLUSIONS PopPK analysis assuming steady state with full adherence produced similar results to those based on detailed electronic dosing history reconciled with patients' allegations. Self-reported last dose intake appeared reliable for concentration predictions and therapeutic drug monitoring interpretation for most patients followed at the medication adherence program. Yet, clinicians should be aware that concentration predictions based on self-reported last dose intake might be overestimated in case of undetected patterns of nonadherence, increasing the risk of forthcoming therapeutic failure.
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Challenges and perspectives of compliance with pediatric antiretroviral therapy in Sub-Saharan Africa. Med Mal Infect 2017; 47:511-518. [PMID: 28943171 DOI: 10.1016/j.medmal.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/17/2016] [Accepted: 07/20/2017] [Indexed: 11/22/2022]
Abstract
More than 3 million children aged less than 15years are infected with HIV worldwide, mainly in Sub-Saharan Africa. The survival of HIV-infected children depends on their access to antiretroviral therapy whose success mainly depends on a good life-long compliance with antiretroviral therapy. Given its complexity and specificity, assessment and monitoring of pediatric compliance with antiretroviral therapy is a major challenge. There is no consensus on a gold standard for monitoring compliance with antiretroviral therapy. Compliance is also influenced by many factors related to the child, the caregiver, the healthcare staff, the healthcare system, and antiretroviral drugs. This review aimed to assess scientific knowledge on pediatric compliance with antiretroviral therapy in Sub-Saharan Africa, and to identify areas for future interventions to improve compliance. Good compliance is essential to achieve the "90% coverage of children on antiretroviral therapy" gold standard of the World Health Organization, and to eliminate HIV infection by 2030.
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McCoy SI, Fahey C, Rao A, Kapologwe N, Njau PF, Bautista-Arredondo S. Pilot study of a multi-pronged intervention using social norms and priming to improve adherence to antiretroviral therapy and retention in care among adults living with HIV in Tanzania. PLoS One 2017; 12:e0177394. [PMID: 28486553 PMCID: PMC5423659 DOI: 10.1371/journal.pone.0177394] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background Interventions incorporating constructs from behavioral economics and psychology have the potential to enhance HIV ‘treatment as prevention’ (TasP) strategies. To test this hypothesis, we evaluated an intervention to improve antiretroviral therapy (ART) adherence based on the concepts of social norms and priming. Methods We used tools from marketing research and patient-centered design to develop a combination intervention that included visual feedback about clinic-level retention in care, a self-relevant prime, and useful take-home items with the priming image. The intervention was implemented at two HIV primary clinics in Shinyanga, Tanzania in 2-week intervals for six months. We conducted a quasi-experimental pilot study with a random sample of exposed and unexposed adult patients living with HIV infection (PLHIV) to compare retention and the proportion of patients with medication possession ratio (MPR) ≥95% after six months. Intervention acceptability was determined with a convenience sample of 405 PLHIV at baseline (n = 189) and endline (n = 216). Results Medical records were reviewed for 438 PLHIV (320 intervention, 118 standard of care). In adjusted analyses, PLHIV exposed to the intervention were significantly more likely to be in care after 6 months (87% vs. 79%, adjusted odds ratio (ORa) = 1.73, 95% CI: 1.08, 2.78, p<0.05) and were more likely to achieve MPR≥95% (70% vs. 59%, OR = 1.51, 95% CI: 0.96, 2.37, p = 0.07). The intervention was associated with increases in staff support of treatment goals (100% vs. 95%, p = 0.01) and life goals (66% vs. 50%, p<0.01), the perceived likelihood of other patients’ adherence (54% vs. 32%, p<0.01), support from other patients (71% vs. 60%, p = 0.03), and being very satisfied with care (53% vs. 35%, p<0.01). Conclusions This novel intervention has the potential to improve the clinic experience, short-term retention in care, and ART adherence. Future studies are needed to expand the generalizability of the approach and evaluate effectiveness on clinical outcomes. Trial registration Clinicaltrials.gov NCT02938533
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Affiliation(s)
- Sandra I. McCoy
- Division of Epidemiology, University of California, Berkeley, California, United States of America
- * E-mail:
| | - Carolyn Fahey
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - Aarthi Rao
- Enterprise Product Innovation, CVS Health, Rhode Island, United States of America
| | - Ntuli Kapologwe
- Regional Medical Office, Ministry of Health, Community Development, Gender, Elderly, and Children, Shinyanga, Tanzania
| | - Prosper F. Njau
- Prevention of Mother-to-Child HIV Transmission Programme, Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam, Tanzania
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McCoy SI, Njau PF, Fahey C, Kapologwe N, Kadiyala S, Jewell NP, Dow WH, Padian NS. Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania. AIDS 2017; 31:815-825. [PMID: 28107221 PMCID: PMC5342932 DOI: 10.1097/qad.0000000000001406] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We evaluated the effectiveness of short-term cash and food assistance to improve adherence to antiretroviral therapy (ART) and retention in care among people living with HIV in Tanzania. METHODS At three clinics, 805 participants were randomized to three groups in a 3 : 3 : 1 ratio, stratified by site : nutrition assessment and counseling (NAC) and cash transfers (∼$11/month, n = 347), NAC and food baskets (n = 345), and NAC-only (comparison group, n = 113, clinicaltrials.gov NCT01957917). Eligible people living with HIV were at least 18 years, initiated ART 90 days or less prior, and food insecure. Cash or food was provided for 6 or less consecutive months, conditional on visit attendance. The primary outcome was medication possession ratio (MPR ≥ 95%) at 6 months. Secondary outcomes were appointment attendance and loss to follow-up (LTFU) at 6 and 12 months. RESULTS The primary intent-to-treat analysis included 800 participants. Achievement of MPR ≥ 95% at 6 months was higher in the NAC + cash group compared with NAC-only (85.0 vs. 63.4%), a 21.6 percentage point difference [95% confidence interval (CI): 9.8, 33.4, P < 0.01]. MPR ≥ 95% was also significantly higher in the NAC + food group vs. NAC-only (difference = 15.8, 95% CI: 3.8, 27.9, P < 0.01). When directly compared, MPR ≥ 95% was similar in the NAC + cash and NAC + food groups (difference = 5.7, 95% CI: -1.2, 12.7, P = 0.15). Compared with NAC-only, appointment attendance and LTFU were significantly higher in both the NAC + cash and NAC + food groups at 6 months. At 12 months, the effect of NAC + cash, but not NAC + food, on MPR ≥ 95% and retention was sustained. CONCLUSION Short-term conditional cash and food assistance improves ART possession and appointment attendance and reduces LTFU among food-insecure ART initiates in Tanzania.
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Affiliation(s)
- Sandra I McCoy
- aDivision of Epidemiology, University of California, Berkeley, California, USA bPrevention of Mother-to-Child HIV Transmission Programme, Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam cRegional Medical Office, Ministry of Health, Community Development, Gender, Equity, and Children, Shinyanga, Tanzania dFaculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK eDivision of Biostatistics fDivision of Health Policy and Management, University of California, Berkeley, California, USA
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Rubtsova AA, Kempf MC, Taylor TN, Konkle-Parker D, Wingood GM, Holstad MM. Healthy Aging in Older Women Living with HIV Infection: a Systematic Review of Psychosocial Factors. Curr HIV/AIDS Rep 2017; 14:17-30. [PMID: 28194650 PMCID: PMC5988360 DOI: 10.1007/s11904-017-0347-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Due to life-enhancing effects of antiretroviral therapy, HIV-positive persons have the potential for long life comparable to their uninfected peers. Older women (age 50+) living with HIV (OWLH) are often an under-recognized aging group. We conducted a systematic review to examine psychosocial factors that impact how OWLH live, cope, and age with HIV. Initial key word search yielded 1527 records, and 21 studies met our inclusion criteria of original quantitative or qualitative research published between 2013 and 2016 with results specific to OWLH. These focused on health care and self-management, sexual health and risk, stigma, loneliness, mental health (depression, substance use), and protective factors (coping, social support, well-being). Due to the scarcity of studies on each topic and inconclusive findings, no clear patterns of results emerged. As the number of OWLH continues to grow, more research, including longitudinal studies, is needed to fully characterize the psychosocial factors that impact aging with HIV.
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Affiliation(s)
- Anna A Rubtsova
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, USA.
| | - Mirjam-Colette Kempf
- School of Nursing at University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL, 35294, USA
| | - Tonya N Taylor
- College of Medicine/Special Treatment and Research (STAR) Program at SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA
| | - Deborah Konkle-Parker
- University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health at Columbia University, 722 West 168th Street, Room 937, New York, NY, 10032, USA
| | - Marcia McDonnell Holstad
- Nell Hodgson Woodruff School of Nursing at Emory University, 1520 Clifton Road NE, Atlanta, GA, USA
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Ramaiya MK, Sullivan KA, O' Donnell K, Cunningham CK, Shayo AM, Mmbaga BT, Dow DE. A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania. PLoS One 2016; 11:e0165936. [PMID: 27851797 PMCID: PMC5112865 DOI: 10.1371/journal.pone.0165936] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/20/2016] [Indexed: 12/20/2022] Open
Abstract
Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12–24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth.
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Affiliation(s)
- Megan K. Ramaiya
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Psychology, University of Washington, Seattle, Washington, United States of America
| | - Kristen A. Sullivan
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Karen O' Donnell
- Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Center for Child & Family Health, Duke University, Durham, North Carolina, United States of America
| | - Coleen K. Cunningham
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Aisa M. Shayo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Dorothy E. Dow
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Insights into Adherence among a Cohort of Adolescents Aged 12-20 Years in South Africa: Reported Barriers to Antiretroviral Treatment. AIDS Res Treat 2016; 2016:4161738. [PMID: 27867661 PMCID: PMC5102702 DOI: 10.1155/2016/4161738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/05/2016] [Indexed: 12/27/2022] Open
Abstract
Adolescents experience disproportionately high rates of poor ART outcomes compared to adults despite prolonged use of antiretroviral therapy in Southern African treatment programs, presenting a significant challenge to national attempts to meet the UNAIDS 90-90-90 targets for 2020. This cohort study among adolescents aged 12-20 years accessing ART care at two urban public-sector clinics in Johannesburg between September and November 2013 aimed to identify factors potentially associated with poor attendance at clinic visits. Patients were followed up through routine medical records to identify missed visits (failing to attend clinic within 30 days of scheduled visit date) up to 2 years after enrolment. We enrolled 126 adolescents on ART for a median of 6.3 years (IQR: 2.7-8.4). A total of 47 (38%) adolescents missed a scheduled visit within 24 months of enrolment. Older adolescents (18-20 years) were more likely to miss a visit compared to adolescents aged 12-14 years (risk ratio (RR) = 1.72; 95% CI: 1.00-2.95). Those who were identified to have difficulty in taking medication (RR = 1.57; 95% CI: 1.13-2.18) as a barrier to care were more likely to miss a visit compared to adolescents who did not. Awareness of treatment fatigue, challenges to taking ART, and caregiver difficulties is important when considering interventions to improve treatment outcomes among adolescents.
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Côté J, Delmas P, de Menezes Succi RC, Galano E, Auger P, Sylvain H, Colson S, Machado DM. Predictors and Evolution of Antiretroviral Therapy Adherence Among Perinatally HIV-Infected Adolescents in Brazil. J Adolesc Health 2016; 59:305-310. [PMID: 27320032 DOI: 10.1016/j.jadohealth.2016.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/20/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Antiretroviral therapy medication adherence is a complex phenomenon influenced by multiple factors. This study examines its evolution and predictors among perinatally HIV-infected youths in São Paulo, Brazil. METHODS During a 1-year longitudinal cohort study, perinatally HIV-infected youths aged 13-21 years taking antiretroviral therapy were recruited in hospitals and HIV/AIDS reference centers. Data were collected at baseline and after 12 months. Variables assessed were adherence, self-efficacy regarding medication intake, social support, stress level, depression, CD4 cell count, viral load, and symptoms. Adherence was defined as taking ≥95% of prescribed HIV medication in the past 7 days. Generalized estimating equation and analysis of variance methods were used. RESULTS A total of 268 adolescents participated in the study (59% female; mean age of 16 years). At baseline, 63.06% of the sample was adherent to their HIV medication, and 52.99% had an undetectable viral load. All participants, regardless of adherence, reported: low levels of stress and symptoms of depression; high perception of medication self-efficacy and social support; and a mean of 6.8 symptoms related to their HIV medication. Predictors of adherence were: high perception of medication self-efficacy (odds ratio = 2.81; 95% confidence interval: 1.94-4.05) and low number of reported medication side effects (odds ratio = .97; 95% confidence interval: .95-.99]. Between baseline and follow-up, 49.6% remained adherent, 22.3% remained nonadherent, and the adherence level changed over time for 28.2%. CONCLUSIONS These findings suggest the need to develop interventions to enhance self-efficacy toward medication and to help youth better manage HIV medication symptoms.
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Affiliation(s)
- José Côté
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Research Chair in Innovative Nursing Practices, Montreal, Quebec, Canada; Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada.
| | - Philippe Delmas
- La Source, School of Nursing, University of Applied Sciences, Lausanne, Switzerland
| | | | - Eliana Galano
- Centro de Referencia e Treinamento DST/Aids-Programa Estadual de São Paulo, São Paulo, Brazil
| | - Patricia Auger
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Research Chair in Innovative Nursing Practices, Montreal, Quebec, Canada
| | - Hélène Sylvain
- Department of Nursing, Université du Québec à Rimouski, Rimouski, Quebec, Canada
| | - Sebastien Colson
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Daisy Maria Machado
- Escola Paulista de Medicina, Universidade Federal De São Paulo (UNIFESP), São Paulo, Brazil
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Rotzinger A, Locatelli I, Reymermier M, Amico S, Bugnon O, Cavassini M, Schneider MP. Association of disclosure of HIV status with medication adherence. PATIENT EDUCATION AND COUNSELING 2016; 99:1413-1420. [PMID: 27033978 DOI: 10.1016/j.pec.2016.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Disclosure may affect adherence to antiretroviral treatment. In a medication adherence program, this cross-sectional study describes disclosure, perceived reaction after disclosure, living situations, and the relationship of disclosure with antiretroviral adherence. METHODS A combination of a questionnaire to measure disclosure and longitudinal electronic monitoring of medication adherence was used. RESULTS A total of 103 out of 159 eligible patients gave informed consent. The characteristics differed between participants and nonparticipants (race, education, sexual orientation, medication adherence). Thirteen participants did not disclose their HIV status. Seventy-three (81%) participants judged the reaction after disclosure positive. Among the 62 participants cohabiting, 52% disclosed to all co-residents. Adherence was high (median 100%). HIV disclosure was negatively associated with adherence, when disclosing to the mother (OR=2.46, p-value=0.086) and to siblings (OR=2.89, p-value=0.029). Living alone was associated to a lower adherence than cohabitation (Rate Ratio=1.42, p-value=0.007). CONCLUSION HIV disclosure and adherence are sensitive issues, which may explain the reason for refusal. Nonparticipants may be those with the most difficulties disclosing. PRACTICE IMPLICATIONS An unbiased collection of sensitive information, as HIV disclosure, is a difficult task. A cohort design, with research data collected systematically by a trusted healthcare provider, may better describe the association between adherence and disclosure.
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Affiliation(s)
- Aurélie Rotzinger
- Community pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Community pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Department of Ambulatory care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthias Reymermier
- Community pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sebastian Amico
- Community pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Olivier Bugnon
- Community pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Community pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthias Cavassini
- Infectious Disease Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie Paule Schneider
- Community pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland; Community pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland.
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Gross IM, Hosek S, Richards MH, Fernandez MI. Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV. AIDS Patient Care STDS 2016; 30:324-38. [PMID: 27410496 PMCID: PMC4948258 DOI: 10.1089/apc.2015.0351] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) is crucial for thwarting HIV disease progression and reducing secondary HIV transmission, yet youth living with HIV (YLH) struggle with adherence. The highest rates of new HIV infections in the United States occur in young African American men. A sample of 387 HIV-positive young African American males on ART was selected from a cross-sectional assessment of (YLH) receiving medical care within the Adolescent Trials Network for HIV/AIDS Interventions (ATN) from 2010 to 2012 (12-24 years old, median 22.00, SD 2.08). Participants completed self-reported adherence, demographic, health, and psychosocial measures. Sixty-two percent self-reported 100% ART adherence. Optimal data analysis identified frequency of cannabis use during the past 3 months as the strongest independent predictor of adherence, yielding moderate effect strength sensitivity (ESS) = 27.1, p < 0.001. Among participants with infrequent cannabis use, 72% reported full adherence; in contrast, only 45% of participants who used cannabis frequently reported full adherence. Classification tree analysis (CTA) was utilized to improve classification accuracy and to identify the pathways of ART adherence and nonadherence. The CTA model evidenced a 38% improvement above chance for correctly classifying participants as ART adherent or nonadherent. Participants most likely to be adherent were those with low psychological distress and minimal alcohol use (82% were adherent). Participants least likely to be adherent were those with higher psychological distress and engaged in weekly cannabis use (69% were nonadherent). Findings suggest multiple profiles of ART adherence for young African American males living with HIV and argue for targeted psychosocial interventions.
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Affiliation(s)
- Israel Moses Gross
- 1 Department of Psychiatry, John H. Stroger Hospital of Cook County , Chicago, Illinois
| | - Sybil Hosek
- 1 Department of Psychiatry, John H. Stroger Hospital of Cook County , Chicago, Illinois
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Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R, Kennedy E, Mahon J, McGovern T, Mokdad AH, Patel V, Petroni S, Reavley N, Taiwo K, Waldfogel J, Wickremarathne D, Barroso C, Bhutta Z, Fatusi AO, Mattoo A, Diers J, Fang J, Ferguson J, Ssewamala F, Viner RM. Our future: a Lancet commission on adolescent health and wellbeing. Lancet 2016; 387:2423-78. [PMID: 27174304 PMCID: PMC5832967 DOI: 10.1016/s0140-6736(16)00579-1] [Citation(s) in RCA: 1783] [Impact Index Per Article: 222.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- George C Patton
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia.
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia; Murdoch Childrens Research Institute, Columbia University, New York, NY, USA
| | - John S Santelli
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David A Ross
- World Health Organization, Geneva, Switzerland; London School of Hygiene & Tropical Medicine, London, UK
| | - Rima Afifi
- Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; University of Oregon, Eugene, OR, USA
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
| | - Peter Azzopardi
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, Melbourne, VIC, Australia
| | | | | | - Ritsuko Kakuma
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Terry McGovern
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ali H Mokdad
- Institute of Health Metrics and Evaluation, University of Washinton, Seattle, WA, USA
| | - Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India
| | - Suzanne Petroni
- International Centre for Research on Women, Washington, DC, USA
| | - Nicola Reavley
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Jane Waldfogel
- School of Social Work, Columbia University, New York, NY, USA
| | | | | | - Zulfiqar Bhutta
- University of Toronto, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan
| | | | - Amitabh Mattoo
- Australia India Centre, University of Melbourne, Melbourne, VIC, Australia; Jawaharlal Nehru University, New Delhi, India
| | | | - Jing Fang
- Kunming Medical University, Kunming, China
| | - Jane Ferguson
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Russell M Viner
- Institute of Child Health, University College London, London, UK
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Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM. Adherence to Antiretroviral Therapy and Virologic Failure: A Meta-Analysis. Medicine (Baltimore) 2016; 95:e3361. [PMID: 27082595 PMCID: PMC4839839 DOI: 10.1097/md.0000000000003361] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The often cited need to achieve ≥95% (nearly perfect) adherence to antiretroviral therapy (ART) for successful virologic outcomes in HIV may present a barrier to initiation of therapy in the early stages of HIV. This meta-analysis synthesized 43 studies (27,905 participants) performed across >26 countries, to determine the relationship between cut-off point for optimal adherence to ART and virologic outcomes. Meta-analysis was performed using a random-effect model to calculate pooled odds ratios with corresponding 95% confidence intervals. The mean rate of patients reporting optimal adherence was 63.4%. Compared with suboptimal adherence, optimal adherence was associated with a lower risk of virologic failure (0.34; 95% CI: 0.26-0.44). There were no significant differences in the pooled odds ratios among different optimal adherence thresholds (≥98-100%, ≥95%, ≥80-90%). Study design (randomized controlled trial vs observational study) (regression coefficient 0.74, 95% CI: 0.04-1.43, P < 0.05) and study region (developing vs developed countries; regression coefficient 0.56, 95% CI: 0.01-1.12, P < 0.05) remained as independent predictors of between-study heterogeneity, with more patients with optimal adherence from developing countries or randomized controlled trials experiencing virologic failure. The threshold for optimal adherence to achieve better virologic outcomes appears to be wider than the commonly used cut-off point (≥95% adherence). The cut-off point for optimal adherence could be redefined to a slightly lower level to encourage the prescribing ART at an early stage of HIV infection.
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Conn VS, Ruppar TM, Enriquez M, Cooper PS. Patient-Centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:277-85. [PMID: 27021763 PMCID: PMC4812829 DOI: 10.1016/j.jval.2015.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 10/11/2015] [Accepted: 12/01/2015] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Using meta-analytic procedures to synthesize changes in patient-centered outcomes after medication adherence interventions. METHODS Strategies to locate studies included online searches of 13 databases and 19 research registries, hand searches of 57 journals, and author and ancestry searches of all eligible studies. Search terms included patient compliance, medication adherence, and related terms. Searches were conducted for all studies published since 1960. Eligible published or unpublished primary studies tested medication adherence interventions and reported medication knowledge, quality of life, physical function, and symptom outcomes. Primary study attributes and outcome data were reliably coded. Overall standardized mean differences (SMDs) were analyzed using random-effects models. Dichotomous and continuous moderator analyses and funnel plots were used to explore risks of bias. RESULTS Thorough searching located 141 eligible reports. The reports included 176 eligible comparisons between treatment and control subjects across 23,318 subjects. Synthesis across all comparisons yielded statistically significant SMDs for medication knowledge (d = 0.449), quality of life (d = 0.127), physical function (d = 0.142), and symptoms (d = 0.182). The overall SMDs for studies focusing on subsamples of patients with specific illnesses were more modest but also statistically significant. Of specific symptoms analyzed (depression, anxiety, pain, energy/vitality, cardiovascular, and respiratory), only anxiety failed to show a significant improvement after medication adherence interventions. Most SMDs were significantly heterogeneous, and risk of bias analyses suggested links between study quality and SMDs. CONCLUSIONS Modest but significant improvements in patient-centered outcomes were observed after medication adherence interventions.
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Affiliation(s)
- Vicki S Conn
- School of Nursing, University of Missouri, Columbia, MO, USA.
| | - Todd M Ruppar
- School of Nursing, University of Missouri, Columbia, MO, USA
| | - Maithe Enriquez
- School of Nursing, University of Missouri, Columbia, MO, USA
| | - Pamela S Cooper
- School of Nursing, University of Missouri, Columbia, MO, USA
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Chang CA, Meloni ST, Eisen G, Chaplin B, Akande P, Okonkwo P, Rawizza HE, Tchetgen Tchetgen E, Kanki PJ. Tuberculosis Incidence and Risk Factors Among Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy in a Large HIV Program in Nigeria. Open Forum Infect Dis 2015; 2:ofv154. [PMID: 26613097 PMCID: PMC4654399 DOI: 10.1093/ofid/ofv154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/09/2015] [Indexed: 12/18/2022] Open
Abstract
Background. Despite the benefits of antiretroviral therapy (ART), tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV)-infected persons in Africa. Nigeria bears the highest TB burden in Africa and second highest HIV burden globally. This long-term multicenter study aimed to determine the incidence rate and predictors of TB in adults in the Harvard/AIDS Prevention Initiative in Nigeria (APIN) and President's Emergency Plan for AIDS Relief (PEPFAR) Nigeria ART program. Methods. This retrospective evaluation used data collected from 2004 to 2012 through the Harvard/APIN PEPFAR program. Risk factors for incident TB were determined using multivariate Cox proportional hazards regression with time-dependent covariates. Results. Of 50 320 adults enrolled from 2005 to 2010, 11 092 (22%) had laboratory-confirmed active TB disease at ART initiation, and 2021 (4%) developed active TB after commencing ART. During 78 228 total person-years (PY) of follow-up, the TB incidence rate was 25.8 cases per 1000 PY (95% confidence interval [CI], 24.7-27.0) overall, and it decreased significantly both with duration on ART and calendar year. Risk factors at ART initiation for incident TB included the following: earlier ART enrollment year, tenofovir-containing initial ART regimen, and World Health Organization clinical stage above 1. Time-updated risk factors included the following: low body mass index, low CD4(+) cell count, unsuppressed viral load, anemia, and ART adherence below 80%. Conclusions. The rate of incident TB decreased with longer duration on ART and over the program years. The strongest TB risk factors were time-updated clinical markers, reinforcing the importance of consistent clinical and laboratory monitoring of ART patients in prompt diagnosis and treatment of TB and other coinfections.
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Affiliation(s)
| | | | - Geoffrey Eisen
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Beth Chaplin
- Departments ofImmunology and Infectious Diseases
| | | | | | - Holly E. Rawizza
- Departments ofImmunology and Infectious Diseases
- Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review self-report medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care.
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Safety and efficacy of darunavir/ritonavir in treatment-experienced pediatric patients: week 48 results of the ARIEL trial. Pediatr Infect Dis J 2015; 34:e132-7. [PMID: 25719453 DOI: 10.1097/inf.0000000000000644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND ARIEL (Darunavir in treatment-experienced pediatric population) was a phase II, open-label study assessing safety and antiviral activity of darunavir/ritonavir twice daily with an optimized background regimen (OBR) in treatment-experienced, HIV-1-infected pediatric patients (3 to <6 years, weighing 10 to <20 kg). METHODS The study consisted of an initial 4-week screening period, 48 weeks of treatment and a 4-week follow-up period. Patients initially received darunavir/ritonavir 20/3 mg/kg twice-daily for 2 weeks. Following review of pharmacokinetic, safety and antiviral data, the doses of darunavir/ritonavir were adjusted to 25/3 mg/kg twice-daily for patients <15 kg, and 375/50 mg twice-daily for patients 15 to <20 kg. RESULTS Of the 34 patients screened, 21 were treated (median treatment duration 48.6 weeks). Darunavir plus an OBR was well tolerated over 48 weeks, with no new safety concerns, and a comparable safety profile to that seen in older children and adults. All treatment-emergent lipid-related and glucose-related laboratory abnormalities were grade 1 or 2. At week 48, 17 of 21 patients (81.0%) had a confirmed virologic response (intent-to-treat, time-to-loss of virologic response). Improvements in height and weight were seen during the study. CONCLUSIONS No new safety concerns were observed over a 48 week period. These results led to lowering the age to 3 years at which darunavir/ritonavir is indicated for use in treatment-experienced pediatric patients. This study also established doses of darunavir to use in treatment-experienced, HIV-1-infected patients aged 3 to <6 years. A high virologic response was observed with this dose. No development of resistance was observed in patients who experienced virologic failure.
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Monitoring outcomes for newly diagnosed and prevalent HIV cases using a care continuum created with New York city surveillance data. J Acquir Immune Defic Syndr 2015; 68:217-26. [PMID: 25394192 DOI: 10.1097/qai.0000000000000424] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The HIV care continuum has been used to show the proportion of persons living with HIV/AIDS (PWHA) who are engaged in each stage of HIV care. We present 1 care continuum for persons newly diagnosed with HIV and 1 for PWHA using New York City HIV surveillance registry data. METHODS Persons newly diagnosed with HIV in 2011 or PWHA as of December 31, 2011, were included. We constructed each continuum for persons engaged at each stage of HIV care and calculated the proportion achieving each step as both dependent on or independent of preceding steps. RESULTS Of the 3408 newly diagnosed persons, 67% had timely linkage to care (≤3 months after diagnosis), 58% were established in care 3-9 months after timely linkage, and 43% achieved viral suppression (≤200 copies/mL) ≤6 months after establishment in care; losses were highest from diagnosis to linkage. Independent measures showed 84% linked, 72% established, and 61% suppressed ≤18 months after diagnosis. Of the 87,268 PWHA, 83% were in care in 2011 (≥1 visit), 70% retained in care (≥2 visits ≥3 months apart), and 52% suppressed at their last visit; losses were highest from retention to suppression. When measured independently, suppression increased to 58%. CONCLUSIONS A minority of persons newly diagnosed with HIV and a narrow majority of PWHA achieved viral suppression and all intermediate care-related steps. Outcomes measured independently of previous care-related steps were higher, particularly for newly diagnosed persons. To improve outcomes among persons with HIV and reduce transmissibility, clinical and public health efforts should focus on linkage to care among newly diagnosed persons and viral suppression among PWHA.
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Mullan LE, Mullan PC, Anabwani GM. Psychosocial issues among children and adolescents in an integrated paediatric HIV psychology service in Botswana. JOURNAL OF PSYCHOLOGY IN AFRICA 2015. [DOI: 10.1080/14330237.2015.1021534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Gabriel M. Anabwani
- Botswana-Baylor Children's Clinical Centre of Excellence, Princess Marina Hospital, Gaborone, Botswana
- Baylor College of Medicine, Houston, Texas, USA
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46
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Duarte HA, Harris DR, Tassiopoulos K, Leister E, Negrini SFBDM, Ferreira FF, Cruz MLS, Pinto J, Allison S, Hazra R. Relationship between viral load and behavioral measures of adherence to antiretroviral therapy in children living with human immunodeficiency virus in Latin America. Braz J Infect Dis 2015; 19:263-71. [PMID: 25743569 PMCID: PMC4911806 DOI: 10.1016/j.bjid.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 11/29/2022] Open
Abstract
Few studies have examined antiretroviral therapy adherence in Latin American children. Standardized behavioral measures were applied to a large cohort of human immunodeficiency virus-infected children in Brazil, Mexico, and Peru to assess adherence to prescribed antiretroviral therapy doses during the three days prior to study visits, assess timing of last missed dose, and evaluate the ability of the adherence measures to predict viral suppression. Time trends in adherence were modeled using a generalized estimating equations approach to account for possible correlations in outcomes measured repeatedly in the same participants. Associations of adherence with human immunodeficiency virus viral load were examined using linear regression. Mean enrollment age of the 380 participants was 5 years; 57.6% had undetectable’ viral load (<400 copies/mL). At enrollment, 90.8% of participants were perfectly (100%) adherent, compared to 87.6% at the 6-month and 92.0% at the 12-month visit; the proportion with perfect adherence did not differ over time (p = 0.1). Perfect adherence was associated with a higher probability of undetectable viral load at the 12-month visit (odds ratio = 4.1, 95% confidence interval: 1.8–9.1; p < 0.001), but not at enrollment or the 6-month visit (p > 0.3). Last time missed any antiretroviral therapy dose was reported as “never” for 52.0% at enrollment, increasing to 60.7% and 65.9% at the 6- and 12-month visits, respectively (p < 0.001 for test of trend). The proportion with undetectable viral load was higher among those who never missed a dose at enrollment and the 12-month visit (p ≤ 0.005), but not at the 6-month visit (p = 0.2). While antiretroviral therapy adherence measures utilized in this study showed some association with viral load for these Latin American children, they may not be adequate for reliably identifying non-adherence and consequently children at risk for viral resistance. Other strategies are needed to improve the evaluation of adherence in this population.
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Affiliation(s)
- Horacio A Duarte
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Erin Leister
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA
| | | | - Flávia Faleiro Ferreira
- Faculdade de Medicina de Universidade Federal de Minais Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Jorge Pinto
- Faculdade de Medicina de Universidade Federal de Minais Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Rohan Hazra
- Maternal and Pediatric Infectious Disease Branch, NICHD-NIH, Bethesda, MD, USA
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47
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Evans SD, Mellins CA, Leu CS, Warne P, Elkington KS, Dolezal C, Santamaria EK, Wiznia A, Bamji M, Jurgrau-Voulgari AS, Abrams EJ. HIV treatment adherence measurement and reporting concordance in youth with perinatally acquired HIV infection and their caregivers. AIDS Patient Care STDS 2015; 29:43-51. [PMID: 25372391 DOI: 10.1089/apc.2014.0058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We examined youth-caregiver adherence report concordance and association of different adherence self-report items with HIV RNA viral load (VL) in perinatally HIV-infected adolescents assessed in 2003-2008. Youth (n=194; 9-19 years) and their caregivers completed a multi-step 2-day recall, one item on last time medications were missed, and one item on responsibility for managing youths' medications. Across early (9-12 years), middle (13-15 years), and late (16+years) adolescence, both youth and caregivers reported having primary responsibility for youths' medication regimens and demonstrated poor to moderate youth-caregiver concordance on adherence items. Responses to the last-time-missed item had greater association with VL than did the 2-day recall, particularly for longer times (e.g., past month). By age group, significant associations with VL were found for caregiver reports in early adolescence, caregiver and youth reports in middle adolescence, and youth reports in late adolescence, suggesting that caregivers offer better reports of youth adherence during early adolescence, but by later adolescence, youth are better informants. Although design limitations preclude definitive conclusions about the reliability and validity of specific adherence items, this study suggests important issues related to age group, caregiver vs. youth informants of adherence, and recall periods for child adherence assessment that warrant further research.
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Affiliation(s)
- Shenell D. Evans
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Patricia Warne
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Katherine S. Elkington
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - E. Karina Santamaria
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York
| | - Andrew Wiznia
- Albert Einstein College of Medicine and Jacobi Medical Center, New York, New York
| | | | | | - Elaine J. Abrams
- ICAP, Mailman School of Public Health and College of Physicians and Surgeons, Columbia University, New York, New York
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48
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Kaihin R, Kasatpibal N, Chitreechuer J, Grimes RM. Effect of an Empowerment Intervention on Antiretroviral Drug Adherence in Thai Youth. Behav Med 2015; 41:186-94. [PMID: 24758271 PMCID: PMC4375063 DOI: 10.1080/08964289.2014.911717] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A pilot study was conducted to determine effects of an empowerment intervention on antiretroviral therapy (ART) adherence among Thai youth living with HIV/AIDS. It compared two groups of 23 young persons (15-24 years) who receive ART from AIDS clinics at two community hospitals. One hospital's patients served as the experimental group, and the other as a control group. The experimental groups attended five sessions that empowered them to take control of their own health. The control group received the standard of care. The data were analyzed using descriptive statistics and Chi-square statistics. Before the empowerment, no one from the experimental group or the control group had ART adherence ≥ 95%. After the intervention, the 82.6% of the experimental group had ≥ 95% adherence compared to the control group, which had 21.7% adherence (p < .0001). The empowerment intervention resulted in a significant increase in ART adherence among Thai youth.
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Affiliation(s)
| | | | | | - Richard M. Grimes
- School of Medicine, University of Texas Health Science Center at Houston, and Baylor-UT Houston Center for AIDS Research
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49
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Azzopardi C, Wade M, Salter R, Macdougall G, Shouldice M, Read S, Bitnun A. Medical nonadherence in pediatric HIV: psychosocial risks and intersection with the child protection system for medical neglect. CHILD ABUSE & NEGLECT 2014; 38:1766-1777. [PMID: 25262535 DOI: 10.1016/j.chiabu.2014.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 06/03/2023]
Abstract
Nonadherence to antiretroviral treatment has serious health implications for HIV-infected children, at times warranting referral to child protective services (CPS). The current study of 134 children with perinatally acquired HIV infection aimed to investigate rates of treatment adherence and CPS involvement, multilevel variables associated with nonadherence, and the manner in which these risks operated together in the prediction of adherence outcomes. Risk factors for nonadherence were grouped on the basis of confirmatory factor models, and factor score regression was carried out to determine which factors were uniquely predictive of adherence. A series of indirect effects models were then tested in order to examine how these factors operated together in the prediction of adherence. Results showed that almost half of the sample demonstrated suboptimal adherence to treatment, and in one-fifth, CPS was involved for medical neglect. Caregiver Health, Caregiver Involvement, Caregiver Acceptance, and Child Adaptation were predictive of nonadherence, and together explained 54% of the variance in treatment adherence. There were significant indirect effects of Caregiver Health on adherence that operated through Caregiver Involvement and Child Adaptation and an indirect effect of Caregiver Involvement on adherence through Child Adaptation. Findings extend current literature that has independently linked various factors predictive of medical adherence in pediatric HIV by showing separate but simultaneous associations with nonadherence and unique pathways to adherence involving multilevel risks. Healthcare and child welfare implications are discussed.
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Affiliation(s)
- Corry Azzopardi
- The Hospital for Sick Children, Division of Pediatric Medicine, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Factor-Inwentash Faculty of Social Work, Toronto, Ontario, Canada
| | - Mark Wade
- The Hospital for Sick Children, Division of Pediatric Medicine, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Department of Applied Psychology and Human Development, Toronto, Ontario, Canada
| | - Robyn Salter
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - Georgina Macdougall
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
| | - Michelle Shouldice
- The Hospital for Sick Children, Division of Pediatric Medicine, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Stanley Read
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Ari Bitnun
- The Hospital for Sick Children, Division of Infectious Diseases, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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50
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Bryson Y. Taking care of the caretakers to enhance antiretroviral adherence in HIV-infected children and adolescents. J Pediatr (Rio J) 2014; 90:533-5. [PMID: 25128224 DOI: 10.1016/j.jped.2014.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Yvonne Bryson
- David Geffen School of Medicine, Mattel Children's Hospital UCLA, Department of Pediatrics, Division of Infectious Diseases, Los Angeles, United States.
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