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Sadeghi M, Abraham E, McAuley T. Assessing adherence and clinical utility of modified goal management training for adolescents with ADHD: A pilot study. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-11. [PMID: 38859564 DOI: 10.1080/21622965.2024.2353828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Many adolescents with attention-deficit hyperactivity disorder (ADHD) have executive functioning (EF) difficulties that contribute to academic and social-emotional challenges. This pilot explored adherence to and effectiveness of modified Goal Management Training (GMT), an EF intervention, with ADHD youth. Six adolescents with ADHD (14-17 years, 2 female) participated in a 6-session online group. Adherence was tracked via attendance and homework. Reliable change scores gaged pre-post differences on measures before and after training (primary: everyday EF and goal attainment; secondary: EF task performance, functional impairment, emotional adjustment, and self-concept). All youth attended at least 4 sessions, though homework completion was mixed. Four youth achieved their goal, some demonstrated reliable change on outcome measures, and all evidenced a reduction in impairment. Results support the feasibility of modified GMT in adolescents with ADHD and suggest that youth may benefit from this more personalized and holistic approach to EF intervention.
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Affiliation(s)
- Mahsa Sadeghi
- Department of Psychology & Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON, Canada
| | - Eleenor Abraham
- Department of Psychology & Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON, Canada
| | - Tara McAuley
- Department of Psychology & Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON, Canada
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Bandiera C, Pasquier J, Locatelli I, Schneider MP. Using a Semiautomated Procedure (CleanADHdata.R Script) to Clean Electronic Adherence Monitoring Data: Tutorial. JMIR Form Res 2024; 8:e51013. [PMID: 38776539 PMCID: PMC11153970 DOI: 10.2196/51013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Patient adherence to medications can be assessed using interactive digital health technologies such as electronic monitors (EMs). Changes in treatment regimens and deviations from EM use over time must be characterized to establish the actual level of medication adherence. OBJECTIVE We developed the computer script CleanADHdata.R to clean raw EM adherence data, and this tutorial is a guide for users. METHODS In addition to raw EM data, we collected adherence start and stop monitoring dates and identified the prescribed regimens, the expected number of EM openings per day based on the prescribed regimen, EM use deviations, and patients' demographic data. The script formats the data longitudinally and calculates each day's medication implementation. RESULTS We provided a simulated data set for 10 patients, for which 15 EMs were used over a median period of 187 (IQR 135-342) days. The median patient implementation before and after EM raw data cleaning was 83.3% (IQR 71.5%-93.9%) and 97.3% (IQR 95.8%-97.6%), respectively (Δ+14%). This difference is substantial enough to consider EM data cleaning to be capable of avoiding data misinterpretation and providing a cleaned data set for the adherence analysis in terms of implementation and persistence. CONCLUSIONS The CleanADHdata.R script is a semiautomated procedure that increases standardization and reproducibility. This script has broader applicability within the realm of digital health, as it can be used to clean adherence data collected with diverse digital technologies.
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Affiliation(s)
- Carole Bandiera
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Marie P Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Schwartz JK, Aylmer K, Green S, Tayeb S, Wolf TJ, Unni E, Somerville E. Performance of Medication Tasks: Relationship Among Patient-Reported Outcomes, Performance-Based Assessments, and Objective Assessments. Am J Occup Ther 2024; 78:7803205060. [PMID: 38758764 PMCID: PMC11117467 DOI: 10.5014/ajot.2024.050500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners use standardized assessments to guide their clinical decision-making, but it is unclear how well performance on standardized assessments translates to performance at home. OBJECTIVE To understand the concurrent and predictive validity of patient-reported outcomes and performance-based assessments for monitoring performance at home within the context of medication management and adherence. DESIGN Exploratory study. SETTING Participants completed standardized assessments in a lab or at home, which were followed by home-based electronic monitoring of medication adherence. PARTICIPANTS Sixty community-dwelling adults with hypertension or stroke who independently took antihypertensive medications. OUTCOMES AND MEASURES Participants completed the Hill-Bone Medication Adherence Scale, the Hill-Bone Medication Adherence Reasons Scale, the Performance Assessment of Self-Care Skills Medication Management subtask, and the Executive Function Performance Test-Enhanced Medication Management subtest. Then, they used an electronic pill cap to monitor medication adherence at home for 1 month. RESULTS Patient-reported outcomes and performance-based assessments in the context of medication management and adherence demonstrated poor concurrent and predictive validity to medication adherence at home. CONCLUSIONS AND RELEVANCE There is a gap between what people think they will do, what they can do on a standardized assessment, and what they actually do at home. Future research is needed to strengthen concurrent and predictive validity to clinically meaningful outcomes. Plain-Language Summary: Occupational therapy practitioners should use caution when using standardized assessments to try to predict client performance at home. They should also continue to use a battery of assessments, clinical reasoning, and client preferences to guide their decision-making for monitoring performance at home within the context of medication management and adherence.
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Affiliation(s)
- Jaclyn K Schwartz
- Jaclyn K. Schwartz, PhD, OTR/L, FAOTA, is Assistant Professor, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO;
| | - Katherine Aylmer
- Katherine Aylmer, OTD, OTR/L, is Occupational Therapist, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Samara Green
- Samara Green, MS, OTR/L, is Occupational Therapist, MedStar National Rehabilitation Hospital, Washington, DC
| | - Sami Tayeb
- Sami Tayeb, MA, is Research Coordinator, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Timothy J Wolf
- Timothy J. Wolf, PhD, OTD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Washington University in St. Louis, St. Louis, MO
| | - Elizabeth Unni
- Elizabeth Unni, PhD, MBA, is Associate Professor, Department of Social, Behavioral and Administrative Sciences, Touro College of Pharmacy, New York, NY
| | - Emily Somerville
- Emily Somerville, OTD, OTR/L, is Assistant Professor, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
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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 2024:1-9. [PMID: 38555604 DOI: 10.1080/09540121.2024.2332451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Douma ER, Wirtz S, Fernandez MS, Schäfer H, Widdershoven JW, Habibović M, Gil CP, Bosch JA, Schmitz B, Kop WJ. Patient-reported preferences in eHealth-based cardiac rehabilitation: A qualitative investigation of behavior change techniques, barriers and facilitators. Internet Interv 2024; 35:100728. [PMID: 38405384 PMCID: PMC10883827 DOI: 10.1016/j.invent.2024.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Background Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR. Purpose To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR. Methods Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation. Results The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior. Conclusions Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.
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Affiliation(s)
- Emma R. Douma
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Svenja Wirtz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Manuela Sestayo Fernandez
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Hendrik Schäfer
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Jos W.M.G. Widdershoven
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
- Elisabeth-TweeSteden Hospital, Department of Cardiology, Tilburg, the Netherlands
| | - Mirela Habibović
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Carlos Peña Gil
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Jos A. Bosch
- University of Amsterdam, Faculty of Social and Behavioral Sciences, Amsterdam, the Netherlands
| | - Boris Schmitz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Willem J. Kop
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
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Phillips T, Gomba Y, Myer L. Comparing a point-of-care urine tenofovir lateral flow assay to self-reported adherence and their associations with viral load suppression among adults on antiretroviral therapy. Trop Med Int Health 2024; 29:96-103. [PMID: 38084797 PMCID: PMC10872537 DOI: 10.1111/tmi.13953] [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] [Indexed: 01/14/2024]
Abstract
BACKGROUND Point-of-care (POC) lateral flow assays (LFA) to detect tenofovir (TFV) in urine have been developed to measure short-term ART adherence. Limited data exist from people living with HIV in routine care. METHODS Adults on TFV-containing regimens, having a routine viral load (VL) at an HIV clinic in Cape Town, South Africa were enrolled in a cross-sectional study. Patients recalled missed ART doses in the past three and 7 days and urine was tested using a POC TFV LFA. VL on the day was abstracted from medical records. RESULTS Among 314 participants, 293 (93%) had VL <1000 copies/mL, 20 (6%) had no TFV detected and 24 (8%) reported ≥1 missed dose in the past 3 days. Agreement between VL ≥1000 and undetectable TFV was higher compared to 3-day recall of ≥1 missed dose (Kappa 0.504 vs. 0.163, p = 0.015). The AUC to detect VL ≥1000 was 0.747 (95% CI 0.637-0.856) for undetectable TFV. This was statistically significantly better than for 7-day recall (0.571 95% CI 0.476-0.666, p = 0.040) but not for 3-day recall (0.587 95% CI 0.492-0.681, p = 0.071) of ≥1 missed dose. CONCLUSION In this largely virally suppressed cohort, TFV in urine had better agreement with VL than self-reported adherence and was a better predictor of viraemia on two of three self-report measures. Used in combination with VL, the POC urine TFV LFA could flag patients with viraemia in the presence of ART. Further research is needed to understand the potential application in different populations on ART, including pregnant women.
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Affiliation(s)
- Tamsin Phillips
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Yolanda Gomba
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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Campbell R, Curran C, Hayward J, Godwin J, Johnston S, Armstrong J, Collier A. How effective is public health policy in Scotland on vitamin D deficiency during pregnancy? Public Health Nutr 2023; 26:3311-3319. [PMID: 37881857 PMCID: PMC10755384 DOI: 10.1017/s1368980023002227] [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: 06/20/2022] [Revised: 08/16/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To evaluate the uptake of universal vitamin D supplementation during pregnancy, its effectiveness in preventing vitamin D deficiency and the factors associated with these. DESIGN The regional public health organisation in Ayrshire, Scotland has a policy of universal provision of vitamin D supplements (10 µg/d) to all pregnant women for the duration of their pregnancy. Pregnant women in this area were recruited at their 12-week antenatal appointment. Blood samples were collected at the 12-week and 34-week appointments. To account for the seasonal variation, women were recruited in two cohorts: summer and winter. Telephone interviews were conducted at 34 weeks to assess the uptake of vitamin D supplements during pregnancy. Other variables were obtained from medical records. SETTING The study was conducted in the NHS Ayrshire and Arran Health Board in Scotland. PARTICIPANTS 612 pregnant women (aged 15-44 years) living in Ayrshire (latitude 55°), Scotland. RESULTS Sixty-six percentage took supplementation as recommended. Consumption of supplementation was significantly associated with a higher median serum 25-hydroxyvitamin D concentrations at 34 weeks. Despite this at 34 weeks, 33 % of the summer cohort had insufficient or deficient vitamin D status, while 15 % of the winter cohort had insufficient or deficient status. In multivariable analysis, only adherence and season were independent predictors of vitamin D status. CONCLUSIONS While supplementation improved and maintained vitamin D status during pregnancy, it was not adequate to ensure all those insufficient at 12 weeks achieved sufficient status at the end of pregnancy.
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Affiliation(s)
- Ruth Campbell
- Department of Public Health, NHS Ayrshire and Arran, Ailsa Hospital, Dalmellington Road, AyrKA6 6AB, UK
| | - Christopher Curran
- Department of Diabetes and Endocrinology, University Hospital Ayr, NHS Ayrshire and Arran, Dalmellington Road, AyrKA6 6DX, UK
| | - Jonathan Hayward
- Department of Diabetes and Endocrinology, University Hospital Ayr, NHS Ayrshire and Arran, Dalmellington Road, AyrKA6 6DX, UK
| | - Jon Godwin
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, OxfordOX3 7LF, UK
| | - Susan Johnston
- Glasgow Royal Infirmary, 84 Castle St, GlasgowG4 0SF, UK
| | - Julie Armstrong
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Andrew Collier
- Department of Diabetes and Endocrinology, University Hospital Ayr, NHS Ayrshire and Arran, Dalmellington Road, AyrKA6 6DX, UK
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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Vauterin D, Van Vaerenbergh F, Vanoverschelde A, Quint JK, Verhamme K, Lahousse L. Methods to assess COPD medications adherence in healthcare databases: a systematic review. Eur Respir Rev 2023; 32:230103. [PMID: 37758274 PMCID: PMC10523153 DOI: 10.1183/16000617.0103-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease 2023 report recommends medication adherence assessment in COPD as an action item. Healthcare databases provide opportunities for objective assessments; however, multiple methods exist. We aimed to systematically review the literature to describe existing methods to assess adherence in COPD in healthcare databases and to evaluate the reporting of influencing variables. METHOD We searched MEDLINE, Web of Science and Embase for peer-reviewed articles evaluating adherence to COPD medication in electronic databases, written in English, published up to 11 October 2022 (PROSPERO identifier CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. Methods to assess initiation (dispensing of medication after prescribing), implementation (extent of use over a specific time period) and/or persistence (time from initiation to discontinuation) were listed descriptively. Each included study was evaluated for reporting variables with an impact on adherence assessment: inpatient stays, drug substitution, dose switching and early refills. RESULTS 160 studies were included, of which four assessed initiation, 135 implementation and 45 persistence. Overall, one method was used to measure initiation, 43 methods for implementation and seven methods for persistence. Most of the included implementation studies reported medication possession ratio, proportion of days covered and/or an alteration of these methods. Only 11% of the included studies mentioned the potential impact of the evaluated variables. CONCLUSION Variations in adherence assessment methods are common. Attention to transparency, reporting of variables with an impact on adherence assessment and rationale for choosing an adherence cut-off or treatment gap is recommended.
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Affiliation(s)
- Delphine Vauterin
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Frauke Van Vaerenbergh
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer K Quint
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katia Verhamme
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Singh Y, Castillo-Mancilla J, Madimabe R, Jennings L, Ferraris CM, Robbins RN, Anderson PL, Remien RH, Orrell C. Tenofovir diphosphate in dried blood spots and HIV-1 resistance in South Africa. AIDS Res Ther 2023; 20:67. [PMID: 37705102 PMCID: PMC10500931 DOI: 10.1186/s12981-023-00552-w] [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: 06/02/2023] [Accepted: 07/29/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Suboptimal antiretroviral (ART) adherence can lead to virologic failure with consequent HIV-1 resistance. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a powerful biomarker of cumulative adherence, predictive of future viremia. It has been associated with resistance in Persons With HIV (PWH) in South Africa and the US. We explored the relationship of TFV-DP concentrations with antiretroviral drug resistance at the time of treatment failure in SA. METHODS Adult PWH from health clinics in Cape Town, South Africa on efavirenz-based first-line ART containing tenofovir disoproxil fumarate (TDF) with an undetectable (< 50 copies/mL) HIV-1 viral load (VL) were prospectively enrolled in an observational cohort for 12 months. Monthly study visits included blood collection for HIV-1 VL and DBS for TFV-DP. The first confirmed viral breakthrough (VB) > 400 copies/mL triggered HIV-1 genotyping at the subsequent visit. An electronic adherence (EA) device monitored ART adherence in real-time, estimated as a percent for the 30-days prior to VB. Wilcoxon rank sum test was used to compare median [IQR] TFV-DP by genotype outcome. RESULTS Of 250 individuals, (n = 195, 78% women), 21 experienced VB, with a median of 5 [4;7] months on study, and a median EA of 33.3 [13.3;53.3]%. Demographic characteristics between those with and without VB were similar. Median VL at VB was 4.0 [3.2;4.5] log copies/mL. TFV-DP concentrations trended down towards the VB visit. Median TFV-DP concentrations were significantly higher in those HIV-1 genotype did not amplify due to being virally suppressed at the subsequent visit (n = 10; 380 [227-661] fmol/punch, p = 0.035; EA 45 [24.9; 59.2]%); than in those who were successfully genotyped with evidence of drug resistance (n = 5, 241 [150-247] fmol/punch, EA 20 [6.7;36.7]%) and in individuals who did not have resistance (n = 3, 39.9 [16.6; 93.9] fmol/punch; EA 33.3 [16-38]%). Three genotype collections were not done. Only non-nucleoside reverse transcriptase inhibitor-associated mutations were identified on resistance testing. (K103N, E138K, Y118H). CONCLUSION TFV-DP in DBS showed a step-wise inverse relationship with VB and drug resistance, with evidence of low cumulative ART adherence in PWH who developed antiretroviral resistance. Monitoring TFV-DP concentrations could be a valuable tool for predicting future VB and future resistance.
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Affiliation(s)
- Y Singh
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | | | - R Madimabe
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - L Jennings
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - C M Ferraris
- New York State Psychiatric Institute, New York, USA
| | - R N Robbins
- New York State Psychiatric Institute, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | | | - R H Remien
- New York State Psychiatric Institute, New York, USA
- Columbia University Irving Medical Center, New York, USA
| | - C Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
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Bleasdale J, Liu Y, Leone LA, Morse GD, Przybyla SM. The impact of food insecurity on receipt of care, retention in care, and viral suppression among people living with HIV/AIDS in the United States: a causal mediation analysis. Front Public Health 2023; 11:1133328. [PMID: 37601182 PMCID: PMC10433761 DOI: 10.3389/fpubh.2023.1133328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Attaining The Joint United Nations Programme on HIV/AIDS 95-95-95 targets to end the HIV epidemic by 2030 will require a greater understanding of the underlying mechanisms influencing care engagement among people living with HIV/AIDS (PLWHA). One such mechanism is food insecurity, defined as limited or uncertain access to food. Food insecurity has been shown to significantly impact HIV outcomes. Yet, few studies have examined the mechanisms through which food insecurity may influence these outcomes. We aimed to examine the effects of nutritional, behavioral, and mental health mechanisms through which food insecurity may impact HIV care continuum outcomes: receipt of care, retention in care, and viral suppression. Methods We conducted a cross-sectional study of 200 PLWHA in New York State, United States from May-August 2022. Participants were recruited using convenience sampling methods. Multivariable logistic regression models were conducted to examine the associations between food insecurity and care continuum outcomes (receipt of care, retention in care, viral suppression), adjusting for age, race, ethnicity, education, income, and marital status. Individual causal mediation analyses were conducted to assess whether behavioral, mental health, and nutritional mechanisms mediated the hypothesized associations. Results The median age of participants was 30 years (IQR: 27-37 years). The majority self-identified as Black (54.0%), male (55.5%) and straight/heterosexual (63.0%). Increasing severity of food insecurity was associated with greater odds of non-retention in care (aOR: 1.35, 95% CI: 1.07, 1.70) and viral non-suppression (aOR: 1.29, 95% CI: 1.08, 1.54). For the impact of food insecurity on non-retention in care, there was an indirect relationship (natural indirect effect; NIE) mediated through Body Mass Index (BMI) (ORNIE: 1.08, 95% CI: 1.00, 1.18). For viral non-suppression, there was an indirect relationship mediated through BMI (ORNIE: 1.07, 95% CI: 1.00,1.16) and an indirect relationship mediated through depression (ORNIE: 1.27, 95% CI: 1.07, 1.47). Discussion Food insecurity was associated with greater odds of non-retention in care and viral non-suppression among PLWHA. Nutritional and mental health pathways are important mediators of these relationships. Results highlight the need for interventions to target these pathways to address food insecurity as an underlying mechanism influencing engagement in HIV care.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Sarahmona M. Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
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Tibble H, Sheikh A, Tsanas A. Estimating medication adherence from Electronic Health Records: comparing methods for mining and processing asthma treatment prescriptions. BMC Med Res Methodol 2023; 23:167. [PMID: 37438684 PMCID: PMC10337150 DOI: 10.1186/s12874-023-01935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/26/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Medication adherence is usually defined as the extent of the agreement between the medication regimen agreed to by patients with their healthcare provider and the real-world implementation. Proactive identification of those with poor adherence may be useful to identify those with poor disease control and offers the opportunity for ameliorative action. Adherence can be estimated from Electronic Health Records (EHRs) by comparing medication dispensing records to the prescribed regimen. Several methods have been developed in the literature to infer adherence from EHRs, however there is no clear consensus on what should be considered the gold standard in each use case. Our objectives were to critically evaluate different measures of medication adherence in a large longitudinal Scottish EHR dataset. We used asthma, a chronic condition with high prevalence and high rates of non-adherence, as a case study. METHODS Over 1.6 million asthma controllers were prescribed for our cohort of 91,334 individuals, between January 2009 and March 2017. Eight adherence measures were calculated, and different approaches to estimating the amount of medication supply available at any time were compared. RESULTS Estimates from different measures of adherence varied substantially. Three of the main drivers of the differences between adherence measures were the expected duration (if taken as in accordance with the dose directions), whether there was overlapping supply between prescriptions, and whether treatment had been discontinued. However, there are also wider, study-related, factors which are crucial to consider when comparing the adherence measures. CONCLUSIONS We evaluated the limitations of various medication adherence measures, and highlight key considerations about the underlying data, condition, and population to guide researchers choose appropriate adherence measures. This guidance will enable researchers to make more informed decisions about the methodology they employ, ensuring that adherence is captured in the most meaningful way for their particular application needs.
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Affiliation(s)
- Holly Tibble
- Usher Institute, University of Edinburgh, Edinburgh, Scotland.
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland.
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland
| | - Athanasios Tsanas
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland
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12
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Marston MT, Berben L, Dobbels F, Russell CL, de Geest S. Prevalence and Patient-Level Correlates of Intentional Non-Adherence to Immunosuppressive Medication After Heart-Transplantation-Findings From the International BRIGHT Study. Transpl Int 2023; 36:11308. [PMID: 37492859 PMCID: PMC10363605 DOI: 10.3389/ti.2023.11308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/15/2023] [Indexed: 07/27/2023]
Abstract
After heart transplantation (HTx), non-adherence to immunosuppressants (IS) is associated with poor outcomes; however, intentional non-adherence (INA) is poorly understood regarding its international variability in prevalence, contributing factors and impact on outcomes. We investigated (1) the prevalence and international variability of INA, (2) patient-level correlates of INA, and (3) relation of INA with clinical outcomes. Secondary analysis of data from the BRIGHT study-an international multi-center, cross-sectional survey examining multi-level factors of adherence in 1,397 adult HTx recipients. INA during the implementation phase, i.e., drug holiday and dose alteration, was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS©). Descriptive and inferential analysis was performed with data retrieved through patient interview, patient self-report and in clinical records. INA prevalence was 3.3% (n = 46/1,397)-drug holidays: 1.7% (n = 24); dose alteration: 1.4% (n = 20); both: 0.1% (n = 2). University-level education (OR = 2.46, CI = 1.04-5.83), insurance not covering IS costs (OR = 2.21, CI = 1.01-4.87) and barriers (OR = 4.90, CI = 2.73-8.80) were significantly associated with INA; however, clinical outcomes were not. Compared to other single-center studies, this sample's INA prevalence was low. More than accessibility or financial concerns, our analyses identified patient-level barriers as INA drivers. Addressing patients' IS-related barriers, should decrease INA.
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Affiliation(s)
- Mark T. Marston
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Lut Berben
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Sabina de Geest
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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13
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Scott NA, Sadowski C, Vernon A, Arevalo B, Beer K, Borisov A, Cayla JA, Chen M, Feng PJ, Moro RN, Holland DP, Martinson N, Millet JP, Miro JM, Belknap R. Using a medication event monitoring system to evaluate self-report and pill count for determining treatment completion with self-administered, once-weekly isoniazid and rifapentine. Contemp Clin Trials 2023; 129:107173. [PMID: 37004811 PMCID: PMC11078335 DOI: 10.1016/j.cct.2023.107173] [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: 12/28/2022] [Revised: 03/20/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Treatment completion is essential for the effectiveness of any latent tuberculosis infection (LTBI) regimen. The Tuberculosis Trials Consortium (TBTC) Study 33 (iAdhere) combined self-report and pill counts - standard of care (SOC) with a medication event monitoring system (MEMS) to determine treatment completion for 12-dose once-weekly isoniazid and rifapentine (3HP). Understanding the performance of SOC relative to MEMS can inform providers and suggest when interventions may be applied to optimize LTBI treatment completion. METHOD iAdhere randomized participants to directly observed therapy (DOT), SAT, or SAT with text reminders in Hong Kong, South Africa, Spain and the United States (U.S.). This post-hoc secondary analysis evaluated treatment completion in both SAT arms, and compared completion based on SOC with MEMS to completion based on SOC only. Treatment completion proportions were compared. Characteristics associated with discordance between SOC and SOC with MEMS were identified. RESULTS Overall 80.8% of 665 participants completed treatment per SOC, compared to 74.7% per SOC with MEMS, a difference of 6.1% (95%CI: 4.2%, 7.8%). Among U.S. participants only, this difference was 3.3% (95% CI: 1.8%, 4.9%). Differences in completion was 3.1% (95% CI: -1.1%, 7.3%) in Spain, and 36.8% (95% CI: 24.3%, 49.4%) in South Africa. There was no difference in Hong Kong. CONCLUSION When used for monitoring 3HP, SOC significantly overestimated treatment completion in U.S. and South Africa. However, SOC still provides a reasonable estimate of treatment completion of the 3HP regimen, in U.S., Spain, and Hong Kong.
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Affiliation(s)
- Nigel A Scott
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA.
| | - Claire Sadowski
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Andrew Vernon
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | | | - Karlyn Beer
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Andrey Borisov
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Joan A Cayla
- Foundation of TB Research Unit of Barcelona, Barcelona, Spain
| | - Michael Chen
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Pei-Jean Feng
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Ruth N Moro
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | | | - Neil Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, South Africa and Johns Hopkins University Center for TB Research, Baltimore, MD, USA
| | - Joan-Pau Millet
- Agència de Salut Pública de Barcelona, Spain; CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Robert Belknap
- Public Health Institute at Denver Health, Denver, CO, USA
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Adherence to the CDK 4/6 Inhibitor Palbociclib and Omission of Dose Management Supported by Pharmacometric Modelling as Part of the OpTAT Study. Cancers (Basel) 2023; 15:cancers15010316. [PMID: 36612312 PMCID: PMC9818079 DOI: 10.3390/cancers15010316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
The cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) palbociclib is administered orally and cyclically, causing medication adherence challenges. We evaluated components of adherence to palbociclib, its relationship with pharmacokinetics (PK), and drug-induced neutropenia. Patients with metastatic breast cancer (MBC) receiving palbociclib, delivered in electronic monitors (EM), were randomized 1:1 to an intervention and a control group. The intervention was a 12-month interprofessional medication adherence program (IMAP) along with monthly motivational interviews by a pharmacist. Implementation adherence was compared between groups using generalized estimating equation models, in which covariates were included. Model-based palbociclib PK and neutrophil profiles were simulated under real-life implementation scenarios: (1) optimal, (2) 2 doses omitted and caught up at cycle end. At 6 months, implementation was slightly higher and more stable in the intervention (n = 19) than in the control (n = 19) group, 99.2% and 97.3% (Δ1.95%, 95% CI 1.1−2.9%), respectively. The impact of the intervention was larger in patients diagnosed with MBC for >2 years (Δ3.6%, 95% CI 2.1−5.4%), patients who received >4 cycles before inclusion (Δ3.1%, 95% CI 1.7−4.8%) and patients >65 (Δ2.3%, 95% CI 0.8−3.6%). Simulations showed that 25% of patients had neutropenia grade ≥3 during the next cycle in scenario 1 versus 30% in scenario 2. Education and monitoring of patient CDK4/6i cycle management and adherence along with therapeutic drug monitoring can help clinicians improve prescription and decrease toxicity.
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15
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Self-reported and pill count measures of adherence to oral HIV PrEP among female sex workers living in South-Western Uganda. PLoS One 2022; 17:e0277226. [DOI: 10.1371/journal.pone.0277226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/23/2022] [Indexed: 11/12/2022] Open
Abstract
Background
Female sex workers (FSWs) in Uganda are at high risk of HIV infection. Scaling up oral pre-exposure prophylaxis (PrEP) will reduce HIV incidence if high levels of adherence are maintained. This study evaluates PrEP adherence using clinic-based pill counts and self-reported measures, and factors associated with protective levels of adherence.
Methods
Participants were sex workers who had been taking PrEP for at least 5 months and were attending routine follow-up visits for PrEP care in fishing communities and along the Trans-African Highway. Participants who had a pill count showing at least 85% use since their last clinic visit and those who reported taking their PrEP every day in the last 5 months were categorised as having ‘protective adherence’. Spearman’s correlation and weighted kappa assessed the relationship between pill count and self-reported measures. Bivariate and multivariate logistic regression was used to determine factors associated with protective adherence as measured by pill count.
Results
We recruited 524 FSWs, with a median age of 29 years (IQR 23–35). Participants were recruited from fishing communities and Trans-African Highway towns (n = 297, 56.7%, and n = 227, 43.0%). Nearly three quarters (n = 372, 71.0%) of women were estimated to have protective adherence based on pill count (i.e., a pill count of >85%) and 50.4% by self-report in last 3 months. There was a strong positive association between self-reported measures and pill count measures (rest = 0.6453, 95% CI = 0.5924–0.6927) and a moderate agreement between self-reported measures and pill count measures, κ = 0.544 (95%CI = 0.4869–0.6011, p < 0.001).
Factors associated with protective adherence included being aged 35 years or older (aOR = 2.40, 95% CI = 1.17–4.86), living in a fishing community (aOR = 1.45, 95% CI = 0.62–3.38), and having an STI in last 3 months (aOR = 1.64, 95% CI = 1.07–2.49).
Conclusion
Our findings indicate that PrEP-experienced FSWs attending clinical follow-up visits reported high protective levels of oral pre-exposure prophylaxis, as measured by both pill count and self-reported measures, and a moderate agreement between pill count and self-reported measures.
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16
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Smith R, Villanueva G, Probyn K, Sguassero Y, Ford N, Orrell C, Cohen K, Chaplin M, Leeflang MM, Hine P. Accuracy of measures for antiretroviral adherence in people living with HIV. Cochrane Database Syst Rev 2022; 7:CD013080. [PMID: 35871531 PMCID: PMC9309033 DOI: 10.1002/14651858.cd013080.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Good patient adherence to antiretroviral (ART) medication determines effective HIV viral suppression, and thus reduces the risk of progression and transmission of HIV. With accurate methods to monitor treatment adherence, we could use simple triage to target adherence support interventions that could help in the community or at health centres in resource-limited settings. OBJECTIVES To determine the accuracy of simple measures of ART adherence (including patient self-report, tablet counts, pharmacy records, electronic monitoring, or composite methods) for detecting non-suppressed viral load in people living with HIV and receiving ART treatment. SEARCH METHODS The Cochrane Infectious Diseases Group Information Specialists searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, African-Wide information, and Web of Science up to 22 April 2021. They also searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included studies of all designs that evaluated a simple measure of adherence (index test) such as self-report, tablet counts, pharmacy records or secondary database analysis, or both, electronic monitoring or composite measures of any of those tests, in people living with HIV and receiving ART treatment. We used a viral load assay with a limit of detection ranging from 10 copies/mL to 400 copies/mL as the reference standard. We created 2 × 2 tables to calculate sensitivity and specificity. DATA COLLECTION AND ANALYSIS We screened studies, extracted data, and assessed risk of bias using QUADAS-2 independently and in duplicate. We assessed the certainty of evidence using the GRADE method. The results of estimated sensitivity and specificity were presented using paired forest plots and tabulated summaries. We encountered a high level of variation among studies which precluded a meaningful meta-analysis or comparison of adherence measures. We explored heterogeneity using pre-defined subgroup analysis. MAIN RESULTS We included 51 studies involving children and adults with HIV, mostly living in low- and middle-income settings, conducted between 2003 and 2021. Several studies assessed more than one index test, and the most common measure of adherence to ART was self-report. - Self-report questionnaires (25 studies, 9211 participants; very low-certainty): sensitivity ranged from 10% to 85% and specificity ranged from 10% to 99%. - Self-report using a visual analogue scale (VAS) (11 studies, 4235 participants; very low-certainty): sensitivity ranged from 0% to 58% and specificity ranged from 55% to 100%. - Tablet counts (12 studies, 3466 participants; very low-certainty): sensitivity ranged from 0% to 100% and specificity ranged from 5% to 99%. - Electronic monitoring devices (3 studies, 186 participants; very low-certainty): sensitivity ranged from 60% to 88% and the specificity ranged from 27% to 67%. - Pharmacy records or secondary databases (6 studies, 2254 participants; very low-certainty): sensitivity ranged from 17% to 88% and the specificity ranged from 9% to 95%. - Composite measures (9 studies, 1513 participants; very low-certainty): sensitivity ranged from 10% to 100% and specificity ranged from 49% to 100%. Across all included studies, the ability of adherence measures to detect viral non-suppression showed a large variation in both sensitivity and specificity that could not be explained by subgroup analysis. We assessed the overall certainty of the evidence as very low due to risk of bias, indirectness, inconsistency, and imprecision. The risk of bias and the applicability concerns for patient selection, index test, and reference standard domains were generally low or unclear due to unclear reporting. The main methodological issues identified were related to flow and timing due to high numbers of missing data. For all index tests, we assessed the certainty of the evidence as very low due to limitations in the design and conduct of the studies, applicability concerns and inconsistency of results. AUTHORS' CONCLUSIONS We encountered high variability for all index tests, and the overall certainty of evidence in all areas was very low. No measure consistently offered either a sufficiently high sensitivity or specificity to detect viral non-suppression. These concerns limit their value in triaging patients for viral load monitoring or enhanced adherence support interventions.
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Affiliation(s)
- Rhodine Smith
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Nathan Ford
- Department of HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Catherine Orrell
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Karen Cohen
- Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Marty Chaplin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Hine
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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17
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Tibble H, Sheikh A, Tsanas A. Estimating Medication Adherence from Electronic Health Records Using Rolling Averages of Single Refill-based Estimates. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3554-3557. [PMID: 36086002 DOI: 10.1109/embc48229.2022.9871486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medication adherence is usually defined as the manner in which a patient takes their medication, in relation to the regimen agreed to with their healthcare provider. Electronic Health Records (EHRs) can be used to estimate adherence in a cost-effective and non-invasive manner across large-scale populations, although there is no universally agreed optimal approach to doing so. We sought to explore patterns of asthma ICS prescription refills in a large EHR dataset, and to evaluate the use of rolling-average based measures towards short-term adherence estimation. Over 1.6 million asthma controllers were prescribed for our cohort of 91,332 individuals, between January 2009 and March 2017. The Continuous Single interval measures of medication Availability (CSA) and Gaps (CSG) were calculated for individual prescriptions, as well as rolling-average adherence measures of the CSA over 3, 5, or 10 past prescription intervals. 16.7% of the study population had only a single prescription during their follow-up (a median duration of 7.1 years). 51% of prescriptions were refilled before (or on the day that) supply was exhausted, and for 19% of prescription refills, the amount of medication dispensed should have lasted at least twice as long as the duration before the next refill was filled. The rolling average measures had statistically strong associations (Spearman |R|>0.7) with the estimate for the subsequent prescription refill. Rolling averages of multiple individual refill-level adherence estimates provide a novel and simple way to crudely smoothen estimates from individual prescription refills, which are strongly influenced by common (and adherent) real-world behaviors, for more meaningful and effective trend detection. Clinical Relevance- This demonstrates a novel methodology for estimating medication adherence which can detect recent changes in trends.
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18
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Nutor JJ, Marquez S, Slaughter-Acey JC, Hoffmann TJ, DiMaria-Ghalili RA, Momplaisir F, Opong E, Jemmott LS. Water Access and Adherence Intention Among HIV-Positive Pregnant Women and New Mothers Receiving Antiretroviral Therapy in Zambia. Front Public Health 2022; 10:758447. [PMID: 35433591 PMCID: PMC9010721 DOI: 10.3389/fpubh.2022.758447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/11/2022] [Indexed: 01/07/2023] Open
Abstract
Background Mother-to-infant transmission of HIV is a major problem in Sub-Saharan Africa despite free or subsidized antiretroviral treatment (ART), but is significantly reduced when mothers adhere to ART. Because potable water access is limited in low-resource countries, we investigated water access and ART adherence intention among HIV-positive pregnant women and new mothers in Zambia. Methods Our convenience sample consisted of 150 pregnant or postpartum women receiving ART. Descriptive statistics compared type of water access by low and high levels of ART adherence intention. Results Most (71%) had access to piped water, but 36% of the low-adherence intention group obtained water from a well, borehole, lake or stream, compared to only 22% of the high-adherence intention group. The low-adherence intention group was more rural (62%) than urban (38%) women but not statistically significant [unadjusted Prevalence Ratio (PR) 0.73, 95% CI: 0.52-1.02; adjusted PR 1.06, 95% CI: 0.78-1.45]. Conclusion Providing potable water may improve ART adherence. Assessing available water sources in both rural and urban locations is critical when educating women initiating ART.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Jerry John Nutor
| | - Shannon Marquez
- Undergraduate Global Engagement, Columbia University, New York City, NY, United States
| | - Jaime C. Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Thomas J. Hoffmann
- Department of Epidemiology and Biostatistics, and Office of Research, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | | | - Florence Momplaisir
- School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Loretta Sweet Jemmott
- College of Nursing and Health Professions Drexel University, Philadelphia, PA, United States
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19
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Hughes JP, Williamson BD, Krakauer C, Chau G, Ortiz B, Wakefield J, Hendrix C, Amico KR, Holtz TH, Bekker LG, Grant R. Combining information to estimate adherence in studies of pre-exposure prophylaxis for HIV prevention: Application to HPTN 067. Stat Med 2022; 41:1120-1136. [PMID: 35080038 PMCID: PMC8881405 DOI: 10.1002/sim.9321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/11/2022]
Abstract
In trials of oral HIV pre-exposure prophylaxis (PrEP), multiple approaches have been used to measure adherence, including self-report, pill counts, electronic dose monitoring devices, and biological measures such as drug levels in plasma, peripheral blood mononuclear cells, hair, and/or dried blood spots. No one of these measures is ideal and each has strengths and weaknesses. However, accurate estimates of adherence to oral PrEP are important as drug efficacy is closely tied to adherence, and secondary analyses of trial data within identified adherent/non-adherent subgroups may yield important insights into real-world drug effectiveness. We develop a statistical approach to combining multiple measures of adherence and show in simulated data that the proposed method provides a more accurate measure of true adherence than self-report. We then apply the method to estimate adherence in the ADAPT study (HPTN 067) in South African women.
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Affiliation(s)
- James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Brian D Williamson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Chloe Krakauer
- Department of Biostatistics, University of Washington, Seattle, Washington, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Gordon Chau
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Brayan Ortiz
- Modeling and Optimization, Amazon, Bellevue, Washington, USA
| | - Jon Wakefield
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Craig Hendrix
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - K Rivet Amico
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy H Holtz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Office of AIDS Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Robert Grant
- Gladstone Institutes, University of California, San Francisco, San Francisco, California, USA.,San Francisco AIDS Foundation, San Francisco, California, USA
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20
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Lin B, Liu J, He W, Pan H, Ma Y, Zhong X. Effect of Reminder System on Pre-exposure Prophylaxis Adherence in Men Who Have Sex with Men: A Prospective Cohort Study Based on WeChat Intervention (Preprint). J Med Internet Res 2022; 24:e37936. [PMID: 35969436 PMCID: PMC9412721 DOI: 10.2196/37936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/16/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions Trial Registration
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Affiliation(s)
- Bing Lin
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Jiaxiu Liu
- School of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Wei He
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Haiying Pan
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Yingjie Ma
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
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21
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GLICK JL, RUSSO RG, HUANG AKH, JIVAPONG B, RAMASAMY V, ROSMAN LM, PELAEZ DL, SHERMAN SG. ART uptake and adherence among female sex workers (FSW) globally: A scoping review. Glob Public Health 2022; 17:254-284. [PMID: 33301704 PMCID: PMC8190161 DOI: 10.1080/17441692.2020.1858137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We conducted the first scoping literature review on ART uptake and adherence among Female Sex Workers (FSW), following PRISMA-ScR guidelines. Searches were conducted in PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting an ART uptake or adherence result among FSW aged 18 or older; peer-reviewed; published in English between 1996 and 2018. Our search identified 6,735 studies; 30 met eligibility requirements. ART uptake ranges from 0 to 100% and adherence ranges from 50-90%, depending on measurement methods. Uptake and adherence influencing factors are mapped onto a social ecological model (SEM). Knowledge and beliefs, substance use, food insecurity and sex-work engagement were negatively associated, while older age, relationships and social support were positively associated with ART uptake and adherence. Standardised methods to measure uptake and adherence prevalence must be established for data comparison. Evidence regarding ART uptake and adherence barriers and facilitators span multiple SEM levels, although more research is needed regarding structural and occupational level influencers. Results suggest that the multi-level ART uptake and adherence barriers faced by FSW require complex multi-level evidence-based interventions. Study findings can inform ART interventions, future research, and offer guidance to other support services with FSW, such as PrEP interventions.
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Affiliation(s)
- Jennifer L. GLICK
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Rienna G. RUSSO
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Aimee Kao-Hsuan HUANG
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Belinda JIVAPONG
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Lori M. ROSMAN
- Welch Medical Library, Johns Hopkins University, Baltimore MD, USA
| | - Danielle L PELAEZ
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Susan G. SHERMAN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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22
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Fuge TG, Tsourtos G, Miller ER. Factors affecting optimal adherence to antiretroviral therapy and viral suppression amongst HIV-infected prisoners in South Ethiopia: a comparative cross-sectional study. AIDS Res Ther 2022; 19:5. [PMID: 35093100 PMCID: PMC8800260 DOI: 10.1186/s12981-022-00429-4] [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: 06/15/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maintaining optimal adherence and viral suppression in people living with HIV (PLWH) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine factors affecting optimal adherence to antiretroviral therapy and viral suppression amongst HIV-infected prisoners in South Ethiopia. METHODS A comparative cross-sectional study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWH. Patient information including demographic, socio-economic, behavioral, and incarceration-related characteristics were collected using a structured questionnaire. Medication adherence was assessed according to self-report and pharmacy refill. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate logistic and fractional regression models were used to analyse data. RESULTS Seventy-four inmates living with HIV (ILWH) and 296 non-incarcerated PLWH participated in the study. While ILWH had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWH (89 vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral non-suppression was also slightly higher in ILWH (6.0%; 95% confidence interval (CI): 1.7-14.6%) compared to non-incarcerated PLWH (4.5%; 95%CI: 2.4-7.5%). Overall, missing ART appointments, dissatisfaction with ART services, inability to comply with a specified medication schedule, and types of methods used to monitor the schedule (e.g., news time on radio/TV or other social cues) were significantly associated with non-adherence according to self-report. In ILWH specifically, accessing ART services from a hospital, inability to properly attend clinic appointments, depressive symptoms, and lack of social support predicted NA. Viral non-suppression was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. CONCLUSIONS Sub-optimal dose adherence and viral suppression are generally higher in HIV-infected prisoners in South Ethiopia compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.
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Affiliation(s)
- Terefe Gone Fuge
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Emma R Miller
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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23
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Delta T, a Useful Indicator for Pharmacy Dispensing Data to Monitor Medication Adherence. Pharmaceutics 2022; 14:pharmaceutics14010103. [PMID: 35056999 PMCID: PMC8778707 DOI: 10.3390/pharmaceutics14010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Calculating patients' medication availability from dispensing or refill data is a common method to estimate adherence. The most often used measures, such as the medication possession ratio (MPR), average medication supplies over an arbitrary period. Averaging masks the variability of refill behavior over time. GOAL To derive a new absolute adherence estimate from dispensing data. METHOD Dispensing histories of patients with 19 refills of direct oral anticoagulants (DOAC) between 1 January 2008 and 31 December 2017 were extracted from 39 community pharmacies in Switzerland. The difference between the calculated and effective refill day (ΔT) was determined for each refill event. We graphed ΔT and its dichotomized version (dΔT) against the MPR, calculated mean ΔT and mean dΔT per refill, and applied cluster analysis. RESULTS We characterized 2204 refill events from 116 DOAC patients. MPR was high (0.975 ± 0.129) and showed a positive correlation with mean ΔT. Refills occurred on average 17.8 ± 27.9 days "too early", with a mean of 75.8 ± 20.2 refills being "on time". Four refill behavior patterns were identified including constant gaps within or at the end of the observation period, which were critical. CONCLUSION We introduce a new absolute adherence estimate ΔT that characterizes every refill event and shows that the refill behavior of DOAC patients is dynamic.
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24
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Tegegn HG, Wark S, Tursan d’Espaignet E, Spark MJ. Measurement Properties of Patient-Reported Outcome Measures for Medication Adherence in Cardiovascular Disease: A COSMIN Systematic Review. Clin Drug Investig 2022; 42:879-908. [PMID: 36180813 PMCID: PMC9617955 DOI: 10.1007/s40261-022-01199-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Several medication adherence patient-reported outcome measures (MA-PROMs) are available for use in patients with cardiovascular disease (CVD); however, little evidence is available on the most suitable MA-PROM to measure medication adherence in patients with CVD. The aim of this systematic review is to synthesise the measurement properties of MA-PROMs for patients with CVD and identify the most suitable MA-PROM for use in clinical practice or future research in patients with CVD. METHODS An electronic search of nine databases (PubMed, MEDLINE, CINAHL, ProQuest Health and Medicine, Cochrane Library, PsychInfo, Scopus, Embase, and Web of Science) was conducted to identify studies that have reported on at least one of the measurement properties of MA-PROMs in patients with CVD. The methodological quality of the studies included in the systematic review was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS A total of 40 MA-PROMs were identified in the 84 included studies. This review found there is a lack of moderate-to-high quality evidence of sufficient content validity for all MA-PROMs for patients with CVDs. Only eight MA-PROMs were classified in COSMIN recommendation category A. They exhibited sufficient content validity with very low-quality evidence, and moderate-to-high quality evidence for sufficient internal consistency. The 28 MA-PROMs that meet the requirements for COSMIN recommendation category 'B' require further validation studies. Four MA-PROMs including Hill-Bone Compliance Medication Scale (HBMS), the five-item Medication Adherence Report Scale (MARS-5), Maastricht Utrecht Adherence in Hypertension (MUAH), and MUAH-16 have insufficient results with high quality evidence for at least one measurement property and consequently are not recommended for use in patients with CVD. Two MA-PROMs (Adherence to Refills and Medications Scale [ARMS] and ARMS-7) are comprehensive and have moderate to high quality evidence for four sufficient measurement properties. CONCLUSION From the eight MA-PROMs in COSMIN recommendation category A, ARMS and ARMS-7 were selected as the most suitable MA-PROMs for use in patients with CVD. They are the most comprehensive with be best quality evidence to support their use in clinical practice and research.
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Affiliation(s)
- Henok G. Tegegn
- School of Rural Medicine, University of New England, Armidale, 2351 Australia ,Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Stuart Wark
- School of Rural Medicine, University of New England, Armidale, 2351 Australia
| | - Edouard Tursan d’Espaignet
- School of Rural Medicine, University of New England, Armidale, 2351 Australia ,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2300 Australia
| | - M. Joy Spark
- School of Rural Medicine, University of New England, Armidale, 2351 Australia
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25
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Review of the methods to measure non-adherence with a focus on chemical adherence testing. TRANSLATIONAL METABOLIC SYNDROME RESEARCH 2022. [DOI: 10.1016/j.tmsr.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Engler K, Vicente S, Ma Y, Hijal T, Cox J, Ahmed S, Klein M, Achiche S, Pant Pai N, de Pokomandy A, Lacombe K, Lebouché B. Implementation of an electronic patient-reported measure of barriers to antiretroviral therapy adherence with the Opal patient portal: Protocol for a mixed method type 3 hybrid pilot study at a large Montreal HIV clinic. PLoS One 2021; 16:e0261006. [PMID: 34969046 PMCID: PMC8717992 DOI: 10.1371/journal.pone.0261006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) remains problematic. Regular monitoring of its barriers is clinically recommended, however, patient-provider communication around adherence is often inadequate. Our team thus decided to develop a new electronically administered patient-reported outcome measure (PROM) of barriers to ART adherence (the I-Score) to systematically capture this data for physician consideration in routine HIV care. To prepare for a controlled definitive trial to test the I-Score intervention, a pilot study was designed. Its primary objectives are to evaluate patient and physician perceptions of the I-Score intervention and its implementation strategy. METHODS This one-arm, 6-month study will adopt a mixed method type 3 implementation-effectiveness hybrid design and be conducted at the Chronic Viral Illness Service of the McGill University Health Centre (Montreal, Canada). Four HIV physicians and 32 of their HIV patients with known or suspected adherence problems will participate. The intervention will involve having patients complete the I-Score through a smartphone application (Opal), before meeting with their physician. Both patients and physicians will have access to the I-Score results, for consideration during the clinic visits at Times 1, 2 (3 months), and 3 (6 months). The implementation strategy will focus on stakeholder involvement, education, and training; promoting the intervention's adaptability; and hiring an Application Manager to facilitate implementation. Implementation, patient, and service outcomes will be collected (Times 1-2-3). The primary outcome is the intervention's acceptability to patients and physicians. Qualitative data obtained, in part, through physician focus groups (Times 2-3) and patient interviews (Times 2-3) will help evaluate the implementation strategy and inform any methodological adaptations. DISCUSSION This study will help plan a definitive trial to test the efficacy of the I-Score intervention. It will generate needed data on electronic PROM interventions in routine HIV care that will help improve understanding of conditions for their successful implementation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04702412; https://clinicaltrials.gov/.
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Affiliation(s)
- Kim Engler
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Serge Vicente
- Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada
| | - Yuanchao Ma
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Tarek Hijal
- Department of Radiation Oncology, Cedars Cancer Center, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sara Ahmed
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marina Klein
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sofiane Achiche
- Department of Mechanical Engineering, École Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Nitika Pant Pai
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra de Pokomandy
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Karine Lacombe
- Sorbonne Université, Inserm IPLESP, Hôpital St Antoine, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Bertrand Lebouché
- Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Infectious Disease, Department of Medicine, Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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27
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Comparing medication adherence using a smartphone application and electronic monitoring among patients with acute coronary syndrome. Appl Nurs Res 2021; 60:151448. [PMID: 34247788 DOI: 10.1016/j.apnr.2021.151448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/23/2021] [Accepted: 05/16/2021] [Indexed: 11/21/2022]
Abstract
AIM The purpose of this study was to determine the extent of agreement between adherence measures obtained using two technological interventions, electronic monitoring (EM) and a smartphone application (App). BACKGROUND Clinicians, patients, and researchers depend on valid measurements of medication adherence to inform the delivery of preemptive care when needed. Technology is routinely used for monitoring medication adherence in both clinical practice and research, yet there is a dearth of research comparing novel App based approaches to traditional approaches used for assessing medication adherence. METHODS Adherence rates were captured on both the EM and the App for 3697 daily observations from 44 participants with acute coronary syndrome over 90 days immediately following discharge from acute care. For EM, adherence was measured using EM equipped pill bottles. For the App, adherence was measured by having participants upload daily photos to the App prior to taking their daily aspirin. Agreement was assessed using a Bland-Altman analysis. RESULTS The mean adherence rate was higher on the App, 92%, than the EM, 78% (p < 0.001). The mean difference in adherence rates between these methods was 14% (95% Confidence Interval: -23%, -5%). CONCLUSIONS These findings illustrate a lack of agreement between technological interventions used for measuring adherence in cardiovascular patient populations, with higher adherence rates observed with the App compared to EM. These findings are salient given the increased reliance on telehealth due to the ongoing COVID-19 pandemic.
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28
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Amico KR, Crawford J, Ubong I, Lindsey JC, Gaur AH, Horvath K, Goolsby R, Mueller Johnson M, Dallas R, Heckman B, Filipowicz T, Polier M, Rupp BM, Hudgens M. Correlates of High HIV Viral Load and Antiretroviral Therapy Adherence Among Viremic Youth in the United States Enrolled in an Adherence Improvement Intervention. AIDS Patient Care STDS 2021; 35:145-157. [PMID: 33960843 DOI: 10.1089/apc.2021.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A sizable portion of youth (ages 13-24) living with HIV in the United States have unsuppressed viral load. The AIDS Interventions (ATN) 152 study [evaluating the Triggered Escalating Real-Time Adherence (TERA) intervention] baseline data were examined to identify correlates of high viremia (>5000 copies/mL) and self-reported adherence, which can help in planning of differentiated services for viremic youth. Depression, HIV-stigma, and cannabis use were common in this sample of 87 youth. Almost half (48%) had high viremia, which associated with enacted stigma, moderate- to high-risk alcohol use, mental health diagnosis, and age ≥21. Self-reported adherence was related to viral load and associated with mental and physical health functioning, depression, social support, self-confident decision-making, total and internalized stigma, adherence motivation, and report of a missed a care visit in the past 6 months. Mental health emerged as a common correlate of viral load and adherence. Clinical Trial Registration number: NCT03292432.
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Affiliation(s)
- K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Crawford
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ini Ubong
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane C. Lindsey
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Keith Horvath
- Department of Clinical Psychology, San Diego State University, San Diego, California, USA
| | - Rachel Goolsby
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Megan Mueller Johnson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald Dallas
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Amherst, New York, USA
| | - Teresa Filipowicz
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Polier
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Betty M. Rupp
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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29
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Judd RT, Friedman EE, Schmitt J, Ridgway JP. Association between patient-reported barriers and HIV clinic appointment attendance: A prospective cohort study. AIDS Care 2021; 34:545-553. [PMID: 33779423 PMCID: PMC8476655 DOI: 10.1080/09540121.2021.1906401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The association between patients' confidence in their ability to attend appointments and future retention in care has not previously been studied in a general HIV clinic. A survey of potential and known risk factors for poor retention was developed using validated screening tools and administered to 105 patients at an HIV clinic. Retention in care was assessed prospectively using two definitions: (1) two appointments at least three months apart within one year ("HRSA/HAB retention") and (2) no missed appointments within one year ("missed visits retention"). Most patients were African American (86%) and male (59%). Although most patients were confident they could keep their HIV appointments (89%), fewer were retained (HRSA/HAB: 73%; missed visits: 56%). Patients' confidence in their ability to keep future appointments was not associated with retention. Employment was associated with lower odds of HRSA/HAB retention (aOR 0.26 [95% CI 0.09-0.77]), and childcare was a common barrier that was associated with lower odds of missed visits retention (aOR 0.06 [95% CI 0.006-0.62]). Other known risk factors for poor retention were inconsistently associated with retention in care.
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Affiliation(s)
- Ryan T Judd
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Jessica Schmitt
- Department of Medicine, University of Chicago, Chicago, IL, USA
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30
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Neter E, Glass-Marmor L, Wolkowitz A, Lavi I, Miller A. Beliefs about medication as predictors of medication adherence in a prospective cohort study among persons with multiple sclerosis. BMC Neurol 2021; 21:136. [PMID: 33761887 PMCID: PMC7992850 DOI: 10.1186/s12883-021-02149-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though adherence to disease-modifying therapies (DMTs) among persons with multiple sclerosis (PwMS) varies and is often below 80%, only few prospective studies on adherence examined predictors beyond demographic and clinical characteristics. OBJECTIVES Identify antecedents to adherence and persistence to DMT in a prospective design among PwMS. METHODS PwMS (n = 186) were prospectively assessed at three time points: baseline, 6 (Time 1) and 12 months later (Time 2). Clinical, demographic information and patient-reported medication beliefs, illness perceptions, medication habits, perceived health and affect were surveyed in-person. Adherence and persistence were assessed by a combination of self-reports and retrospective review of medication claims. FINDINGS PwMS were 69.9% (Time 1) and 71% (Time 2) adherent to their DMTs and 64.5.9% were persistent. Beliefs about Medications were consistently predictive at both time points (baseline to Time 1 and Time 1 to Time 2) of medication adherence and persistence whereas other perceptions were predictive in some analyses; clinical and demographic characteristics were mostly not predictive of adherence nor persistence. The prospective association of beliefs about medication with adherence held also in multivariate analyses (OR = 0.88, 95% CI 0.78-0.99, p = 0.029). CONCLUSIONS Adherence and persistence are predicted by medication beliefs of PwMS. As medication beliefs are modifiable, they should be assessed periodically and targeted as a focus of tailored interventions aimed to improve adherence and consequently health outcomes in PwMS. REGISTRATION Clinical trials registry # NCT02488343 , date: 06/08/2015.
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Affiliation(s)
- Efrat Neter
- Ruppin Academic Center, 3 Bait, Ruppin Academic Center, 4025000, Emeq Hefer, Israel.
| | - Lea Glass-Marmor
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Anat Wolkowitz
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine & Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Ariel Miller
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
- Multiple Sclerosis Center & Department of Neurology, Carmel Medical Center, Haifa, Israel
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31
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Oslin DW, Chapman S, Duvall SL, Gelernter J, Ingram EP, Kranzler HR, Lehmann LS, Lynch JA, Lynch KG, Pyne JM, Shih MC, Stone A, Thase ME, Wray LO. Study design and implementation of the PRecision Medicine In MEntal health Care (PRIME Care) Trial. Contemp Clin Trials 2021; 101:106247. [PMID: 33316457 DOI: 10.1016/j.cct.2020.106247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Genomic testing has the potential to improve patient outcomes and reduce patient care costs by personalizing medication selection. Commercial pharmacogenetic (PGx) testing for psychotropic and other medications is widely available and promoted as a means to implement "precision medicine." Despite evidence that genetic variation affects the metabolism of psychotropic medications, the clinical utility of these test results has not been established. Moreover, implementing such testing in routine clinical care is complex, requiring informatics support and a systematic approach to patient and provider education. The PRIME Care program is designed to bridge this gap, applying both clinical trials and implementation science methods to conduct a program of research. It is centered on a large, pragmatic randomized clinical trial (RCT) in which 2000 Veterans with a major depressive disorder (MDD) and their health care providers are randomized together to receive PGx test results at the beginning of an episode of care or 6 months later. We hypothesize that providers who receive the PGx test results will prescribe an antidepressant guided by the PGx findings and Veterans whose care is guided by PGx testing will experience higher rates of remission from MDD. If the results of the trial replicate those of prior PGx studies, which provided preliminary evidence of the utility of PGx guided prescribing, it would strongly support using a precision medicine approach to treat MDD. This program of research is also evaluating dissemination influencers, other biomarkers (e.g., genetic variation associated with depression response), and the health care cost implications of PGx testing. ClinicalTrials.gov Identifier: NCT03170362.
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Affiliation(s)
- David W Oslin
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center(,) University of Pennsylvania, Perelman School of Medicine, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Sara Chapman
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA
| | - Scott L Duvall
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, 500 Foothills Driver, Salt Lake City, UT 84148, USA
| | - Joel Gelernter
- VA CT Healthcare Center, Yale Univ. School of Medicine, 950 Campbell Avenue (116A2), West Haven, CT 06516, USA
| | - Erin P Ingram
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center(,) University of Pennsylvania, Perelman School of Medicine, 3900 Woodland Ave, Philadelphia, PA 19104, USA.
| | - Henry R Kranzler
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center(,) University of Pennsylvania, Perelman School of Medicine, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
| | | | - Julie A Lynch
- VA Salt Lake City Healthcare System, 500 Foothills Drive, Salt Lake City, UT, USA; College of Nursing & Health Sciences, University of Massachusetts, Boston, Morrissey Boulevard, Dorchester, MA, USA.
| | - Kevin G Lynch
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center(,) University of Pennsylvania, Perelman School of Medicine, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Jeff M Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, USA.
| | - Mei-Chiung Shih
- Cooperative Studies Program Coordinating Center, VA Palo Alto Healthcare System, Stanford University, 701B N. Shoreline Blvd, Mountain View, CA 94043, USA.
| | - Annjanette Stone
- Pharmacogenomics Analysis Laboratory, Central Arkansas Veterans Healthcare System, 4300 West 7(th) Street, Little Rock, AR 72205, USA
| | - Michael E Thase
- Cpl Michael J Crescenz VA Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center(,) University of Pennsylvania, Perelman School of Medicine, 3900 Woodland Ave, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
| | - Laura O Wray
- VA Center for Integrated Healthcare, VAWNYHS (116N), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 3495 Bailey Avenue, Buffalo, NY 14215, USA.
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Dima AL, Allemann SS, Dunbar-Jacob J, Hughes DA, Vrijens B, Wilson IB. TEOS: A framework for constructing operational definitions of medication adherence based on Timelines-Events-Objectives-Sources. Br J Clin Pharmacol 2020; 87:2521-2533. [PMID: 33220097 DOI: 10.1111/bcp.14659] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 01/27/2023] Open
Abstract
AIMS Managing adherence to medications is a priority for health systems worldwide. Adherence research is accumulating, yet the quality of the evidence is reduced by various methodological limitations. In particular, the heterogeneity and low accuracy of adherence measures have been highlighted in many literature reviews. Recent consensus-based guidelines advise on best practices in defining adherence (ABC) and reporting of empirical studies (EMERGE). While these guidelines highlight the importance of operational definitions in adherence measurement, such definitions are rarely included in study reports. To support researchers in their measurement decisions, we developed a structured approach to formulate operational definitions of adherence. METHODS A group of adherence and research methodology experts used theoretical, methodological and practical considerations to examine the process of applying adherence definitions to various research settings, questions and data sources. Consensus was reached through iterative review of discussion summaries and framework versions. RESULTS We introduce TEOS, a four-component framework to guide the operationalization of adherence concepts: (1) describe treatment as four simultaneous interdependent timelines (recommended and actual use, conditional on prescribing and dispensing); (2) locate four key events along these timelines to delimit the three ABC phases (first and last recommended use, first and last actual use); (3) revisit study objectives and design to fine-tune research questions and assess measurement validity and reliability needs, and (4) select data sources (e.g., electronic monitoring, self-report, electronic healthcare databases) that best address measurement needs. CONCLUSION Using the TEOS framework when designing research and reporting explicitly on these components can improve measurement quality.
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Affiliation(s)
- Alexandra L Dima
- Health Services and Performance Research (HESPER EA 7425), University Claude Bernard Lyon 1, Lyon, France
| | - Samuel S Allemann
- Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, North Wales, UK
| | - Bernard Vrijens
- AARDEX Group & Department of Public Health Liège University, Liège, Belgium
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
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Tibble H, Lay-Flurrie J, Sheikh A, Horne R, Mizani MA, Tsanas A. Linkage of primary care prescribing records and pharmacy dispensing Records in the Salford Lung Study: application in asthma. BMC Med Res Methodol 2020; 20:303. [PMID: 33302885 PMCID: PMC7731758 DOI: 10.1186/s12874-020-01184-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Records of medication prescriptions can be used in conjunction with pharmacy dispensing records to investigate the incidence of adherence, which is defined as observing the treatment plans agreed between a patient and their clinician. Using prescribing records alone fails to identify primary non-adherence; medications not being collected from the dispensary. Using dispensing records alone means that cases of conditions that resolve and/or treatments that are discontinued will be unaccounted for. While using a linked prescribing and dispensing dataset to measure medication non-adherence is optimal, this linkage is not routinely conducted. Furthermore, without a unique common event identifier, linkage between these two datasets is not straightforward. METHODS We undertook a secondary analysis of the Salford Lung Study dataset. A novel probabilistic record linkage methodology was developed matching asthma medication pharmacy dispensing records and primary care prescribing records, using semantic (meaning) and syntactic (structure) harmonization, domain knowledge integration, and natural language feature extraction. Cox survival analysis was conducted to assess factors associated with the time to medication dispensing after the prescription was written. Finally, we used a simplified record linkage algorithm in which only identical records were matched, for a naïve benchmarking to compare against the results of our proposed methodology. RESULTS We matched 83% of pharmacy dispensing records to primary care prescribing records. Missing data were prevalent in the dispensing records which were not matched - approximately 60% for both medication strength and quantity. A naïve benchmarking approach, requiring perfect matching, identified one-quarter as many matching prescribing records as our methodology. Factors associated with delay (or failure) to collect the prescribed medication from a pharmacy included season, quantity of medication prescribed, previous dispensing history and class of medication. Our findings indicate that over 30% of prescriptions issued were not collected from a dispensary (primary non-adherence). CONCLUSIONS We have developed a probabilistic record linkage methodology matching a large percentage of pharmacy dispensing records with primary care prescribing records for asthma medications. This will allow researchers to link datasets in order to extract information about asthma medication non-adherence.
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Affiliation(s)
- Holly Tibble
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX.
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX.
| | | | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Health Data Research U004B, Edinburgh, UK
| | - Rob Horne
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Mehrdad A Mizani
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
| | - Athanasios Tsanas
- Usher Institute, University of Edinburgh, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
- Asthma UK Centre for Applied Research, Bioquarter 9, 9 Little France Road, Edinburgh, Scotland, EH16 4UX
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Performance of a short, self-report adherence scale in a probability sample of persons using HIV antiretroviral therapy in the United States. AIDS 2020; 34:2239-2247. [PMID: 32932340 DOI: 10.1097/qad.0000000000002689] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Excellent adherence to HIV antiretroviral therapy (ART) remains a cornerstone of HIV care. A three-item adherence self-report scale was recently developed and validated, but the scale has not been previously tested in a nationally representative sample. DESIGN We administered the adherence scale to participants in the Centers for Disease Control and Prevention's Medical Monitoring Project, which is a probability sample of US adults with diagnosed HIV. METHODS We combined sociodemographic and clinical participant data from three consecutive cycles of the Medical Monitoring Project (6/2015-5/2018). We used medical record reviews to determine most recent viral load, and whether viral loads were suppressed at all measurement points in the past 12 months. We describe the relationship between adherence scale score and two measures of viral load suppression (most recent and sustained), and estimate linear regression models using sampling weights to determine independent predictors of ART adherence scores. RESULTS Of those using ART, the median adherence score was 93 (100 = perfect adherence), and the standardized Cronbach's alpha was 0.83. For both measures of viral load suppression, the relationship with the adherence score was generally linear; there was no 'cutoff' point indicating good vs. poor adherence. In the multivariable model, younger age, nonwhite race, poverty, homelessness, depression, binge-drinking, and both non-IDU and IDU were independently associated with lower adherence. CONCLUSION The adherence measure had good psychometric qualities and a linear relationship with viral load, supporting its use in both clinical care and research. Adherence interventions should focus on persons with the highest risk of poor adherence.
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Zulfa IM, Handayani W. Patient�s Compliance with Oral Antibiotics Treatments at Community Health Centers in Surabaya: A 20-KAO Questionnaire Development. BORNEO JOURNAL OF PHARMACY 2020. [DOI: 10.33084/bjop.v3i4.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The irrational and incompliance use of antibiotics has been correlated to bacterial resistance. Several methods evaluated patients' compliance with oral antibiotics have been conducted. However, a standard questionnaire for evaluating oral antibiotics compliance in Indonesian has not been developed yet. This study was conducted to record the content validity of the developed questionnaire called 20-KAO to assess compliance with oral antibiotics. The validity content test was conducted through six experts review using the Item Content Validity Index (I-CVI) and Scale-Content Validity Index (S-CVI). The experts were also requested to provide recommendations for each item, whether revisions or deletion. After the review process, the number of questions remains unchanged. A total of 19 out of 20 items had an I-CVI of 1.00, and S-CVI was calculated at 0.98. Therefore, 20 items of the 20-KAO questionnaire have excellent content validity. However, future construct validity and reliability test to analyze the responses of targeted respondents and the questionnaire's consistency are needed.
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Watson CH, Fish LJ, Falkovic M, Monuszko K, Lorenzo A, Havrilesky LJ, Secord AA, Davidson BA. Adherence to Oral Anticancer Therapeutics in the Gynecologic Oncology Population. Obstet Gynecol 2020; 136:1145-1153. [DOI: 10.1097/aog.0000000000004170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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ART uptake and adherence among women who use drugs globally: A scoping review. Drug Alcohol Depend 2020; 215:108218. [PMID: 32916450 PMCID: PMC7899784 DOI: 10.1016/j.drugalcdep.2020.108218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the state of peer-reviewed literature surrounding uptake and adherence of antiretroviral therapy (ART) among HIV-positive women who use drugs (WWUD). METHODS Consistent with PRISMA-ScR guidelines, we conducted a scoping literature review on ART uptake and adherence among WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting at least one ART uptake or adherence related result among WWUD aged 18 or older; peer-reviewed; published in English between 1996-2018. RESULTS Our search identified 6735 studies; 86 met eligibility requirements. ART uptake ranged from 30 % to 76 % and adherence ranged from 27 % to 95 %. Substance use, co-morbid psychiatric disorders, and side effects emerged as the primary ART uptake and adherence barriers among this population. Few facilitators were identified. CONCLUSION This study is the first scoping review to look at ART uptake and adherence among WWUD globally. The wide range in uptake and adherence outcomes indicates the need for gold standard assessments, which may differ between high and low resource settings. This study offers rich insight into uptake and adherence barriers and facilitators, primarily at the intrapersonal level. More research is needed to examine interventions that focus on additional levels of the SEM (e.g., community and policy levels). These review findings can inform ART interventions, future research, and offer guidance to other support services with WWUD, such as PrEP interventions.
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Aspirin non-response in pregnant women at increased risk of pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 2020; 254:292-297. [PMID: 33039837 DOI: 10.1016/j.ejogrb.2020.09.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Low dose aspirin (LDA) is recommended for women at increased risk of preeclampsia (PE), however it is not always effective. The study sought to determine the prevalence of non-response to LDA and to ascertain the effect of increasing aspirin dose in non-responders. STUDY DESIGN Single centre, cohort study of 166 women at increased risk of PE was conducted in a large maternity unit in the UK between 2013 and 2016. All women were prescribed 75 mg of aspirin and invited to attend study visits at 18-24 weeks' and 32-36 weeks' gestation. Non-response was defined as a serum thromboxane B2 (TXB2) ≤10 ng/mL. Aspirin dose was increased to 150 mg if a bedside VerifyNow test suggested non-response (test value ≥ 550 arachidonic acid reactive units [ARU]) at 18-24 weeks. Adherence was assessed by self-report. RESULTS Based on serum TXB2, response rates were 85.3 % at 18-24 weeks and 79.3 % at 32-36 weeks' gestation. Compared to serum TXB2, the VerifyNow test demonstrated moderate test performance (AUC 0.79 95 % CI 0.71-0.88, p < 0.0001) to detect non-response. High prevalence of non-adherence (6/10) was evident in persistent non-response group. Dose change from 75 to 150 mg of aspirin in adherent participants improved response (VerifyNow: 598 [95 % CI 550-665] ARU at 18-24 weeks on 75 mg aspirin, 509 [95 % CI 350-667] at 32-36 weeks on 150 mg of aspirin, [p < 0.0001]). CONCLUSIONS Non-response to LDA is common in pregnancy but appears to be largely attributable to non-adherence. Dose change could be useful to improve response to LDA in this cohort.
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A data-driven typology of asthma medication adherence using cluster analysis. Sci Rep 2020; 10:14999. [PMID: 32929109 PMCID: PMC7490405 DOI: 10.1038/s41598-020-72060-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Asthma preventer medication non-adherence is strongly associated with poor asthma control. One-dimensional measures of adherence may ignore clinically important patterns of medication-taking behavior. We sought to construct a data-driven multi-dimensional typology of medication non-adherence in children with asthma. We analyzed data from an intervention study of electronic inhaler monitoring devices, comprising 211 patients yielding 35,161 person-days of data. Five adherence measures were extracted: the percentage of doses taken, the percentage of days on which zero doses were taken, the percentage of days on which both doses were taken, the number of treatment intermissions per 100 study days, and the duration of treatment intermissions per 100 study days. We applied principal component analysis on the measures and subsequently applied k-means to determine cluster membership. Decision trees identified the measure that could predict cluster assignment with the highest accuracy, increasing interpretability and increasing clinical utility. We demonstrate the use of adherence measures towards a three-group categorization of medication non-adherence, which succinctly describes the diversity of patient medication taking patterns in asthma. The percentage of prescribed doses taken during the study contributed to the prediction of cluster assignment most accurately (84% in out-of-sample data).
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Leddy AM, Sheira LA, Tamraz B, Sykes C, Kashuba ADM, Wilson TE, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Bacchetti P, Weiser SD. Food Insecurity Is Associated With Lower Levels of Antiretroviral Drug Concentrations in Hair Among a Cohort of Women Living With Human Immunodeficiency Virus in the United States. Clin Infect Dis 2020; 71:1517-1523. [PMID: 31608363 PMCID: PMC7486839 DOI: 10.1093/cid/ciz1007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/08/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Food insecurity is a well-established determinant of suboptimal, self-reported antiretroviral therapy (ART) adherence, but few studies have investigated this association using objective adherence measures. We examined the association of food insecurity with levels of ART concentrations in hair among women living with human immunodeficiency virus (WLHIV) in the United States. METHODS We analyzed longitudinal data collected semiannually from 2013 through 2015 from the Women's Interagency HIV Study, a multisite, prospective, cohort study of WLHIV and controls not living with HIV. Our sample comprised 1944 person-visits from 677 WLHIV. Food insecurity was measured using the US Household Food Security Survey Module. ART concentrations in hair, an objective and validated measure of drug adherence and exposure, were measured using high-performance liquid chromatography with mass spectrometry detection for regimens that included darunavir, atazanavir, raltegravir, or dolutegravir. We conducted multiple 3-level linear regressions that accounted for repeated measures and the ART medication(s) taken at each visit, adjusting for sociodemographic and clinical characteristics. RESULTS At baseline, 67% of participants were virally suppressed and 35% reported food insecurity. In the base multivariable model, each 3-point increase in food insecurity was associated with 0.94-fold lower ART concentration in hair (95% confidence interval, 0.89 to 0.99). This effect remained unchanged after adjusting for self-reported adherence. CONCLUSIONS Food insecurity was associated with lower ART concentrations in hair, suggesting that food insecurity may be associated with suboptimal ART adherence and/or drug absorption. Interventions seeking to improve ART adherence among WLHIV should consider and address the role of food insecurity.
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Affiliation(s)
- Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Bani Tamraz
- Department of Clinical Pharmacy, University of California–San Francisco, San Francisco, California, USA
| | - Craig Sykes
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela D M Kashuba
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, Illinois, USA
| | - Eryka L Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California, USA
| | - Sheri D Weiser
- Division of Prevention Science, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California–San Francisco, San Francisco, California, USA
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Yeager KA, Waldrop-Valverde D, Paul S, Bruner DW, Klisovic R, Burns E, Mason TA, Patel N, Jennings BM. Adherence trajectories in oral therapy for chronic myeloid leukemia: Overview of a research protocol. Res Nurs Health 2020; 43:443-452. [PMID: 32866350 DOI: 10.1002/nur.22069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/16/2020] [Indexed: 12/15/2022]
Abstract
Over a quarter of chemotherapy regimens now include oral agents. Individuals living with cancer are now responsible for administering this lifesaving therapy at home by taking every dose as prescribed. One type of oral chemotherapy, tyrosine kinase inhibitors (TKIs), is the current recommended treatment for chronic myeloid leukemia. This targeted therapy has markedly improved survival but comes with significant side effects and financial costs. In the study described in this protocol, the investigators seek to understand the dynamic nature of TKI adherence experienced by individuals diagnosed with CML. Using a mixed-method approach in this prospective observational study, funded by the National Cancer Institute, we seek to describe subjects' adherence trajectories over 1 year. We aim to characterize adherence trajectories in individuals taking TKIs using model-based cluster analysis. Next, we will determine how side effects and financial toxicity influence adherence trajectories. Then we will examine the influence of TKI adherence trajectories on disease outcomes. Additionally, we will explore the experience of patients taking TKIs by interviewing a subset of participants in different adherence trajectories. The projected sample includes 120 individuals taking TKIs who we will assess monthly for 12 months, measuring adherence with an objective measure (Medication Event Monitoring System). Identifying differential trajectories of adherence for TKIs is important for detecting subgroups at the highest risk of nonadherence and will support designing targeted interventions. Results from this study can potentially translate to other oral agents to improve care across different types of cancer.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Deborah Watkins Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.,Department of Radiation Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Rebecca Klisovic
- Department of Hematology and Medical Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Emily Burns
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Tamara A Mason
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Nisha Patel
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Kardas P, Aguilar-Palacio I, Almada M, Cahir C, Costa E, Giardini A, Malo S, Massot Mesquida M, Menditto E, Midão L, Parra-Calderón CL, Pepiol Salom E, Vrijens B. The Need to Develop Standard Measures of Patient Adherence for Big Data: Viewpoint. J Med Internet Res 2020; 22:e18150. [PMID: 32663138 PMCID: PMC7484771 DOI: 10.2196/18150] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/26/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022] Open
Abstract
Despite half a century of dedicated studies, medication adherence remains far from perfect, with many patients not taking their medications as prescribed. The magnitude of this problem is rising, jeopardizing the effectiveness of evidence-based therapies. An important reason for this is the unprecedented demographic change at the beginning of the 21st century. Aging leads to multimorbidity and complex therapeutic regimens that create a fertile ground for nonadherence. As this scenario is a global problem, it needs a worldwide answer. Could this answer be provided, given the new opportunities created by the digitization of health care? Daily, health-related information is being collected in electronic health records, pharmacy dispensing databases, health insurance systems, and national health system records. These big data repositories offer a unique chance to study adherence both retrospectively and prospectively at the population level, as well as its related factors. In order to make full use of this opportunity, there is a need to develop standardized measures of adherence, which can be applied globally to big data and will inform scientific research, clinical practice, and public health. These standardized measures may also enable a better understanding of the relationship between adherence and clinical outcomes, and allow for fair benchmarking of the effectiveness and cost-effectiveness of adherence-targeting interventions. Unfortunately, despite this obvious need, such standards are still lacking. Therefore, the aim of this paper is to call for a consensus on global standards for measuring adherence with big data. More specifically, sound standards of formatting and analyzing big data are needed in order to assess, uniformly present, and compare patterns of medication adherence across studies. Wide use of these standards may improve adherence and make health care systems more effective and sustainable.
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Affiliation(s)
- Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Isabel Aguilar-Palacio
- Preventive Medicine and Public Health Department, Zaragoza University, Zaragoza, Spain.,Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Marta Almada
- UCIBIO REQUIMTE, ICBAS, Porto4Ageing - Competences Center on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Caitriona Cahir
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elisio Costa
- UCIBIO REQUIMTE, ICBAS, Porto4Ageing - Competences Center on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Anna Giardini
- IT Department, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Sara Malo
- Preventive Medicine and Public Health Department, Zaragoza University, Zaragoza, Spain.,Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Mireia Massot Mesquida
- Servei d'Atenció Primària Vallès Occidental, Institut Català de la Salut, Barcelona, Spain
| | - Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.,Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Luís Midão
- UCIBIO REQUIMTE, ICBAS, Porto4Ageing - Competences Center on Active and Healthy Ageing, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Carlos Luis Parra-Calderón
- Group of Research and Innovation in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, IBiS / Virgen del Rocío University Hospital / CSIC / University of Seville, Seville, Spain
| | - Enrique Pepiol Salom
- International Commitee, Muy Ilustre Colegio Oficial de Farmacéuticos, Valencia, Spain
| | - Bernard Vrijens
- AARDEX Group, Seraing, Belgium.,Liège University, Liège, Belgium
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Tegegn HG, Tursan D'Espaignet E, Wark S, Spark MJ. Self-reported medication adherence tools in cardiovascular disease: protocol for a systematic review of measurement properties. JBI Evid Synth 2020; 18:1546-1556. [PMID: 32813394 DOI: 10.11124/jbisrir-d-19-00117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this review is to identify high-quality, self-reported medication adherence tools for adults with cardiovascular disease to improve health outcomes. INTRODUCTION Medication adherence is a complex concept affected by multiple factors and positively associated with clinical outcomes. Poor adherence to cardiovascular medications is a hindrance to the effective management of cardiovascular disease, leading to poor disease prognosis or increased risk of death. Valid and reliable measurement is crucial to identify patients with poor adherence, preferably before an adverse outcome occurs. INCLUSION CRITERIA This review will consider studies that include adults, aged 18 years and over, with a diagnosis of cardiovascular disease. The construct of medication adherence has three phases: initiation, implementation and discontinuation. Included tools need to measure at least one of these phases. The review will consider studies of any study design that report on the measurement properties of self-reported medication adherence tools among adults with cardiovascular disease. METHODS The following databases will be searched from inception to present: PubMed, MEDLINE, CINAHL, ProQuest Health and Medicine, Cochrane Library, PsycINFO, Scopus, Embase and Web of Science. Articles published in any language will be included, with no date limit. Data extraction will be performed by one reviewer and cross-checked by another reviewer. Data from the included studies will be synthesized using tables for the quality of methods, and measurement property results. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019124291.
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Affiliation(s)
- Henok G Tegegn
- 1School of Rural Medicine, University of New England, Armidale, Australia 2Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia 3School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Labeau SO. Recommendation and protocol compliance: "Yes, I do" may not be true; the complexity of measuring provider adherence. Intensive Crit Care Nurs 2020; 60:102890. [PMID: 32536513 PMCID: PMC7529399 DOI: 10.1016/j.iccn.2020.102890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Affiliation(s)
- S O Labeau
- HOGENT University of Applied Sciences and Arts, Faculty of Education, Health and Social Work, Nursing Dept., Keramiekstraat 80, 9000 Ghent, Belgium.
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Mboup A, Béhanzin L, Guédou F, Giguère K, Geraldo N, Zannou DM, Kêkê RK, Bachabi M, Gangbo F, Affolabi D, Marzinke MA, Hendrix C, Diabaté S, Alary M. Comparison of adherence measurement tools used in a pre-exposure prophylaxis demonstration study among female sex workers in Benin. Medicine (Baltimore) 2020; 99:e20063. [PMID: 32481273 PMCID: PMC7249870 DOI: 10.1097/md.0000000000020063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Measuring adherence to PrEP (pre-exposure prophylaxis) remains challenging. Biological adherence measurements are reported to be more accurate than self-reports and pill counts but can be expensive and not suitable on a daily basis in resource-limited countries. Using data from a demonstration project on PrEP among female sex workers in Benin, we aimed to measure adherence to PrEP and compare self-report and pill count adherence to tenofovir (TFV) disoproxil fumarate (TDF) concentration in plasma to determine if these 2 measures are reliable and correlate well with biological adherence measurements. METHODS Plasma TFV concentrations were analyzed in samples collected at day 14 follow-up visit and months 6, 12, 18, and 24 (or at last visit when follow-up was shorter). Self-reported adherence was captured at day 14 follow-up visit and then quarterly by asking participants to report the number of missed pills within the last week. For pill count, medications were refilled monthly and participants were asked to bring in their medication bottles at each follow-up visit. Using generalized estimating equations adherence measured by self-report and pill count was compared to plasma drug concentrations. RESULTS Of 255 participants, 47.1% completed follow-up. Weighted optimal adherence combining data from all visits was 26.8% for TFV concentration, 56.0% by self-report and 18.9% by pill count. Adherence measured by both TFV concentrations and self-report decreased over time (P = .009 and P = .019, respectively), while the decreasing trend in adherence by pill count was not significant (P = .087). The decrease in adherence was greater using TFV concentrations than the other 2 adherence measures. CONCLUSION With high levels of misreporting of adherence using self-report and pill count, the objective biomedical assessment of adherence via laboratory testing is optimal and more accurately reflects PrEP uptake and persistence. Alternative inexpensive and accurate approaches to monitor PrEP adherence should be investigated.
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Affiliation(s)
- Aminata Mboup
- Département de médecine sociale et préventive, Université Laval
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Luc Béhanzin
- Département de médecine sociale et préventive, Université Laval
- Dispensaire IST, Cotonou, Bénin
- École Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Épidémiologique, Université de Parakou
| | - Fernand Guédou
- Département de médecine sociale et préventive, Université Laval
- Dispensaire IST, Cotonou, Bénin
| | - Katia Giguère
- Département de médecine sociale et préventive, Université Laval
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | | | | | | | | | | | - Dissou Affolabi
- Faculté des sciences de la santé, Université d’Abomey-Calavi
- Centre national hospitalier universitaire HMK de Cotonou, Bénin
| | | | - Craig Hendrix
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Souleymane Diabaté
- Département de médecine sociale et préventive, Université Laval
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Université Alassane Ouattara, Bouaké, Côte d’Ivoire
| | - Michel Alary
- Département de médecine sociale et préventive, Université Laval
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Institut national de santé publique du Québec, Québec, Canada
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Duncan NA, Kronenberger WG, Roberson CP, Janson IA, Shapiro AD. Adherence is a human behaviour, assessing it requires multimethod evaluation with validated measures: Comment on Guedes VG et al (2019). Haemophilia 2020; 26:934-936. [DOI: 10.1111/hae.14022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Isaac A. Janson
- Indiana Hemophilia and Thrombosis Center, Inc. Indianapolis IN USA
| | - Amy D. Shapiro
- Indiana Hemophilia and Thrombosis Center, Inc. Indianapolis IN USA
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Treatment Adherence Among Persons Receiving Concurrent Multidrug-Resistant Tuberculosis and HIV Treatment in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr 2020; 82:124-130. [PMID: 31513073 DOI: 10.1097/qai.0000000000002120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Success in multidrug-resistant tuberculosis (MDR-TB) and HIV treatment requires high medication adherence despite high pill burdens, frequent adverse events, and long treatment duration, which may jeopardize adherence. We prospectively compared MDR-TB/HIV-coinfected persons to those with MDR-TB alone to determine the impact of concurrent treatment on adherence and outcomes. METHODS We assessed medication adherence monthly using 3-day recall, 30-day recall, and visual analog scale and examined adherence to monthly study visits (months 0-12). We determined the proportion of participants fully adherent (no reported missed doses) to MDR-TB vs. HIV treatment by each measure. We assessed the association of medication and clinic visit adherence with MDR-TB treatment success (cure or completion, 18-24 months) and HIV virologic suppression. RESULTS Among 200 patients with MDR-TB, 63% were women, median age was 33 years, 144 (72%) were HIV-infected, and 81% were receiving antiretroviral therapy (ART) at baseline. Adherence to medications (81%-98% fully adherent across all measures) and clinic visits (80% missed ≤1 visit) was high, irrespective of HIV status. Adherence to ART was significantly higher than to MDR-TB treatment by all self-reported measures (3-day recall: 92% vs. 84%, respectively; P = 0.003). In multivariable analysis, the adjusted risk ratio of unsuccessful MDR-TB treatment increased with every missed visit: 1.50, 2.25, and 3.37 for unsuccessful treatment, for 1, 2, and ≥3 missed visits. CONCLUSIONS Adherence to ART was higher than to MDR-TB treatment among persons with MDR-TB/HIV coinfection. Missed clinic visits may be a simple measure for identifying patients at risk of unsuccessful MDR-TB treatment outcome.
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Neter E, Wolkowitz A, Glass-Marmor L, Lavi I, Ratzabi S, Leibkovitz I, Miller A. Multiple modality approach to assess adherence to medications across time in Multiple Sclerosis. Mult Scler Relat Disord 2020; 40:101951. [PMID: 32004857 DOI: 10.1016/j.msard.2020.101951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/01/2019] [Accepted: 01/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medication adherence is especially challenging in a chronic condition such as Relapsing Multiple Sclerosis (RMS). Medication adherence among persons with MS (PwMS) is usually assessed via a single measure, mostly electronic pharmacy records. OBJECTIVES Assess medication adherence in multiple modes across time among PwMS; examine consistency across time and associations between measures. METHODS PwMS (N = 194) were surveyed prospectively at three time points (baseline, 6 and 12 months later) and their health records and medication claims were retrospectively obtained. Adherence score was based on medication possession ratio (MPR) and two patient-reported outcome (PRO) measures. Electronic monitoring devices assessing medication adherence were also initiated. RESULTS MPR of each nonadherent PwMS, once compared to medical records containing prescription changes, was found as underestimating adherence. MPR was between the two PROs in identifying nonadherence and associations between the measures and across time was moderate (Kappa ranged 0.37-0.42). The use of electronic monitoring devices was not adopted by patients. A score indicated adherence as 66% and 64.9% at Time1 and Time 2, respectively, with 21.1% of PwMS nonadherent at both time points. Adherence did not vary significantly by DMT type. CONCLUSIONS Being a dynamic behavior, medication adherence should be repeatedly monitored by using multiple modalities and focused on in clinician-patient encounters, especially in chronic diseases such as MS, which requires long-term treatments. Applying PROs in monitoring medication adherence would facilitate implementation of Participatory Medicine and patient-centered strategies in MS care.
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Affiliation(s)
| | - Anat Wolkowitz
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Lea Glass-Marmor
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine & Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Sharonne Ratzabi
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Izabella Leibkovitz
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel
| | - Ariel Miller
- Rappaport Faculty of Medicine & Research Institute, Technion Institute of Technology, Haifa, Israel; Multiple Sclerosis Center & Neuroimmunology Unit, Carmel Medical Center, Haifa, Israel
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Saberi P, Chakravarty D, Ming K, Legnitto D, Gandhi M, Johnson MO, Neilands TB. Moving Antiretroviral Adherence Assessments to the Modern Era: Correlations Among Three Novel Measures of Adherence. AIDS Behav 2020; 24:284-290. [PMID: 31758349 PMCID: PMC6996539 DOI: 10.1007/s10461-019-02744-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is no gold standard for estimating antiretroviral therapy (ART) adherence. Feasible, acceptable, and objective measures that are cost- and time-effective are needed. US adults (N = 93) on ART for ≥ 3 months, having access to a mobile phone and internet, and willing to mail in self-collected hair samples, were recruited into a pilot study of remote adherence data collection methods. We examined the correlation of self-reported adherence and three objective remotely collected adherence measures: text-messaged photographs of pharmacy refill dates for pharmacy-refill-based adherence, text-messaged photographs of pills for pill-count-based adherence, and assays of home-collected hair samples for pharmacologic-based adherence. All measures were positively correlated. The strongest correlation was between pill-count- and pharmacy-refill-based adherence (r = 0.68; p < 0.001), and the weakest correlation was between self-reported adherence and hair drug concentrations (r = 0.14, p = 0.34). The three measures provide objective adherence data, are easy to collect, and are viable candidates for future HIV treatment and prevention research.
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Griffin N, Dowling M. Vitamin D supplementation and clinical outcomes in cancer survivorship. ACTA ACUST UNITED AC 2019; 27:1121-1128. [PMID: 30346823 DOI: 10.12968/bjon.2018.27.19.1121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increasing evidence points to the role of vitamin D supplementation in cancer management. A comprehensive search of online databases was undertaken for all research studies relating to vitamin D supplementation in cancer survivorship published up to November 2017. Eighteen studies meeting the inclusion criteria were selected for this review, the majority of which involved supplementation in breast cancer. This review concludes that vitamin D supplementation plays an important role in disease-free survival in a number of cancers, particularly breast. In other cancers, the role of supplementation is less clear, and more research is required. More research is also required to investigate the most effective dose and duration of vitamin D supplementation to benefit cancer survivors.
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Affiliation(s)
- Niamh Griffin
- Graduate nurse, at time of writing this article final-year undergraduate student, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Maura Dowling
- Senior Lecturer, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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