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Rehman AM, Simms V, McHugh G, Mujuru H, Ngwira LG, Semphere R, Moyo B, Bandason T, Odland JO, Ferrand RA. Adherence to additional medication for management of HIV-associated comorbidities among older children and adolescents taking antiretroviral therapy. PLoS One 2022; 17:e0269229. [PMID: 35704559 PMCID: PMC9200347 DOI: 10.1371/journal.pone.0269229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Management of co-morbidities among persons living with HIV is an emerging priority, which may require additional medication over and above life-long antiretroviral therapy (ART). We explored factors associated with adherence to the trial drug among children and adolescents with perinatally acquired HIV taking antiretroviral therapy (ART) in the Bronchopulmonary Function in Response to Azithromycin Treatment for Chronic Lung Disease in HIV-Infected Children (BREATHE) trial. Methods The BREATHE trial recruited 6–19 year olds with perinatally acquired HIV and co-morbid chronic lung disease as measured by FEV1. This two-site trial was individually randomised (1:1), double-blind and placebo-controlled. Participants received a once-weekly weight-based dose of 1–5 tablets of azithromycin (AZM: 250mg) or placebo, taken orally. We used pharmacy dispensing records and count of returned pills to measure adherence to study medication. Logistic regression was used to explore factors associated with adherence coverage. Poisson regression with Lexis expansion for time was used to explore whether adherence modified the effect of azithromycin on the incidence of acute respiratory exacerbation, a secondary outcome of the trial. Trial registration: ClinicalTrials.gov NCT02426112. Results The 347 participants (median age 15.3, 51% male) consumed 14,622 doses of study medication over 16,220 person-weeks under study. Adherence was higher for those randomised to AZM (73.4%) than placebo (68.4%) and declined over the 48 weeks of the study (Score test for trend <0.02). Those with unsuppressed HIV viral load at baseline had 2.08 (95% CI: 1.19, 3.63) times the odds of non-adherence than those with viral suppression. Differences were also observed between trial sites. Conclusion The majority of children and adolescents tolerated the addition of a once-weekly dose of medication to their pill burden. Barriers in adhering to treatment for co-morbid conditions are likely common to barriers in adhering to ART. Control of co-morbidities will therefore present additional challenges in HIV care.
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Affiliation(s)
- Andrea M. Rehman
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Lucky G. Ngwira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Robina Semphere
- Department of Microbiology & HNTI, College of Medicine, Blantyre, Malawi
| | - Brewster Moyo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jon O. Odland
- Department of Public Health and Nursing, Norwegian University of Science & Technology, Trondheim, Norway
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Sefah IA, Mensah F, Kurdi A, Godman B. Barriers and facilitators of adherence to antiretroviral treatment at a public health facility in Ghana: a mixed method study. Hosp Pract (1995) 2022; 50:110-117. [PMID: 35189065 DOI: 10.1080/21548331.2022.2045132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness towards viral suppression leading to disease progression, greater risk of death and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups. METHOD A mixed method approach was used comprising of a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analysed using bivariate and multivariate methods while qualitative data were analysed using thematic framework approach. RESULTS Adherence levels was found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR =0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. Conclusion: Adherence to ART among patients living with HIV was sub-optimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Frederick Mensah
- Pharmacy Department, Atua Government Hospital, Eastern Region, Ghana
| | - Amanj Kurdi
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom.,School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, 0208, South Africa.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
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Lim PC, Chung YY, Tan SJ, Wong TY, Permalu DD, Cheah TK, Lim SL, Lee CY. Comparing the cost, glycaemic control and medication adherence of utilizing patients' own medicines (POMs) versus usual dispensing among diabetic patients in an outpatient setting. Daru 2021; 29:125-132. [PMID: 33538999 DOI: 10.1007/s40199-021-00389-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Millions worth of unused drugs particularly those indicated for chronic diseases such as diabetes were returned and disposed leading to substantial wastage. Use of patients' own medications (POMs) in the inpatient setting has reduced wastage and saved cost. The impact of utilizing POMs in the outpatient setting has hitherto not been determined. PURPOSE This study aims to compare the cost, medication adherence and glycaemic control of utilizing POMs versus usual dispensing. METHODS Prospective randomized controlled study was conducted among diabetic patients that required monthly medication refill in the Outpatient Pharmacy in 2017. Patients who consented were equally divided into POMs and control groups. Both groups brought excess medications from home at week-0 and week-12. Patients in the POMs group brought excess medications monthly and sufficient amount of drugs were added until the next refill date. Drugs were dispensed as usual in the control group. Total cost consisting of the cost of drugs, staff and building was calculated. Glycosylated haemoglobin (HbA1c) was measured at baseline and week-12. Adherence was measured based on pill counting. RESULTS Thirty patients aged 56.77 ± 14.67 years with 13.37 ± 7.36 years of diabetes participated. Baseline characteristics were similar between the groups. POMs minimized the total cost by 38.96% which translated to a cost saving of USD 42.76 ± 6.98, significantly different versus USD 0.02 ± 0.52 in the control group, p = 0.025. Mean HbA1c reduced significantly (-0.79%, p = 0.016) in the POMs group but not significant in the control group (-0.11%, p = 0.740). Medication adherence improved significantly in both groups at week-12 (p < 0.010). Nevertheless, patients in the POMs group were more adherent, 87.20% vs. 66.32%, p = 0.034. CONCLUSION Utilizing POMs resulted in cost saving, improved adherence and better glycaemic control. Use of POMs should be practiced in the outpatient pharmacy to reduce wastage and cost.
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Affiliation(s)
- Phei Ching Lim
- Pharmacy Department, Hospital Pulau Pinang, Penang, Malaysia
| | - Yin Ying Chung
- Pharmacy Department, Hospital Pulau Pinang, Penang, Malaysia
| | - Shien Joo Tan
- Pharmacy Department, Hospital Pulau Pinang, Penang, Malaysia
| | - Te Ying Wong
- Pharmacy Department, Hospital Pulau Pinang, Penang, Malaysia
| | | | | | - Shueh Lin Lim
- Medical Department, Hospital Pulau Pinang, Penang, Malaysia
| | - Chong Yew Lee
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
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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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Baxi SM, Vittinghoff E, Bacchetti P, Huang Y, Chillag K, Wiegand R, Anderson PL, Grant R, Greenblatt RM, Buchbinder S, Gandhi M, Liu AY. Comparing pharmacologic measures of tenofovir exposure in a U.S. pre-exposure prophylaxis randomized trial. PLoS One 2018; 13:e0190118. [PMID: 29315307 PMCID: PMC5760024 DOI: 10.1371/journal.pone.0190118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/05/2017] [Indexed: 01/22/2023] Open
Abstract
It is critical to assess adherence to pre-exposure prophylaxis (PrEP) in clinical trials. The relationship between pharmacokinetic measures of PrEP adherence and other adherence measures used in PrEP trials requires further characterization. Plasma, peripheral blood mononuclear cells (PBMCs), and hair samples were collected from 88 HIV-uninfected men who have sex with men in a placebo-controlled randomized PrEP trial; announced pill counts, medication electronic monitoring (MEMS), and self-report using visual analog scale (VAS) were also collected. Tenofovir (TFV or TFV-DP) in plasma, hair, and PBMCs were quantified. Proportions with drug detection, Spearman correlation coefficients, and univariate and multivariable regression models were used. Drug detection in plasma, PBMC, and hair samples was highly concordant with treatment arm assignment. TFV or TFV-DP levels were detected in most active-arm participants: 44/47 (94%) in plasma, 46/47 (98%) in hair, and 44/47 (94%) in PBMCs and in only 1/41 placebo arm participant. Correlation coefficients were r = 0.59 for plasma and PBMC, r = 0.34 for PBMC and hair and r = 0.36 for plasma and hair. MEMS and announced pill-counts were moderately correlated (r = 0.52) but less so with pharmacologic measures (range of r = 0.12 to 0.38). Self-reported adherence by visual analog scale demonstrated essentially no correlation with drug levels (r = 0.06 for hair, PBMC or plasma) and was a poor indicator of exposure to study product. Indices of drug exposure are important indicators in assessing adherence to PrEP; accounting for variability between measures may improve interpretation and use of adherence measures in future PrEP studies.
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Affiliation(s)
- Sanjiv M. Baxi
- Department of Medicine, University of California, San Francisco, California, United States of America
- School of Public Health, Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Yong Huang
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California, United States of America
| | - Kata Chillag
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Atlanta, Georgia, United States of America
| | - Ryan Wiegand
- Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Peter L. Anderson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, United States of America
| | - Robert Grant
- Department of Medicine, University of California, San Francisco, California, United States of America
- Gladstone Institutes, San Francisco, California, United States of America
- San Francisco AIDS Foundation, San Francisco, California, United States of America
| | - Ruth M. Greenblatt
- Department of Medicine, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Department of Clinical Pharmacy, University of California, San Francisco, California, United States of America
| | - Susan Buchbinder
- Department of Medicine, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - Albert Y. Liu
- Department of Medicine, University of California, San Francisco, California, United States of America
- San Francisco Department of Public Health, San Francisco, California, United States of America
- * E-mail:
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Clay PG. EMERGE from reporting inconsistencies on pharmacy adherence intervention. J Am Pharm Assoc (2003) 2017; 57:644. [PMID: 28882253 DOI: 10.1016/j.japh.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. J Acquir Immune Defic Syndr 2014; 66:340-8. [PMID: 24784763 PMCID: PMC4059553 DOI: 10.1097/qai.0000000000000172] [Citation(s) in RCA: 258] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Antiretroviral pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy for which adherence is a known determinant of efficacy. Blood concentrations of PrEP medications are one objective marker of adherence. Methods: In a placebo-controlled PrEP efficacy trial of tenofovir disoproxil fumarate (TDF) and TDF with emtricitabine (FTC/TDF) among 4747 African women and men with an HIV-infected partner, we measured plasma tenofovir concentrations from participants in the active PrEP arms: 29 HIV seroconverters (cases) and 196 randomly selected controls who remained uninfected. Results: Among controls, 71% of visits had tenofovir concentrations >40 ng/mL, consistent with steady-state daily dosing, compared with 21% of cases at the visit HIV was first detected. Pill count data indicated that 96% of controls and 66% of cases had >80% adherence for these same visits. The estimated protective effect of PrEP against HIV, based on concentrations >40 ng/mL, was 88% (95% confidence interval: 60 to 96, P < 0.001) for individuals receiving TDF and 91% (95% confidence interval: 47 to 98, P = 0.008) for individuals receiving FTC/TDF. Controls had consistent patterns of PrEP concentrations during follow-up; among the 81% with concentrations >40 ng/mL at month 1, 75% maintained this concentration at month 12. Only 5 of 29 seroconverters seemed to be consistently adherent to PrEP. Tenofovir concentrations >40 ng/mL were associated with older age and shorter time on study; concentrations ≤40 ng/mL occurred more commonly when participants reported no sex with their HIV-infected partner. Conclusions: Plasma concentrations of tenofovir consistent with daily dosing were highly predictive of protection from HIV acquisition. Most of those who took PrEP seemed to have high and consistent adherence.
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