1
|
Afrane AKA, Goka BQ, Renner L, Yawson AE, Alhassan Y, Owiafe SN, Agyeman S, Sagoe KWC, Kwara A. HIV virological non-suppression and its associated factors in children on antiretroviral therapy at a major treatment centre in Southern Ghana: a cross-sectional study. BMC Infect Dis 2021; 21:731. [PMID: 34340689 PMCID: PMC8330060 DOI: 10.1186/s12879-021-06459-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana. METHODS A cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression. RESULTS The mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04-6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58-15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92-126.31], p < 0.001) and being on a nevirapine (NVP) based regimen (AOR 7.93 [95% CI 1.58-1.15], p = 0.005). CONCLUSION The prevelance of virological non-suppression was high. Virological non-suppression was associated with a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment and being on a NVP based regimen. Early initiation of ART and phasing out NVP-based regimen might improve viral load suppression in children. In addition, children with a history of TB may need focused measures to maximize virological suppression.
Collapse
Affiliation(s)
- Adwoa K A Afrane
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana.
| | - Bamenla Q Goka
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Lorna Renner
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, Legon, Accra, Ghana
| | - Yakubu Alhassan
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Seth N Owiafe
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Seth Agyeman
- Department of Immunology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kwamena W C Sagoe
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Awewura Kwara
- Department of Medicine, University of Florida, College of Medicine, Gainesville, Florida, USA
| |
Collapse
|
2
|
Costa CK, Abe SY, da Silva GP, Carneiro E, Miguel MD. Recommended method for health services to determine adherence to antiretroviral therapy: a comparison of three models. Int J STD AIDS 2019; 30:1382-1388. [PMID: 31744394 DOI: 10.1177/0956462419869512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The medication possession ratio (MPR) method is commonly used for the determination of antiretroviral medication adherence. However, different ways of calculating MPR and methodological issues hinder the interpretation of the results and the reproducibility of the method. Thus, this study used three different models of MPR calculation and aimed to identify the one that best represents the situation of patient adherence. The results show that there was a statistically significant difference between the adherence rates determined by the three models, which indicates the need to specify the parameters used for calculation in the MPR method. However, the models individually were found to be related to viral suppression, but none of them had a greater effect than the other in this regard. The model that used residual medication (RM) and a fixed period of analysis allowed for a more precise identification of the number of doses that the patient used when compared to the others. Health services should avoid the application of the model using a variable analysis period. This study found that RM and the period of analysis considered are the main influencing factors in the accuracy of adherence results when the MPR method is used.
Collapse
Affiliation(s)
- Camila K Costa
- DEPARTMENT of Pharmacy, Federal University of Paraná, Curitiba, Brazil
| | - Simone Y Abe
- Academic of Medicine, Federal University of Paraná, Curitiba, Brazil
| | | | - Eliane Carneiro
- Department of Collective Health, Federal University of Paraná, Curitiba, Brazil
| | - Marilis D Miguel
- DEPARTMENT of Pharmacy, Federal University of Paraná, Curitiba, Brazil
| |
Collapse
|
3
|
Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BCP. Assessing methods of measuring medication adherence in chronically ill children-a narrative review. Patient Prefer Adherence 2019; 13:1175-1189. [PMID: 31413546 PMCID: PMC6660631 DOI: 10.2147/ppa.s200058] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/13/2019] [Indexed: 12/24/2022] Open
Abstract
Nonadherence in children who use long-term medication is a serious problem and assessing adherence is an important step to provide solutions to this problem. Medication adherence can be measured by several methods, including (a) self-report questionnaires or structured interviews, (b) therapeutic drug monitoring (TDM), (c) electronic devices, and (d) pick-up/refill rates. The objective of this narrative review is to provide an overview of the literature about methods for the measurement of medication adherence in chronically ill children and adolescents. Therefore, we conducted a literature search by using multiple databases. Four methods of monitoring medication adherence are presented for the most described chronic diseases: asthma, HIV/AIDS, epilepsy, diabetes mellitus and ADHD. First, 10 commonly used self-report questionnaires and structured interviews are described, including the main characteristics, (dis)advantages and their validation studies. Second, the use of TDM in pediatric trials for medication adherence measurement is discussed. New sampling methods (e.g. dried blood spot) and sampling matrices (e.g. hair, saliva and urine) have shown their benefits for TDM in children. Third, electronic devices to measure medication adherence in children are presented, being developed for several drug administration routes. Fourth, the analyses, advantages and disadvantages of pharmacy data are discussed. The usage of this data requires specific calculations and interpretations to assess adherence. As presented in this review, every adherence method has specific (dis)advantages. When deciding which adherence method is applicable, validity and generalizability should be taken into account. Combining multiple methods seems to offer the best solution in the daily clinical practice.
Collapse
Affiliation(s)
- Linda Al-Hassany
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
- Correspondence: Linda Al-HassanyDepartment of Hospital Pharmacy, University Medical Center Rotterdam, Postal Box 2040, Rotterdam3000 CA, The NetherlandsTel +3 110 703 3202Email
| | - Sanne M Kloosterboer
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
| | - Bram Dierckx
- Erasmus MC, University Medical Center Rotterdam, Department Child and Adolescent Psychiatry, Rotterdam, The Netherlands
| | - Birgit CP Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, Rotterdam, The Netherlands
| |
Collapse
|
4
|
Ingle SM, Crane HM, Glass TR, Yip B, Lima VD, Gill MJ, Hanhoff N, Ammassari A, Mugavero MJ, Tate JP, Guest J, Turner NL, May MT, Sterne JAC. Identifying Risk of Viral Failure in Treated HIV-Infected Patients Using Different Measures of Adherence: The Antiretroviral Therapy Cohort Collaboration. J Clin Med 2018; 7:jcm7100328. [PMID: 30301179 PMCID: PMC6209956 DOI: 10.3390/jcm7100328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 11/16/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) is critical for successful treatment of Human Immunodeficiency Virus (HIV), but comparisons across settings are difficult because adherence is measured in different ways. We examined utility of different adherence measures for identification of patients at risk of viral failure (VF). Eight cohorts in the ART Cohort Collaboration contributed data from pharmacy refills or self-report questionnaires collected between 1996 and 2013 (N = 11689). For pharmacy data (N = 7156), we examined associations of percentage adherence during the 1st year of ART with VF (>500 copies/mL) at 1 year. For self-report data (N = 4533), we examined 28-day adherence with VF based on closest viral load measure within 6 months after questionnaire date. Since adherence differed markedly by measurement type, we defined different cut-off points for pharmacy (lower <45%, medium 45–99%, higher 100%) and self-report (lower ≤95%, medium 96–99%, higher 100%) data. Adjusted odds ratios (ORs) for VF in lower and medium, compared to higher adherence groups, were 23.04 (95% CI: 18.44–28.78) and 3.84 (3.36–4.39) for pharmacy data. For self-report data, they were 3.19 (2.31–4.40) and 1.08 (0.80–1.46). Both types of measure were strongly associated with VF. Although adherence measurements over longer time-frames are preferable for prediction, they are less useful for intervention.
Collapse
Affiliation(s)
- Suzanne M Ingle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Heidi M Crane
- Clinical Epidemiology and Health Services Research Core, Center for AIDS Research, University of Washington, WA 98104, USA.
| | - Tracy R Glass
- Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland.
| | - Benita Yip
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | | | - Adriana Ammassari
- Istituto Nazionale Malattie Infettive "L. Spallanzani", IRCCS, 00149 Rome, Italy.
| | - Michael J Mugavero
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, AL 35294, USA.
| | - Jan P Tate
- Yale University School of Medicine, West Haven, CT 06510, USA.
| | - Jodie Guest
- HIV Atlanta VA Cohort Study (HAVACS), Rollins School of Public Health at Emory University, Atlanta, GA 30322, USA.
| | - Nicholas L Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Margaret T May
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
| |
Collapse
|
5
|
Cruz CCP, Mistro S, Mendes CMC, Schooley RT, Badaró RJDS. Monitoring of Delay to Pharmacy Refill in Assessing Adherence to Antiretroviral Therapy. J Pharm Pract 2018; 33:158-163. [PMID: 30122111 DOI: 10.1177/0897190018795339] [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: 11/16/2022]
Abstract
BACKGROUND Adherence to antiretroviral (ARV) therapy remains a major challenge in HIV therapeutics. OBJECTIVE To assess the adherence to ARV therapy by measuring the delay in monthly refilling of ARV drugs using pharmacy records and to correlate this with HIV plasma RNA measurements and CD4+ cell count. METHOD Records of 170 HIV-positive patients were examined to identify HIV viral load (VL)/CD4+ results and the time interval to refill ARVs at the pharmacy. The correlation between the number of days missed to refill ARVs and plasma HIV-RNA detectability/CD4+ count was performed using the Spearman's correlation coefficient (r). RESULTS Fewer days missed to refill ARV was positively correlated with undetectable VL and increase in CD4+ count (r = 0.407 and 0.237, respectively). Increase in adherence was correlated with longer retention in the cohort (r = 0.208). CONCLUSION Monitoring the delay to pick up ARVs from the pharmacy can be an important and simple tool to identify patients requiring assessment of their adherence.
Collapse
Affiliation(s)
| | - Sóstenes Mistro
- Program of Post-Graduation in Public Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | | | | |
Collapse
|
6
|
Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol 2013; 4:91. [PMID: 23898295 PMCID: PMC3722478 DOI: 10.3389/fphar.2013.00091] [Citation(s) in RCA: 429] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE A number of potential determinants of medication non-adherence have been described so far. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. The purpose of this study was a systematic review of current research on determinants of patient adherence on the basis of a recently agreed European consensus taxonomy and terminology. METHODS MEDLINE, EMBASE, CINAHL, Cochrane Library, IPA, and PsycINFO were systematically searched for systematic reviews published between 2000/01/01 and 2009/12/31 that provided determinants on non-adherence to medication. The searches were limited to reviews having adherence to medication prescribed by health professionals for outpatient as a major topic. RESULTS Fifty-one reviews were included in this review, covering 19 different disease categories. In these reviews, exclusively assessing non-adherence to chronic therapies, 771 individual factor items were identified, of which most were determinants of implementation, and only 47-determinants of persistence with medication. Factors with an unambiguous effect on adherence were further grouped into 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 6 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and use of poor measurement methods resulted in many inconsistencies. CONCLUSIONS This study provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore, the prediction of non-adherence of individual patients is difficult, and suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. The limited number of publications assessing determinants of persistence with medication, and lack of those providing determinants of adherence to short-term treatment identify areas for future research.
Collapse
Affiliation(s)
- Przemyslaw Kardas
- First Department of Family Medicine, Medical University of Lodz Lodz, Poland
| | | | | |
Collapse
|