Economic implications of nonadherence to highly active antiretroviral treatment in HIV patients

The efficacy and cost-effectiveness of a family-based economic empowerment intervention (Suubi + Adherence) on suppression of HIV viral loads among adolescents living with HIV: results from a Cluster Randomized Controlled Trial in southern Uganda

INTRODUCTION

Evidence from low-resource settings indicates that economic insecurity is a major barrier to HIV treatment adherence. Economic empowerment (EE) interventions have the potential to improve adherence outcomes among adolescents living with HIV (ALWHIV) by mitigating the effects of poverty. This study aims to assess the efficacy and cost-effectiveness of a savings-led family-based EE intervention, Suubi + Adherence, aimed at improving antiretroviral therapy (ART) adherence outcomes ALWHIV in Uganda.

METHODS

Adolescents (mean age 12 years at enrolment; 56% female) receiving ART for HIV at 39 health centres were randomized to Suubi + Adherence intervention (n = 358) or bolstered standard of care (BSOC; n = 344). A difference-in-differences analysis was employed to assess the change in the proportion of virally suppressed adolescents (HIV RNA viral load <40 copies/mL) over 24 months. The cost-effectiveness analysis examined how much the intervention cost to virally suppress one additional adolescent relative to BSOC from the healthcare provider perspective.

RESULTS

At 24 months, the intervention was associated with an 8.85-percentage point [95% confidence interval (CI) 0.80 to 16.90 percentage points] increase in the proportion of virally suppressed adolescents between the study arms (p = 0.032). Per-participant costs were US$177 and US$263 for the BSOC and intervention groups respectively. The incremental cost of virally suppressing one additional adolescent was estimated at US$970 [95% CI, US$508 to 10,725] over two years.

CONCLUSIONS

Our results support the integration of family-based EE interventions into adherence-support strategies as part of routine HIV care in low-resource settings to address the underlying economic drivers of poor ART adherence among ALWHIV. Moreover, per-participant costs to achieve viral suppression do not seem prohibitive compared to other community-based adherence interventions targeted at ALWHIV in low-resource settings. Further research on combination interventions at the nexus of economic security and HIV treatment and care is needed to inform the development of feasible and scalable HIV policies and programmes.

Predictors of psychotropic medication adherence among HIV+ individuals living with bipolar disorder

OBJECTIVE

HIV infection and bipolar disorder are highly comorbid and associated with frontostriatal disruption, emotional dysregulation, and neurocognitive impairment. Psychiatric and cognitive factors have been linked to antiretroviral nonadherence; however, predictors of psychotropic adherence among HIV+ individuals with psychiatric comorbidities have not been explored. We evaluated predictors of psychotropic adherence among individuals with HIV infection and bipolar disorder.

METHOD

Psychiatric medication adherence of 50 participants with HIV infection and bipolar disorder was tracked for 30 days using Medication Event Monitoring Systems. Participants completed neurocognitive, neuromedical, and psychiatric batteries.

RESULTS

Mean psychotropic adherence rate was 78%; 56% of participants achieved ≥90% adherence. Younger age and onset of depressive symptoms, more severe current depressive symptoms, number of previous psychiatric hospitalizations and suicide attempts, poorer neurocognition, and more negative attitudes and self-beliefs toward medications univariably predicted worse psychotropic adherence (p's < .10). A multivariable model demonstrated a combination of current depressive symptoms and more negative attitudes toward medications significantly predicting poorer adherence (R(2 )= 0.27, p < 0.003). Secondary analyses revealed an interaction between neurocognition and mood, such that individuals with HIV infection and bipolar disorder who had greater executive dysfunction and depressive symptoms evidenced the poorest psychotropic adherence (p < 0.001).

CONCLUSIONS

Both psychiatric and neurocognitive factors contribute to poorer psychotropic adherence among HIV+ individuals with serious mental illness. Adherence interventions aimed at remediating these factors may be especially fruitful.

Exploring ART intake scenes in a human rights-based intervention to improve adherence: a randomized controlled trial

To assess the effectiveness of a psychosocial individual intervention to improve adherence to ART in a Brazilian reference-center, consenting PLHIV with viral load >50 copies/ml were selected. After 4 weeks of MEMS cap use, participants were randomized into an intervention group (IG) (n = 64) or control group (CG) (n = 57). CG received usual care only. The IG participated in a human rights-based intervention approach entailing four dialogical meetings focused on medication intake scenes. Comparison between IG and CG revealed no statistically significant difference in adherence measured at weeks 8, 12, 16, 20 and 24. Viral load (VL) decreased in both groups (p < 0.0001) with no significant difference between study groups. The lower number of eligible patients than expected underpowered the study. Ongoing qualitative analysis should provide deeper understanding of the trial results. NIH Clinical Trials: NCT00716040.

A cost analysis of an Internet-based medication adherence intervention for people living with HIV

The purpose of the study was to document development costs and estimate implementation costs of an Internet-based medication adherence intervention for people living with HIV in the United States. Participants (n = 61) were enrolled in the 8-week study in 2011 and entered the intervention website remotely in the setting of their choice. Development costs were obtained from a feasibility and acceptability study of an Internet-based medication adherence intervention. Implementation costs were estimated based on an 8-week trial period during the feasibility and acceptability study. Results indicated that although developing an Internet-based medication adherence intervention is expensive, the monthly cost of implementing and delivering the intervention is low. If the efficacy of similar interventions can be established, these results suggest that Internet could be an effective method for delivering medication adherence interventions to persons residing in areas with limited access to in-person adherence services.

[Use and evaluation of the health care services and the antirretroviral medication in HIV diagnosed people]

AIM

To analyze the use or not of antirretrovirals (ART) human inmunodeficiency virus (HIV) diagnosed people in relation to the utilization and evaluation of the health care services and sociodemographic profiles.

METHODS

The data was collected with a questionnaire to 108 HIV people, in the city of Granada (Spain) between July and September 2005. Participants were contacted from three sources: infectious diseases service, HIV's nongovernmental association and from the street through peers.

RESULTS

The mean age was 40 years, and the participants knew that they were seropositives since a mean of 12 years ago. At the moment of the interview, 55.6% consumed illegal drugs (cannabis not included), and 63.9% were former injecting drug users. In relation to ART, 25% did not take it, 15.7% were totally adherent, and 59.3% were in treatment but failed in the intake of the medication as prescribed. In general, participants have a positive and accurate perception of ART. The group of the adherents showed the best scores and those who do not take ART the lowest, in almost the totality of the studied variables.

CONCLUSION

The present study suggests that is important continuing to improve the access to the health and social resources, to implement strategies of motivation for patients who have been many years in HIV treatment and to integrate in the health care system social excluded HIV positive people.

Adherence: a review of education, research, practice and policy in Switzerland

Nonadherence to medication treatment regimens is a major preventable risk behavior in both acute and chronic diseases. Community pharmacists are facilitators in community care for promoting medication adherence and they should implement interdisciplinary medication adherence programs. To do so, pharmacists should be educated in medication adherence, and new pharmaceutical care policies should be implemented. The healthcare system should evolve to better meet the specific needs of patients.

AIMS

this article describes what has been undertaken in the last decade in medication adherence in terms of education, research, practice and policy in Switzerland.

METHODS

Medline was searched, with the search limited to Switzerland. The three Swiss pharmacy schools were also contacted to collect information about the medication adherence content of both their courses and research programs. National policies related to medication adherence were also reviewed for relevant content.

RESULTS

EDUCATION

two pharmacy schools offer courses devoted specifically to medication adherence. The number of hours dedicated to the topic varies between 4 to13.

RESEARCH

a total of 16 studies met the inclusion criteria. Chronic patients were the focus of 9 studies. Medication adherence was the primary outcome of all studies; 10 studies also measured clinical outcomes. Nine studies evaluated the prevalence of medication nonadherence; three studies evaluated the feasibility of new technologies for monitoring adherence; three studies evaluated medication adherence enhancing programs. Policies: three cognitive pharmaceutical services are reimbursed by healthcare insurers, which are directly related to medication adherence.

CONCLUSIONS

Pharmacists in Switzerland have been actively involved in medication adherence research since the mid '90s. Specific medication adherence courses have entered the curriculum of pharmacy schools, and policies in Switzerland are slowly beginning to meet needs of chronic patients by the introduction of pharmaceutical cognitive services and reimbursement fees.