Non-adherence to anti-retroviral medication in Shiraz, 2014: a cross sectional study

Risk Factors for Non-Adherence to Medication for Liver Transplant Patients: An Umbrella Review

Background/Objectives: Liver Transplantation (LT) is the second most common solid organ transplantation. Medication adherence on LT patients is key to avoiding graft failure, mortality, and important quality of life losses. The aim of this study is to identify risk-factors for non-adherence to treatment of liver transplant patients according to reliable published evidence. Methods: An umbrella review within the context of adherence to immunosuppressant medication of LT patients, was conducted. The review was performed in accordance with the principles of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Results: A total of 11 articles were finally included for the review. Non-adherence factors were identified and allocated using the WHO classification of factors for non-adherence. Each of these groups contains a subset of factors that have been shown to influence adherence to medication, directly or indirectly, according to literature findings. Conclusions: The results of the review indicate that sociodemographic factors, factors related to the patient, factors related to the treatment, condition-related and health system-related factors are good categories of predictors for both adherence and non-adherence to immunosuppressive medication in LT patients. This list of factors may help physicians in the treating and recognizing of patients with a potential risk of non-adherence and it could help in the designing of new tools to better understand non-adherence after LT and targeted interventions to promote adherence of LT patients.

'You just prefer to die early!': how socioecological context impedes treatment for people living with HIV in Iran

INTRODUCTION

Despite the low prevalence of HIV and broad provision of antiretroviral therapy, the Middle East and North Africa (MENA) remains the only region where new HIV infections and AIDS-related deaths are not declining. There is a dearth of evidence from MENA on antiretroviral therapy engagement. In this qualitative study, we sought to identify the ways in which successful treatment is hindered in Iran, which is home to 24% of HIV infections in MENA.

METHODS

From August 2018 to January 2019, we used purposive sampling and conducted 12 individual interviews and 8 focus group discussions with 27 female and 31 male patients, in addition to 5 individual interviews with HIV care providers and 1 focus group discussion with 8 care providers. Social constructivism augmented with realist-informed thematic analysis was used to understand how the socioecological context triggers cognitive and affective mechanisms that disrupt antiretroviral therapy.

RESULTS

The use of Thematic Network Analysis resulted in the identification of three key cognitive and affective mechanisms that appear to shape treatment experience and are triggered via HIV's socioecological context and changing economic conditions in Iran: denial in response to societal negative perceptions of HIV; fear in response to societal lack of awareness regarding HIV and misinformation; and despair in response to HIV-related stigma and enacted discrimination, economic insecurity and social support.

CONCLUSIONS

To our knowledge, this is the first study within MENA to identify pathways through which successful treatment is hindered. It appears that lack of societal awareness regarding HIV is specific to low prevalence settings, such as MENA countries, where negative perceptions, stigma, discrimination and misinformation regarding HIV and its treatment produce denial, fear and despair, acting as mechanisms that disrupt antiretroviral therapy. The experience of despair, in response to changing economic conditions and social support, further impacts treatment experience.

Medication Non-adherence Prevalence and Determinants in Children and Adolescents with Chronic Liver Diseases

Background: Medication adherence is one of the most important challenges in chronic diseases. Objectives: In this study, we investigated medication adherence prevalence among children with chronic liver diseases. Methods: A total of 160 children with chronic liver disease were enrolled in our study. We evaluated medication adherence using the 8-item Morisky Medication Adherence Scale (MMAS-8) and classified them based on the scores (score < 6 = low adherence, scores 6 - 8 = medium adherence, and > 8 = high adherence). Logistic regression recognized final influencing variables on adherence. Results: Of 160 patients, 84 (52.5%) were female, and the mean age of patients was 11.2 ± 4.4 years. Also, 56 participants (35%) were high adherers, and 66 (41.25%) were low adherers. The most common reason for low adherence was forgetfulness in 37 patients (23.13%) and low access to medication in 21 subjects (13.13%). In multivariate logistic regression, age, housing status, and underlying disease were significantly associated with medication adherence. Conclusions: Almost half of the children with chronic liver disease demonstrated low medication adherence. Age, housing status, and underlying disease were significantly associated with medication adherence. We should implement programs to reduce medication non-adherence among children with chronic liver disease.

Antiretroviral Treatment Adherence and Determinant Factors Among Adult People Infected with Human Immunodeficiency Virus in Eastern Tigray General Hospitals, Northern Ethiopia, 2019

Background

Human immune deficiency virus is a significant cause of morbidity and mortality, especially in developing countries. Globally, about 37.9 million people had HIV/AIDS in 2018 and 36.2 million people were adults, Moreover, about 770,000 AIDS-related mortality occurred in adult infected people. Appropriate antiretroviral therapy adherence is important to minimize drug resistance, improve virological response, and decrease morbidity and mortality. Researches done in Ethiopia reported knowledge on antiretroviral therapy adherence and determinant factors were limited and the literature was scared. Moreover, the eastern zone of Tigray was inhabited with a highly rural population and this may be a significant facilitator and barrier to ART adherence. According to a census conducted by the central agency of Ethiopia in 2013, the eastern zone of Tigray has a population of 755,343, of whom 395,705 are women and 609,279 (80.66%) are rural inhabitants.

Objective

This study aimed to assess antiretroviral therapy adherence and determinant factors among Adult HIV infected people in eastern Tigray, 2019.

Methods

A cross-sectional study design was conducted from January 1 to June 30 2019 on 339 adults attending the antiretroviral clinic at eastern Tigray. A systematic random sampling method was used to pick the study samples. Data were collected by a structured questionnaire using face to face interview. P-value < 0.05 in multivariate analysis was used as a cut-point for the statistical significance of the association.

Results

About 74.6% of participants were adhering to antiretroviral therapy. Place of residence (AOR= 5.13 (1.63–13.44), social support (AOR=2.71 (1.37–9.74), HIV disclosure (AOR=3.32 (1.43–9.24), free from depression (AOR=2.54 (1.36–9.43) and free from substance use (AOR=3.42 (1.67–10.87) were the factors associated with adherence to antiretroviral therapy.

Conclusion and Recommendation

Drug adherence in eastern Tigray was low and place of residence, social support, HIV disclosure, free from depression and free substance use were the factors associated with ART. So, awareness creation for rural residence, social support, avoidance of depression, and substance use should be strengthened to increase drug adherence.

Factors Influencing Effectiveness of Peer Education Against Nonadherence to Antiretroviral Therapy Among Adult People Living with HIV/AIDS: A Pre-Post Intervention Study in Arsi Zone, Ethiopia

Background

Nonadherence to antiretroviral therapy (ART) among people with HIV/AIDS can lead to drug resistance and death. Different studies have defined nonadherence, and it denotes at least one missed dose of ART within 28 days. One of the strategies to prevent nonadherence to ART could be peer education. However, published studies which test out whether or not peer education is effective for prevention of nonadherence to ART among adults living with HIV were not available. Moreover, published studies on factors discussing the success of peer education against nonadherence to ART were not available, so we conducted this study.

Objectives

To determine effectiveness of peer education against nonadherence to ART and identify factors influencing the effectiveness of peer education for prevention of nonadherence to ART among people living with HIV/AIDS in Arsi zone, Ethiopia.

Methods

An institution based pre-post intervention study was conducted. The intervention was giving peer education for three months. Frequencies and percentages were used to describe the data. Binary and multivariate logistic regressions were used to assess the variables.

Results

The data was collected from 355 and 319 people with HIV/AIDS at pre- and post-intervention stages, respectively. Experiencing an ART side effect, reminder to take ART, gender, marital status and monthly income were associated with nonadherence. More study participants who had not useda reminder to take ART service missed at least one dose of ART when compared to those who used a reminder to take ART service (adjusted odds ratio (AOR) =6.21; 95% CI=2.12–18.20).

Conclusion

Experiencing a side effect of ART influenced effectiveness of peer education negatively while using reminder to take ART influenced effectiveness positively. Peer education is effective for reduction of nonadherence to ART if it is used with reminder to take ART. This study can be a base for further studies that should be conducted in various areas, since peer education can be influenced by sociodemographic and economic factors.