Adherence Factors Research Articles

Perceived Barriers to Healthy Lifestyle Adherence and Associated Factors Among Patients with Type 2 Diabetes Mellitus: Implications for Improved Self-Care

Perceived Barriers to Healthy Lifestyle Adherence and Associated Factors Among Patients with Type 2 Diabetes Mellitus: Implications for Improved Self-Care

A Review on Knowledge of Diabetes, Medication Adherence, and Factors associated with Non- adherence among Diabetes Mellitus Type 2 Patients

Background: This review paper addresses the critical issue of medication adherence among patients with Type 2 Diabetes Mellitus (T2DM). This review paper aims to evaluates the current literature on prevalence of medication adherence among patients with Type 2 Diabetes Mellitus, assesses the level of knowledge regarding diabetes mellitus and its association with medication adherence. In addition, to identify and analyse the factors contributing to non-adherence to medication among individuals with Type 2 Diabetes Mellitus. Methods: The authors conducted a thorough literature review using databases such as ProQuest, PubMed, ScienceDirect, and Google Scholar. They focused on peer-reviewed articles published between 2019 and 2024, employing keywords related to medication adherence, knowledge, and sociodemographic factors. A total 25 studies selected for inclusion, utilizing various methodologies including quantitative, qualitative, and interventional approaches. Results: The findings revealed significant variability in medication adherence rates among T2DM patients, ranging from 35.8% to 67.5%. Key factors influencing adherence included sociodemographic characteristics such as age, gender, ethnicity, education level, and economic status. Higher levels of diabetes knowledge were associated with better adherence, although the relationship was not universally significant, indicating that other factors also play a role. Conclusion: The review concludes that enhancing medication adherence among T2DM patients requires targeted interventions that address identified barriers, including educational deficits and socioeconomic challenges. Further research is recommended to develop effective educational strategies tailored to diverse patient populations, ultimately aiming to improve health outcomes and adherence rates in this critical area of public health.

Diabetes-related patients’ profile and strategy in improving their knowledge and adherence: A mixed method study

Background: Effective education and information during diabetes patients’ treatment to enhance their knowledge could impact their medication adherence to improve therapeutic outcomes. This study aims to explore diabetes-related patient profiles, including knowledge, adherence, and medication nonadherence factors among diabetic patients. Also, it explores the implemented pharmacists' strategies to raise knowledge and adherence. Methods: This study had two phases. The first phase focused on diabetic patients, assessing their profiles, knowledge about diabetes, medication adherence, and factors contributing to nonadherence. The second phase examined pharmacists' strategies to improve patients' knowledge and adherence. Using a mixed-methods design, participants were recruited from primary healthcare in Yogyakarta. Medication adherence was measured with a four-item Morisky, Green, and Levine Medication Adherence Scale (MGLS), while knowledge was assessed using a 10-item adapted questionnaire from the Diabetes Knowledge Questionnaire (DKQ-24). Results: This study enrolled 104 patients and 24 pharmacists. Most patients (40.4%) had low knowledge of disease and medication related to diabetes. A quarter of the participants (26%) exhibited poor adherence. Almost all of the pharmacists have developed strategies to enhance patients’ knowledge and adherence (95.8%), providing drug information services and medication control cards. Conclusion: Improving patient knowledge, addressing non-adherence, and standardising pharmacists' strategies are necessary, alongside developing a comprehensive service model to enhance therapeutic outcomes.

Conservative surgical repair of placenta increta invading into uterine septum: case report

BackgroundThe prevalence of placenta accreta spectrum is on the rise, primarily as a consequence of an increasing number of Cesarean sections. Nevertheless, uterine anomalies, particularly uterine septum, pose a notable risk factor for its occurrence. While there are limited case reports documenting the association between uterine septum and placenta adherence, most of these cases have been linked to prior hysteroscopic treatment of the septum. Notably, this case represents the first-reported instance in which a uterine septum was preoperatively diagnosed in association with placenta increta adherent to it, and subsequently managed conservatively.Case presentationA 30-year-old pregnant Egyptian female patient, who had undergone two previous cesarean sections, was diagnosed with placenta increta and had an incomplete uterine septum. She was admitted to Elshatby University Hospital in December 2021. During her surgery, it was found that the placenta was adherent to right lower aspect of the septum, as well as the right anterior, lateral, and posterior uterine walls. A conservative surgical approach was scheduled and successfully performed, and 3 months later, an ultrasound examination revealed that the uterus had returned to its normal size, with no evidence of isthmocele or synechiae. The only abnormality noted was the presence of the septum.ConclusionUltrasound plays a crucial role in diagnosing placenta accreta and identifying any additional uterine abnormalities that may guide the planning of conservative treatment. Uterine septum represents a risk factor for placental adherence, as the placenta can indeed become adherent to it. Muscle defects may become apparent following placental separation and can often be effectively managed through the use of running sutures, obviating the need for resection of the affected portion.Trial registration clinicaltrials.gov, registered on 27 April 2021, registration number: NCT04866888, https://clinicaltrials.gov/ct2/show/NCT04866888.

Adherence to secondary antibiotic prophylaxis among patients with acute rheumatic fever and/or rheumatic heart disease: a systematic review and meta-analysis

ObjectivesWorldwide, a number of studies have been conducted to assess the prevalence of adherence to secondary antibiotic prophylaxis and to identify the associated factors (reasons) for poor adherence among patients...

Abstract Su705: Predictive Model and Factors for Out-of-Hospital Cardiac Arrest in Geriatric Patients with insomnia: A Longitudinal Study

Background: Previous studies have shown that geriatric insomnia can impact the quality of life and lead to various health risks and comorbidities, which may further result in out-of-hospital cardiac arrest (OHCA). Therefore, assessing the risk of OHCA in elderly patients with insomnia is crucial. Hypothesis: We hypothesized that a predictive model incorporating demographic, clinical, and treatment adherence factors can effectively estimate the risk of OHCA among geriatric patients with insomnia. Aim: This study aimed to develop and validate a predictive model for OHCA in geriatric patients with insomnia using a large-scale population-based analysis. Method: A retrospective cohort study was conducted using data from Taiwan's Health and Welfare Data Science Center spanning from 2011 to 2020. The study included elderly patients diagnosed with insomnia who received medication. Predictors of OHCA, such as age, sex, comorbidities, medication adherence, and psychotherapy, were analyzed using multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC) with both internal and temporal validation. Results: Among 438,147 eligible elderly patients with insomnia, 7,666 experienced OHCA. Using data from 2011 to 2018 for model development, the AUROC for predicting OHCA within 7 days, 30 days, and 90 days ranged from 0.749 to 0.762 in the training set and 0.768 to 0.784 in the validation set. Key predictors included older age, male sex, prior medical resource use, hemodialysis, pre-existing comorbidities, medication possession ratio, medication changes, and recent psychotherapy (Figure 1). The model was also tested in 2019 and 2020 dataset (began of the COVID-19 in Taiwan), respectively, demonstrating consistent predictive performance (Figure 2). Specifically, the 7-day model in 2019 showed a sensitivity of 0.776, specificity of 0.632, and accuracy of 0.632, with a positive likelihood ratio (PLR) of 2.11, and negative likelihood ratio (NLR) of 0.36. In 2020, it achieved a sensitivity of 0.739, specificity of 0.661, accuracy of 0.661, PLR of 2.18, NLR of 0.40. Conclusion: The study developed a reliable predictive model for OHCA in geriatric patients with insomnia, highlighting significant predictors such as age, comorbidities, medication adherence, and recent psychotherapy. This model can aid clinicians in identifying high-risk patients and improving preventative care strategies.

CTNI-40. PSYCHOLOGICAL DOMAINS CORRELATE WITH ADHERENCE IN TTFIELDS TREATMENT OF GLIOBLASTOMA

Abstract INTRODUCTION Adherence is critical to the success of the treatment with Tumor Treating Fields (TTFields) for Glioblastoma Multiforme (GBM). Previously found factors influencing treatment adherence in general are social support, belief in the efficacy of treatment, communication with physicians, anxiety, and depression. We propose those five factors predict adherence to TTFields treatment since, to our knowledge, no systematic data exists for this treatment. METHODS We conducted a longitudinal study and included 25 patients with newly diagnosed GBM who received treatment with TTFields. Participants were invited to take part in six structured interviews, each four weeks apart, during their treatment with TTFields, assessing the five factors expected to influence treatment adherence over time. RESULTS We found a significant impact of communication, anxiety, and depression on treatment adherence with TTFields. Furthermore, also the time point during treatment (days of treatment) was significantly related to adherence. Better physician communication and a higher level of anxiety were associated with higher adherence and higher depression with less adherence. A higher belief in efficacy showed a trend toward significantly improving treatment adherence. When results were separately compared for early, middle, and later 90-day treatment phases, factors seemed to be differentially influential, with belief in efficacy being significantly relevant in the first, efficacy, communication, and anxiety in the second, and depression in the third phase of treatment with TTFields. CONCLUSIONS Our findings not only confirm the predictive role of psychosocial factors in treatment adherence but also provide specific targets for psychological interventions. This suggests that by addressing these factors, healthcare providers can potentially increase treatment adherence among GBM patients. Moreover, our results indicate that these interventions may be most effective when tailored to the specific phase of treatment, offering a practical approach for healthcare providers.

Evaluation of Hypertension-Related Knowledge, Medication Adherence, and Associated Factors Among Hypertensive Patients in the Aljouf Region, Saudi Arabia: A Cross-Sectional Study.

Background and Objectives: Hypertensive patients' knowledge and adherence to prescribed medicines are critical in managing their condition, as poor adherence may lead to adverse cardiac and cerebrovascular events. The present study assessed hypertension-related knowledge and medication adherence among hypertensive patients attending primary health centers (PHCs) in the Aljouf Province, Saudi Arabia. Materials and Methods: Using a cross-sectional design, we conducted this survey on 390 patients. Self-reported hypertension knowledge was assessed using the Hypertension Knowledge Level Scale (HK-LS), and medication adherence was determined using the Hill-Bone Medication Adherence Scale. We used binomial regression analysis (adjusted with other variables) to find the associated factors of medication adherence. Results: This study found that nearly half (49.2%) of the participants had inadequate knowledge, and poor medication adherence was noted in 40.8% of the participants. We found a positive correlation between HK-LS and the Hill-Bone Medication Adherence Scale scores (Spearman's rho = 0.312, p = 0.002). Medication adherence was significantly associated with job status (private sector (ref: public sector, adjusted odds ratio [AOR] = 2.02, 95% CI = 1.18-3.62, p = 0.005)), living in an urban region (ref: rural, AOR = 3.61, 95% CI = 1.85-5.72, p = 0.002), and duration since diagnosis of more than 5 years (ref: ≤1 year, AOR = 3.53, 95% CI = 2.36-4.95, p = 0.001). Conclusions: The present study findings indicate that there is still a critical gap in managing hypertension at the PHCs in this region, and this may lead to poor health outcomes among the patients and burden the healthcare system. Hence, continuous patient education and targeted counseling are recommended for those with poor medication adherence.

Investigating the adherence factors of Escherichia coli at the bovine recto-anal junction.

E. coli strains that produce Shiga toxin cause foodborne illness in humans but colonize cattle asymptomatically. The molecular mechanisms that E. coli uses to adhere to cattle cells are largely unknown. Various strategies are used to control E. coli in livestock and limit the risk of outbreaks. These include vaccinating animals against common E. coli strains and supplementing their feed with probiotics to reduce the carriage of pathogens. No strategy is completely effective, and probiotics often fail to colonize the animals. We sought to clarify the genes required for E. coli adherence in cattle by quantifying the attachment to bovine cells in a diverse set of bacteria. We also isolated nonpathogenic E. coli from healthy cows and showed that a representative isolate could outcompete pathogenic strains in cocultures. We propose that the focused study of these strains and their adherence factors will better inform the design of probiotics and vaccines for livestock.

The effect of cognitive emotion regulation on direct-acting antivirals adherence in patients with hepatitis C.

Adherence to direct-acting antivirals (DAAs) could be a predictor of chronic viral hepatitis C (HCV) therapeutic failure. We examined the perceptions of patients receiving DAAs to determine how cognitive factors influence their decision to maintain adherence. Also, we explored the threshold of DAAs adherence for obtaining sustained virologic response (SVR) among patients with HCV, in order to better implement a strategy that improves the DAAs adherence in the future clinical practice. A single-arm prospective study was performed. Patients with HCV that started and completed DAAs treatment in the County Hospital of Craiova, Dolj, Romania, were enrolled. Patients' medication adherence was assessed using the HCV-AD10 questionnaire, and the cognitive emotion regulation was measured with CERQ questionnaire (five positive/adaptive cognitive emotion-regulation domains and four negative/maladaptive domains). Spearman correlation analysis was conducted to explore the relationships between adherence and different factors. ROC-curves were used to evaluate the adherence threshold to achieve SVR. A linear regression model was performed to analyze the primary outcome (DAAs adherence) to be the target variable based on given independent variables (age, treatment duration, severity of HCV, the nine adaptive and maladaptive strategies). 368 patients (mean age: 61years) with HCV diagnosed 4.05 ± 6.38 (average) years ago were enrolled. Mean (±SD) adherence via HCV-AD10 was 91.51 ± 8.34, and the proportion of the participants achieving SVR was 96%. Patients with an adherence less than 84% (5 patients, 1.36%) was considered nonadherent and they have a high probability of not achieving response (sensitivity and specificity of 83% and 80%, respectively). We obtained significantly higher values of three adaptive strategies between adherent and nonadherent patients following DAAs treatment: in positive refocusing (p-value = 0.044), refocus on planning (p-value = 0.037), and positive reappraisal (p-value = 0.047). The interplay between the three adaptive strategies of the cognitive emotion regulation and the enhancement of DAAs adherence contributes to a more holistic comprehension of patient behavior in the context of HCV treatment. Increasing refocusing and planning using goal setting and assisting patients in establishing specific, achievable goals can be crucial strategies for clinicians aiming to improve adherence among their patients.

Effect of Socioeconomic and Patient-Related Factors on Abidance and Adherence to Voice Therapy in Lebanese Patients With Voice Disorders

ObjectiveTo examine the rate of abidance and adherence to voice therapy (VT) in a group of Lebanese patients with voice disorders, and to analyze the correlation between the rate of abidance, adherence, and socioeconomic factors in addition to patient- and disease-related factors. Study DesignRetrospective chart review. MethodsThe medical records of patients with voice disorders who presented to the voice unit in a tertiary referral center between January 2022 and December 2023 were reviewed. All patients referred to voice therapy selected were included in this study. Patients were stratified into those who abided to voice therapy and those who did not. Patients who abided to voice therapy were further divided into two subgroups: those who adhered to VT and those who did not. ResultsA total of 236 patients with voice disorders were referred to VT, with only 51 attending VT, resulting in a 21.6% abidance rate. Of the 51 patients who attended VT, only 25 completed the therapy sessions, yielding a 55.6% adherence rate. Younger age and higher education level were positively correlated with adherence (r = 0.382, P = 0.01 and r = 0.506, P < 0.001, respectively). Disease-related factors showed a moderate negative correlation between high Voice Handicap Index-10 (VHI-10) scores and adherence (r = −0.687, P < 0.001). Functional voice disorders were associated with higher adherence rates compared with structural or neurologic voice disorders (P = 0.014). ConclusionThe results of this study indicate that the rate of abidance to VT in a group of Lebanese patients with dysphonia is low. Otolaryngologists referring dysphonic patients to VT should take into account the main factors affecting this low rate and account for alternative treatment plan in case one or more of these deterring factors are present.

Study of mathematical models of type 2 diabetes mellitus and its complications

The rapid increase in type 2 diabetes mellitus (DM) cases in Indonesia, driven by hereditary factors and unhealthy lifestyles, poses significant health challenges. This study develops a compartmental model to analyze the progression of type 2 DM and the onset of complications, classifying individuals into susceptible, patients without complications, patients with complications, and those disabled due to complications. The model examines the influence of two key factors on the recovery from complications: habitual factors, including medication adherence, physical activity, dietary habits, smoking history, and environmental factors, such as stress levels, environmental support, patient trust, and compliance. The results indicate that habitual factors have a more substantial impact on mitigating complications compared to environmental factors, suggesting that lifestyle interventions are crucial in improving patient outcomes. The model also shows that an increase in behavioral interactions leading to disease progression results in instability, emphasizing the need for early and consistent behavioral interventions. This research offers valuable insights for healthcare providers and policymakers. By identifying the most influential factors in managing complications, the model can guide the development of targeted interventions that prioritize habitual changes, such as medication adherence and physical activity. Public health strategies can be tailored to emphasize the importance of these habitual factors, potentially reducing the burden of type 2 DM complications. Overall, this study highlights the critical role of personalized, behavior-focused interventions in the management and prevention of complications in patients with type 2 DM, offering a practical framework for improving patient care.

Medication adherence in geriatric patients attending medical outpatient department.

Adherence to medication represents a challenge in managing chronic conditions in the geriatric population. This study assessed adherence rates and factors affecting adherence of geriatric patients attending the Helen Joseph Hospital outpatient department. This was a prospective cross-sectional study of 130 patients aged 65 years and older, with at least two chronic conditions. Participants were administered a survey incorporating the Medication Adherence Rating Scale and the Adherence Barrier Questionnaire to identify medication adherence and patient-specific barriers to adherence, respectively. These instruments are reliable and valid. Descriptive statistics and logistic regression were used for analysis. Most patients were female (63%) with a mean age of 72 (67-78) years. Common comorbidities included type 2 diabetes mellitus (63%), hypertension (98%), dyslipidaemia (92%) and congestive cardiac failure (38%). Polypharmacy was prevalent, affecting 53% of the participants. Despite 96% of participants being adherent, all had at least one barrier to adherence, with the majority (65%) having more than one barrier. The main barriers were forgetfulness (59%), fear of side effects (39%), problems with taking the medications (26%) and believing medications are poisonous (22%). Although most participants accessed the pharmacy easily, only 83% reported consistent medication availability and 11% could not afford to collect their medication. Polypharmacy is common in the population. Despite high adherence rates, barriers such as believing medications are poisonous remain significant. A good patient-doctor relationship improves adherence.Contribution:Understanding the barriers to adherence in older adults with polypharmacy and multimorbidity can assist practitioners improve patient care.

Socio-demographic and genetic risk factors for drug adherence and persistence across 5 common medication classes

Low drug adherence is a major obstacle to the benefits of pharmacotherapies and it is therefore important to identify factors associated with discontinuing or being poorly adherent to a prescribed treatment regimen. Using high-quality nationwide health registry data and genome-wide genotyping, we evaluate the impact of socio-demographic and genetic risk factors on adherence and persistence for 5 common medication classes that require long-term, regular therapy (N = 1,814,591 individuals from Finnish nationwide registries, 217,005 with genetic data from Finland and Estonia). Need for social assistance and immigration status show a notable negative effect on persistence and adherence across the examined medications (odd ratios between 0.48 and 0.82 for persistence and between 1.1% to 4.3% decrease in adherence) while demographic and health factors show comparably modest or inconsistent effects. A genome-wide scan does not identify genetic variants associated with the two phenotypes, while some pharmacogenes (i.e. CYP2C9 and SLCO1B1) are modestly associated with persistence, but not with adherence. We observe significant genetic correlations between medication adherence and participation in research studies. Overall, our findings suggest that socio-economically disadvantaged groups would benefit from targeted interventions to improve the dispensing and uptake of pharmacological treatments.

Whole-genome sequencing of toxigenic Clostridioides difficile reveals multidrug resistance and virulence genes in strains of environmental and animal origin

BackgroundClostridioides difficile has been recognized as an emerging pathogen in both humans and animals. In this context, antimicrobial resistance plays a major role in driving the spread of this disease, often leading to therapeutic failure. Moreover, recent increases in community-acquired C. difficile infections have led to greater numbers of investigations into the animal origin of the disease. The aim of this study was to evaluate the genetic similarities between 23 environmental and animal isolates by using whole-genome sequencing and to determine antimicrobial resistance and virulence factor genes in toxigenic C. difficile strains to provide important data for the development of diagnostic methods or treatment guidelines.ResultsThe most common sequence type was ST11 (87%), followed by ST2 (9%) and ST19 (4%). In addition, 86.95% of the strains exhibited multidrug resistance, with antimicrobial resistance to mainly aminoglycosides, fluoroquinolones, tetracycline and B-lactams; nevertheless, one strain also carried other resistance genes that conferred resistance to lincosamide, macrolides, streptogramin a, streptogramin b, pleuromutilin, oxazolidinone and amphenicol. In addition, a wide range of virulence factor genes, such as those encoding adherence factors, exoenzymes and toxins, were found. However, we observed variations between toxinotypes, ribotypes and sequence types.ConclusionsThe results of this study demonstrated significant genetic similarity between ST11 strains isolated from environmental sampling and from animal origin; these strains may represent a reservoir for community-acquired C. difficile infection, which is becoming a growing public health threat due to the development of multridug resistant (MDR) bacteria and the number of virulence factors detected.

Psychosocial factors influencing treatment adherence in Brazilian gay men living with HIV

Context and Aim: Adherence to antiretroviral treatment (ART) among men who have sex with men (MSM) living with HIV poses a public health challenge. Although studies in developed countries emphasize the role of psychosocial factors in ART adherence, there is limited research on this association among Brazilian MSM living with HIV. This study examined the impact of depression, anxiety, internalized homonegativity, and HIV-related stigma on ART adherence in a sample of this population. Method: A cross-sectional study recruited 43 MSM living with HIV (Mage = 34.93, SD = 7.90) through social media. Instruments included sociodemographic and clinical questionnaires, the Questionnaire for Assessment of Adherence to Antiretroviral Treatment, the Beck Depression Scale, the Trait-State Anxiety Inventory, the Internalized Homophobia Scale, and the HIV Stigmatization Scale. Results: Twelve participants (27.9%) showed inadequate ART adherence, and 18 (41.8%) reported signs and symptoms of depression at clinical level. Depression was negatively and moderately correlated with ART adherence. HIV-related stigma was positively and moderately correlated with depression, trait anxiety, and homonegativity. Depression significantly impacted ART adherence, explaining 13.4% of the variance. Conclusions: Our results highlight the need for regular depression screening and affirmative interventions to support MSM living with HIV, addressing stigma, and promoting adherence to ART.

An advocacy based cross sectional study of healthcare professionals of factors impacting on medication adherence across nine Sub-Saharan African countries

BackgroundAdherence to anti-seizure medication (ASM) by people diagnosed with epilepsy in sub-Saharan Africa remains low. The factors for low adherence are not well understood. To improve adherence, it is important to understand the perceptions and views of healthcare professionals delivering epilepsy care to this population. The aim was to investigate the factors influencing ASM adherence. MethodsThis study uses a brief online questionnaire which asked healthcare professionals (both from nursing and medical backgrounds) who work in sub-Saharan African countries to rate a set of pre-established options designed with the feedback of a local focus group of epilepsy experts from countries targeted. The questionnaire consisted of six questions and was a mix of multiple choice and Likert scale questions. ResultsThere were 217 healthcare professionals who replied to the questionnaire. The most important factors believed to be influencing adherence from a healthcare professional perspective are; lack of availability of medication for epilepsy (71 %), affordability of medication (60 %), the patient, family, carer lacking in understanding of medication (43 %), cultural misconceptions about epilepsy (40 %) and side effects of the medication (32 %). The survey was answered by many different healthcare professionals; 65 participants were doctors and 152 were other healthcare professionals such as nurses (59 %) pharmacists (10 %) and when comparing them, the three most important categories were consistent across groups. ConclusionHealthcare workers in Sub-Saharan Africa identify that the primary factors impacting adherence to ASMs, in their view, is affordability and availability of ASMs.Addressing this issue may reduce the treatment gap.

Determinants of medication non-adherence among patients with chronic diseases at community pharmacy settings in South Gondar Zone, Northwest Ethiopia: a multicenter cross-sectional study.

Medication non-adherence is a significant public health concern in managing patients with chronic diseases, and community pharmacists are on the frontline in the management of chronic medications. Chronic diseases require lifelong pharmacotherapy and understanding the determinants of medication adherence has paramount importance to develop strategies that improve medication adherence and treatment outcomes. Thus, this study aimed to assess the magnitude of medication non-adherence and its contributing factors among patients with chronic diseases attending community pharmacies in South Gondar Zone, Northwest Ethiopia. A multicenter cross-sectional study was conducted at community pharmacies in South Gondar Zone from September 01 to October 30, 2023. Medication adherence was assessed using a structured questionnaire using the Adherence in Chronic Diseases Scale (ACDS). Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Association between the outcome variable and independent variables was performed using binary logistic regression and a p-value of <0.05 was considered statistically significant. Among three hundred and eighty six (386) study participants recruited in this study, more than half of them 222 (57.51%, 95%CI: 52.4% - 62.5%) were low adherent to their medications. Concerning determinants of medication non-adherence; the presence of side effects (AOR =2.1, 95%CI=1.33-3.29), unable to get ever counseling from community pharmacists (AOR=2.3, 95%CI= 1.46-3.58), and poor about their medications (AOR=3.1, 95% CI= 1.96-4.82) were significantly associated with patients' non-adherence to medications. The medication adherence level in this study was suboptimal, with a significant proportion of the patients being non-adherent to their medications. The presence of side effects, unable to get ever counseling, and poor knowledge about their medications were statistically significant factors of poorer medication adherence. Hence, healthcare professionals, especially community pharmacists, have a crucial role in designing the schedule for health education concerning the needs of these patients in community pharmacy settings.

Antibiotics and Pesticides Enhancing the Transfer of Resistomes among Soil-Bayberry-Fruit Fly Food Chain in the Orchard Ecosystem.

While substantial amounts of antibiotics and pesticides are applied to maintain orchard yields, their influence on the dissemination and risk of antibiotic resisitome in the orchard food chain remains poorly understood. In this study, we characterized the bacterial and fungal communities and differentiated both antibiotic resistance genes (ARGs) and virulence factor genes (VFGs) in the soil, Chinese bayberry (matured and fallen), and fruit fly gut, collected from five geographic locations. Our results showed that fruit fly guts and soils exhibit a higher abundance of ARGs and VFGs compared with bayberry fruits. We identified 112 shared ARGs and 75 shared VFGs, with aminoglycoside and adherence factor genes being among the most abundant. The co-occurrence network revealed some shared microbes, such as Bacillus and Candida, as potential hosts of ARGs, highlighting the vector risks for both above- and below-ground parts of the orchard food chain. Notably, the elevated levels of antibiotics and pesticide residues in orchard soils increase ARGs, mobile genetic elements (MGEs), and VFGs in the soil-bayberry-fruit fly food chain. Our study highlighted that agricultural management, including the overuse of antibiotics and pesticides, could be the key factor in accumulating resistomes in the orchard food chain.

A qualitative dyad analysis of barriers and facilitators of antiretroviral therapy (ART) adherence among people who inject drugs (PWID) with HIV in Kazakhstan.

People with HIV (PWH) who inject drugs (PWID) face many barriers to ART adherence. Kazakhstan has one of the fastest growing HIV epidemics in the world, primarily fueled by injection drug use, yet ART adherence among PWID is low. Social support can help address these barriers, but ART adherence among PWID is rarely examined within the relationship context. We conducted interviews with 20 PWID with HIV and 18 of their intimate partners and performed a qualitative dyad analysis to examine ART adherence factors. The results indicated many barriers and facilitators of ART adherence at the individual level (e.g., substance use), interpersonal level (e.g., social support) and structural level (e.g., stigma, transportation). Reported adherence barriers and facilitators had high congruence between dyad members; however, some notable differences were found between dyads. Compared to PWH, partners without HIV had a lack of awareness about the role of stigma in impeding ART adherence. Different manifestations of social support to facilitate ART adherence were noted between seroconcordant dyads (e.g., taking pills together, attending appointments together) and serodiscordant dyads (e.g., reminders to take pills, providing babysitting to enable attendance at doctor appointments). Future research and programs may benefit from integrating dyad approaches into ART adherence interventions.