Level Of Adherence Research Articles

Implementation fidelity of intravenous ferric carboxymaltose administration for iron deficiency anaemia in pregnancy: a mixed-methods study nested in a clinical trial in Nigeria

BackgroundIron deficiency anaemia is common among pregnant women in Nigeria. The standard treatment is oral iron therapy, which can be sub-optimal due to side effects. Intravenous ferric carboxymaltose (FCM) is an evidenced-based alternative treatment with a more favourable side effect profile requiring administration according to a standardized protocol. In this study, we assessed the fidelity of administering a single dose of FCM according to protocol and identified factors influencing implementation fidelity.MethodsWe used a mixed-method approach with a sequential explanatory design nested in a clinical trial across 11 facilities in Lagos and Kano States, Nigeria. Guided by a conceptual framework of implementation fidelity, we quantitatively assessed adherence to protocol by directly observing every alternate FCM administration, using an intervention procedure checklist, and compared median adherence by facility and state. Qualitative fidelity assessment was conducted via in-depth interviews with 14 skilled health personnel (SHP) from nine purposively selected health facilities, using a semi-structured interview guide. We analyzed quantitative data using descriptive and inferential statistics in Stata and used thematic analysis to analyze the transcribed interviews in NVivo.ResultsA total of 254 FCM administrations were observed across the 11 study sites, with the majority in secondary (63%), followed by primary healthcare facilities (PHCs) (30%). Overall, adherence to FCM administration as per protocol was moderate (63%) and varied depending on facility level. The lowest level of adherence was observed in PHCs (36%). Median, adherence level showed significant differences by facility level (p = 0.001) but not by state (p = 0.889). Teamwork and availability of protocols are facilitation strategies that contributed to high fidelity. However, institutional/ logistical barriers are contextual factors that influenced the varied fidelity levels observed in some facilities.ConclusionsCollaborative teams and access to operating protocols resulted in high fidelity in some facilities. However, in some PHCs, fidelity to FCM was low due to contextual factors and intervention complexities, thereby influencing the quality of delivery. In Nigeria, scale-up of FCM will require attention to staff strength, teamwork and availability of administration protocols, in order to optimize its impact on anaemia in pregnancy.

High-intensity interval training with functional electrical stimulation cycling for incomplete spinal cord injury patients: A pilot feasibility study.

Consequences of spinal cord injury (SCI) with a sedentary lifestyle will progress to muscle weakness and muscle atrophy, leading to muscle fatigue. This study aimed to determine the feasibility and preliminary effects of high-intensity interval training (HIIT) using functional electrical stimulation (FES) cycling on changes in thigh muscle volume and muscle strength, in patients with incomplete SCI. Eight incomplete SCI patients (mean age 50 years; 6 women) with stable SCI paraplegia (mean 6.75 years since injury) participated in the HIIT FES cycling (85%-90% peak Watts; 4 × 4-min intervals) three times a week (over 6 weeks). The main outcomes were adherence, participant acceptability, and adverse events. Secondary outcomes were muscle strength (peak torque) and leg volume changes. Our findings revealed that the program was well-received by participants, with high levels of adherence, positive feedback, and satisfaction, suggesting that it could be a promising option for individuals seeking to enhance their lower body strength and muscle mass. Additionally, all participants successfully completed the training without any serious adverse events, indicating that the program is safe for use. Finally, we found that the 6-week HIIT FES leg cycling exercise program resulted in notable improvements in isometric peak torque of the quadriceps (range 13.9%-25.6%), hamstring muscle (18.2%-23.3%), and leg volume (1.7%-18.2%). This study highlights HIIT FES leg cycling exercise program potential as an effective intervention for improving lower limb muscle function.

Does adherence to physiotherapy depend on the typologies of patients with back pain and their physiotherapists? A qualitative typology study

BackgroundPatient adherence to physiotherapy is influenced by a multitude of factors including the characteristics and attitudes of patients and physiotherapists. This study aims to identify typologies of patients with back pain and their physiotherapists and attempts to explain how typologies could influence patient adherence. MethodThis study was based on a secondary data analysis from focus group interviews to identify barriers and facilitators for adherence. Transcribed interview data were used for a structured content analysis based on deductive and inductive categorization and coding. The Big-five Personality Traits were applied to build deductive categories about the physiotherapists’ and the patients' typologies. ResultsTen patients with low back pain (6 women) and 11 physiotherapists (5 women) were recruited. The four patient types are based on conscientiousness, high activity level (HAL), internal locus of control (ILC), high adherence level (HADL) (= type 1); neuroticism, HAL, ILC, low adherence level (LADL) (= type 2); extraversion, HADL, external locus of control (ELC), HADL (= type 3); agreeableness, active behavior, ELC, HADL (= type 4). The three physiotherapist types are based on conscientiousness, high adherence influence (HADI), use of guidelines (= type 1); agreeableness, acceptance of requests, low adherence influence (= type 2); neuroticism, HADI, preference for active therapy (= type 3). ConclusionAwareness of typologies of patients with back pain and their physiotherapists may help to facilitate adherence and subsequently treatment effectiveness. Further quantitative research should aim to validate the correlation between the identified typologies and the adherence level of patients with back pain.

The Effect of the Fear of COVID-19 on Treatment Adherence and Health-Seeking Behavior in Individuals with Type 2 Diabetes

Objective: This descriptive and cross-sectional study aimed to determine the impact of COVID-19 induced fear on the treatment adherence and health-seeking behavior of individuals with type 2 diabetes. Methods: The sample for this research consisted of 150 type 2 diabetes patients who attended the Mersin City Training and Research Hospital endocrinology outpatient clinics for treatment and follow-up. Data collection involved the use of a Personal Information Form, the COVID-19 Fear Scale, the Type 2 Diabetes Mellitus Patient Treatment Adherence Scale, and the Health-Seeking Behavior Scale. Data was analyzed using Student’s t-test, One Way ANOVA and Multiple Linear Regression analysis. Findings: Among the individuals participating in the study, it was determined that while 54.7% were female, 48.7% had an HbA1c level of 8.1 and above, 64% used insulin, 80.7% developed complications related to diabetes and the average age of the participants were 62.9±11.9. Furthermore, the majority were not diagnosed with COVID-19, and they did not require hospitalization due to COVID-19. The adherence to diabetes treatment among the patients was found to be moderate, with the lowest adherence was observed in terms of lifestyle changes and the highest adherence was observed in terms of the emotional and behavioral adherence dimensions. Multiple regression analysis revealed that the fear of COVID-19 did not affect diabetes treatment adherence levels of the patients (p>0.05). It was found that only those patients who were using insulin and those who were not adhering to medical nutritional treatment had lower adherence to diabetes treatment (p

The impact of diabetes mellitus on HIV virologic control: results of the MACS/WIHS combined cohort study.

Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown. We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/mL) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/mL) between adult PWH with and without DM. Poisson regression was used to examine the rate of incident viremia based on the diagnosis of DM among PWH. DM was defined as two consecutive fasting glucose measurements ≥126 mg/dL, use of anti-diabetic medications, pre-existing DM diagnosis, or a confirmed HbA1c >6.5%. 1,061 women (112 with DM, 949 without DM) and 633 men (41 with DM, and 592 without DM) were included in the analysis. The relative rate (RR) of incident HIV viremia for women with HIV and DM was lower when compared to women without DM (0.85 [95% CI: 0.72-0.99]; p = 0.04). The RR of incident viremia for women with uncontrolled DM (HbA1c>7.5%) was higher when compared to women with controlled DM (HbA1c <7.5%) (1.46 [95%CI: 1.03-2.07]; p = 0.03). In contrast, the RR of incident viremia for men with HIV and DM was not statistically different compared to men without DM (1.2 [95%CI: 0.96- 1.50]; p = 0.12). The results were stratified by adherence levels (100%, 95-99%, and less than 95% based on self-report). Women with DM who are highly adherent to ART (100% self-reported adherence) have a lower risk of viremia compared to women with HIV without DM. However, women with poorly controlled DM were at higher risk of HIV viremia than women with controlled DM. Further research is necessary to understand the impact of sex, DM, and ART adherence on HIV viremia.

Comparing pill counts and patient self-reports versus DBS tenofovir concentrations as ART adherence measurements with virologic outcomes and HIV drug resistance in a cohort of adolescents and young adults failing ART in Harare, Zimbabwe

BackgroundMonitoring adherence presents a challenge in adolescents and it is prudent to explore several options for determining their level of adherence. This study sought to determine ART adherence levels in adolescents and young adults (on a tenofovir-containing regimen) failing ART as measured by self-reports, pill counts and DBS tenofovir concentrations and to compare levels of agreement among the methods and determine the ability of each method to predict virological suppression. MethodsThis was a cohort study involving 107 adolescents and young adults between 10 and 24 years failing ART with viral load > 400copies/ml at enrolment. Pill count (PC) records, self-reports (SR) and DBS tenofovir concentrations (done by liquid Chromatography with tandem mass spectrometry (LC-MS/MS)) were used to determine adherence in adolescent participants failing ART in Harare. The latter was used as the reference method with a cut-off of 64 ng/ml. Determination of DBS tenofovir concentrations was also performed to rule out inadequate viral response due to low cumulative drug exposure despite high adherence (≥90 %). Longitudinal analysis was performed to determine the correlation of viral loads (VL) with adherence. The Kappa (k) coefficient was used to evaluate the level of agreement among the 3 methods. ResultsPoor level of agreement was found between PC records and DBS tenofovir concentrations (k = −0.115). Moderate agreement was found between DBS and SR methods (k = 0.0557). Slight agreement was found between PC and SR methods (k = 0.0078). Adherence was dependent on age at HIV diagnosis (p = 0.0184) and ART initiation (p = 0.0265). Participants who were adherent were six times more likely to be suppressed at end point than their non-adherent counterparts (OR=5.7 CI 2.1 – 16.5, p < 0.0001). ConclusionsSelf-reported measure of adherence and pill counts exhibited poor agreement with the reference method used i.e. DBS tenofovir concentrations and are thus not effective methods of predicting virological suppression. Trial identificationParticipants in the present study were a subset of those in the PESU intervention ClinicalTrials.gov Identifier: NCT02833441

Assesment of adherence to therapeutic recommendations among patients with hypertension

Abstract Hypertension is a multifactorial condition involving environmental and genetic factors along with risk behaviors. Data from the National Health Fund show that nearly 10 million adult Poles have hypertension. The main goal of drug therapy is to effectively lower blood pressure to normal or near-normal values, and the basic prerequisite for effective pharmacotherapy of chronic diseases is patient adherence to pharmacological recommendations. Objectives The aim of this study was to determine the level of adherence to treatment recommendations among patients with hypertension with regard to sociodemographic and medical variables. Methods This survey-based study included 200 patients with hypertension, hospitalized in the Department of Cardiology with the Intensive Cardiac Care Unit of an Independent Public Clinical Hospital. The author’s questionnaire and The Adherence to Refills and Medication Scale (ARMS) were used as research instruments. Results The study demonstrated the effect of age and place of residence on adherence to treatment recommendations (the older the age, the worse the adherence). The overall level of non-adherence to recommendations (ARMS total score), and the level of non-adherence to taking medications or refilling prescriptions were significantly higher in patients with than without diabetes, and in patients without heart failure than in those with this condition. Conclusion Adherence among patients diagnosed with hypertension was at a good level. Age, employment status, place of residence, and diagnosed diseases (diabetes, heart failure) significantly affected adherence to treatment among the subjects.Table1

Evaluation of impact of adherence to inhaled therapy and critical mistakes in inhalation technique on clinical outcomes in patients with obstructive airway diseases in India

Adherence to inhaled therapy is more relevant in respiratory diseases because, to achieve therapeutic efficacy, it is necessary that the patient adhere to the recommended therapy as well as use their inhalers correctly with appropriate inhalation technique.This was a prospective, observational study that included 126 patients &amp;#62;18 years of age of all genders, diagnosed with an obstructive airway disease, and prescribed inhaler medication. Adherence was assessed using the Test of Adherence to Inhalers (TAI) questionnaire, and inhaler device technique was assessed every 3 months. At the end of one year, outcome data like the number of exacerbations, the number of admissions, including critical-care admissions, the number of days of hospitalization, adverse events, and their associations were analyzed.Poor adherence to inhaled therapy was found in 40.48% of patients, with the majority of patients (69.05%) having an unwitting or ignorant pattern of non- adherence. Out of 75 patients using MDI (Metered Dose Inhaler), 34.67% had critical mistakes in technique, and out of 51 patients using Rotahaler, 23.53% had critical mistakes in technique. There was no significant relationship between level of adherence and critical mistakes with gender, BMI category, or past history of smoking. Patients with poor adherence and those with critical mistakes in inhalation technique had poor health outcomes.This study highlights the role of adherence and identifies barriers responsible for non-adherence to inhaled therapy. Identifying the behaviors responsible for non-adherence and counseling the patients on the correct inhalation technique can improve the health outcomes of chronic respiratory diseases.

Assessing Analgesic Adherence and Influencing Factors in Saudi Cancer Patients

Background: As cancer incidences rise within the Saudi population, effective pain management remains a critical component of oncological care. Analgesic adherence is vital for managing cancer-related pain, yet it is often inadequately addressed in clinical practice, leading to diminished quality of life of patients. Objectives: This study aimed to assess the level of adherence to analgesic medications among Saudi cancer patients and to identify demographic and health-related factors that may influence adherence. Methods: In a cross-sectional study at King Abdulaziz Medical City, 132 oncology patients were sampled randomly. Data were collected through an online survey incorporating demographic queries and the Morisky Medication Adherence Scale (MMAS-8). SPSS 26 facilitated the statistical analysis, with descriptive statistics and Spearman’s Rho tests determining the significance of the findings. Results: Among participants, 52.2% were married, 51.5% were unemployed, and 80.4% reported substantial social support. Health insurance was prevalent among 79.5% of patients. Low adherence was observed in 94.6% of patients, with only 0.8% showing high adherence. The primary reasons for non-adherence included forgetting (54.5%) and fear of side effects (38.6%). Age and the number of medications were significantly correlated with adherence levels, highlighting the multifactorial nature of medication adherence in this patient population. Conclusions: The research highlights a concerning level of low adherence to analgesics among Saudi oncology patients, suggesting an urgent need for targeted interventions. Strategies to improve adherence should focus on education regarding the importance of pain management and addressing patients' concerns about medication side effects and dependency, as well as personalized medication management plans to accommodate the complexities of handling multiple medications. These findings are instrumental for oncology healthcare providers to optimize pain management strategies and enhance patient outcomes.

Patient Acceptance and Adherence to the COMPASS Trial Drug Recommendations Following Symptomatic Carotid Endarterectomy

IntroductionThe COMPASS trial demonstrated that in patients with atherosclerotic diseases, low-dose rivaroxaban and aspirin provides greater protection against subsequent major adverse cardiovascular events (MACE) than mono-antiplatelet therapy (MAPT) alone. Drug acceptance and adherence maximises this benefit. We have assessed drug acceptance and adherence to the COMPASS drug regime in patients following carotid endarterectomy (CEA) for symptomatic carotid artery stenosis. MethodsFollowing CEA, the views of 63 patients on the COMPASS drug regime were assessed using the Beliefs about Medicine Questionnaire (BMQ) and drug adherence was determined using the Sidorkiewicz scoring system. These views were compared with those of 54 patients on MAPT. Side effects (bleeding and drug reactions) and new MACE were recorded. ResultsPost-CEA patients on the COMPASS drug regimen had strong positive views on the necessity to take these drugs (Necessity Scale 19.6 +/- 3.6). Although there were some concerns about the COMPASS drug regimen, these were not strongly held (Concern Scale 11.8 +/-4.9) and the Necessity-Concerns Differential was positive (7.8 +/- 6.2). The Drug Adherence Score was “High” to “Good” (level of drug adherence 1.7+/-1.0). The BMQ scales and Drug Adherence Score of post-CEA patients on the COMPASS drug regimen were similar to those on MAPT. The incidence of post-CEA MACE and side effects were similar for those on the COMPASS drug regimen and MAPT. ConclusionsPost-CEA patients on the COMPASS drug regimen had positive views on taking the drugs and drug adherence was high. We did not identify any patient-related barriers to the use of the COMPASS drug regimen to further reduce cardiovascular events.

Adherence to oral anticoagulants in patients with non-valvular atrial fibrillation: the role of patients’ characteristics and out-of-pocket payments

ABSTRACT Background Recent practice guidelines favor direct oral anticoagulants (DOACs) over warfarin for primary stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, challenges persist in Iraq’s private pharmaceutical sector. DOACs have been sold at high and inconsistent retail prices and lack insurance coverage, leading to significant out-of-pocket (OOP) costs. The objective of this study is to investigate the impact of OOP costs on oral anticoagulants (OAC) adherence among NVAF patients. Research design and methods This multicenter cross-sectional study interviewed 359 eligible patients attending three private cardiology clinics within Iraq’s southern region from December 2022 to February 2023. The 8-item Morisky Adherence Scale evaluated patient adherence. Statistical analyses, including descriptive analysis, ANOVA, and chi-square. p < 0.05 was considered statistically significant. Results The most frequently prescribed OAC were DOACs (62.8%). Patient adherence level to OAC was chiefly medium (54.6%) with no significant difference in adherence based on OAC type. Patient adherence was significantly associated with monthly income (p = 0.001), number of daily pills (p = 0.006), and OACs’ average monthly cost (p = 0.011). Conclusion Addressing the issue of cost-related non-adherence to OACs requires multiple actions. These include ensuring comprehensive health insurance coverage for OACs, increasing the use of affordable generic alternatives, and establishing effective cost-related discussions between healthcare providers and patients.

Maternal skepticism regarding children's vaccination in Jordan: Investigating the knowledge, attitude, and adherence.

Vaccination is critical to every responsible healthcare system, yielding several health and economic benefits. However, skepticism is a major challenge to vaccination adherence among parents globally. Mothers are primary decision-makers on children's vaccination; therefore, this study aims to assess maternal knowledge, attitudes, and adherence to children's routine vaccination in Jordan, identify the main sources of related information, and explore the awareness and hesitancy related to elective vaccination, which is not incorporated into the national vaccination program (e.g., varicella, flu, meningitis, and meningococcal vaccines). A descriptive, cross-sectional design was conducted to collect data from 533 Jordanian mothers between August and November 2023. Participant mothers completed an online self-administered questionnaire comprising demographics, knowledge, attitudes, and adherence to children's vaccination. The surveyed mothers in general exhibited high levels of knowledge, attitudes, and adherence concerning children's vaccination and a relatively moderate level of adherence concerning elective vaccines. The mothers' perspectives of reluctance towards elective vaccines were explored. The primary healthcare center and physicians were the most prevalent sources of mothers' vaccine-related information. Future efforts should implement tailored health education campaigns that address specific knowledge gaps, such as misconceptions about contraindications and side effects, promote awareness about elective vaccines, and engage healthcare providers to facilitate informed decision-making among Jordanian mothers and improve children's vaccination coverage.

Leveraging A Digital Pill System to Understand Prevention-Effective Adherence to Oral Hiv Pre-Exposure Prophylaxis Among Men Who Have Sex with Men with Substance Use.

Daily oral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, though efficacy depends on adherence. Digital pill systems (DPS) can enable direct, real-time adherence measurement. HIV-negative men who have sex with men (MSM) with substance use (excluding alcohol) utilized a DPS over 90 days and completed weekly surveys reporting sexual activity, condom use, and substance use. Responses indicating (1) any sexual activity and substance use or (2) condomless anal intercourse (CAI) in the prior week were categorized as high risk for HIV acquisition. PrEP adherence data for the 7-day period preceding each response was dichotomized as ≤ 3 and ≥ 4 doses/week, indicating prevention-effective adherence, and compared by HIV risk level. Thirteen MSM were analyzed (median age: 32). Of 113 surveys, 48.7% indicated high HIV risk, with 12.4% reporting CAI alone, 16.8% any sexual activity and substance use, and 19.5% both CAI and substance use. Weekly mean PrEP adherence was 90.3% (6.3 of 7 doses/week), with ≥ 4 doses/week recorded during 92.0% of weeks. The proportion of participants with ≥ 4 recorded doses/week was 88.9% during weeks with CAI alone, 89.5% during weeks with any sexual activity and substance use, 92.0% during weeks with both CAI and substance use, and 92.8% during lower risk weeks. Participants ingested ≥ 4 doses/week during 89.1% of all high-risk weeks and 94.8% of low-risk weeks. Overall, participants maintained high levels of PrEP adherence while engaging in HIV risk behaviors. DPS can be deployed concurrently with data collection tools to assess ingestion patterns during periods of elevated risk.

Adherence to the 2018 AHA cholesterol management guideline in hyperlipidemia treatment among adults in an outpatient setting.

Although evidence-based guidelines and effective treatments exist for dyslipidemia, a significant disparity remains between guidelines and clinical practice. In this study, we investigated adherence to statin therapy per the 2018 ACC/AHA Guideline recommendations. This is a retrospective, descriptive-analytical study involving 1,224 individuals who presented to the laboratories located in Birjand, Eastern Iran, from June 2022 to March 2023. Analyses were conducted on 700 patients. Data collection utilized a checklist and serum value measurements of laboratory factors deemed necessary for the study. Treatment was administered per the guidelines for 348 out of the 700 patients (49.7%). With 60.7%, the diabetes group exhibited the highest level of adherence to guidelines. In the atherosclerotic cardiovascular disease (ASCVD) group, 31.7% followed the recommendations. The lowest adherence rates were in groups with a 10-year ASCVD risk score of ≥20% and severe hypercholesterolemia, respectively (0% and 2.8%). In our study, atorvastatin was the most frequently prescribed statin, with the majority of patients consuming a moderate-intensity statin. None of the severely hypercholesterolemic patients achieved the LDL goal. Moreover, LDL-C goal achievement was low among the ASCVD group and those with an ASCVD risk score of ≥20%. Patients with hypercholesterolemia adhere inadequately to the AHA Guideline. Consequently, training courses are needed to inform medical doctors, particularly general practitioners, of the latest dyslipidemia treatment recommendations as the AHA advises.

Determinants of virological failure among HIV clients on second-line antiretroviral treatment at Felege-hiwot and University of Gondar comprehensive specialized hospitals in the Amhara Region, Northwest Ethiopia: A case-control study.

Second-line HIV treatment failure has become increasing worldwide, mainly in sub-Sahara Africa including Ethiopia. Even though the problem becomes increasing, inadequate information was available about its magnitude and associated factors in the current study area. To assess the factors of second-line Anti-Retroviral Treatment virological failure among second-line ART users. Institutional-based unmatched case-control study design was conducted from September to December 2021 at Felege Hiowt and University of Gondar Comprehensive Specialized Hospitals; Amhara region, Northwest Ethiopia. A total of 216 patients (60 cases and 156 controls) were recruited by a simple random sampling technique with a 1:3 cases-to-controls ratio. Patients who had two viral load results >1000 copies/ml within a 3-month interval after taking ART drugs for at least 6 months were cases and those who had ≤1,000 copies/ mL were controls. The sample size was calculated by using Epi-Info version 7.2.4. Structured questionnaires were used to gather the required information. SPSS version 26 was used to summarize the findings. In bivariate logistic regression model, Variables with two-tailed P-value ≤ 0.25 at 95% confidence interval were transferred into multivariate binary logistic regression model and P value at ≤ 0.05 was set as statistically significant. Out of 216 patients recruited, 212 have participated with a response rate of 98.2%. From these participants, 117(55.2%) were males and 187(88.2%) were urban dwellers. Among the total respondents, 208(98.1%) had age > 24 years, 200(94.3) were at HIV clinical stage I, 72(34%) had poor ART adherence and 112(52.8) did not disclose their HIV status. Likewise, most of the patients 147(69.37) didn't use condoms. The associated factors were not disclosing HIV status (AOR = 3.4, 95% CI: 1.52-7.79), medium adherence (AOR = 3.7, 95% CI = 1.3-10.7), poor adherence level (AOR = 5.27, 95% CI: 2.2-12.5), not using condoms (AOR = 4.47, 95% CI: 1.63-12.2) and Viral load (>150 copies/ml) when switched to second-line ART (AOR = 3.56, 95% CI: 1.5-8). Non-disclosure, poor or medium adherence, not using condoms and high Viral load (>150 copes/ml) when switched to second-line ART were the main factors for second-line Anti-Retroviral Treatment virological failure. Disclosure about HIV status, using condoms and improving treatment adherence level are crucial to reduce second-line virological failure.

A comprehensive health assessment approach using ensemble deep learning model for remote patient monitoring with IoT

The goal of this research is to create an ensemble deep learning model for Internet of Things (IoT) applications that specifically target remote patient monitoring (RPM) by integrating long short-term memory (LSTM) networks and convolutional neural networks (CNN). The work tackles important RPM concerns such early health issue diagnosis and accurate real-time physiological data collection and analysis using wearable IoT devices. By assessing important health factors like heart rate, blood pressure, pulse, temperature, activity level, weight management, respiration rate, medication adherence, sleep patterns, and oxygen levels, the suggested Remote Patient Monitor Model (RPMM) attains a noteworthy accuracy of 97.23%. The model's capacity to identify spatial and temporal relationships in health data is improved by novel techniques such as the use of CNN for spatial analysis and feature extraction and LSTM for temporal sequence modeling. Early intervention is made easier by this synergistic approach, which enhances trend identification and anomaly detection in vital signs. A variety of datasets are used to validate the model's robustness, highlighting its efficacy in remote patient care. This study shows how using ensemble models' advantages might improve health monitoring's precision and promptness, which would eventually benefit patients and ease the burden on healthcare systems.

Assessment of Factors Associated with Adherence to Antiretroviral Therapy among HIV Patients at Kampala International University Teaching Hospital in Ishaka, Uganda

HIV has increasingly become a chronic, manageable disease due to the introduction of antiretroviral therapies (ARTs). For the effectiveness of antiretroviral therapy, a high level of adherence is required. This study therefore seeks to assess the adherence level and the influence of its determinants in HIV patients on antiretroviral therapy at the Kampala International University Teaching Hospital (KIUTH) HIV clinic in Ishaka, Uganda. Quantitative cross-section study approach was conducted to assess the factors associated with adherence to a-ntiretroviral therapy among HIV patients at KIUTH in Ishaka, Uganda. Data was collected using an interviewer-administered questionnaire in 150 respondents in this study. The qualitative data collected was statistically analysed and documented using Microsoft Excel and Word version 2019, which were then analyzed. The analysed data was presented in the form of tables and graphs, which formed the basis for discussion and conclusion. Of a total of 150 clients interviewed, equal proportions of 26% were in the age groups of 40–49 and 50–59 years, with a mean age of 46 years. The majority (65%) were female, with most (45%) being Anglicans, followed by Catholics (32%), Muslims (14%), and other religions (9%). Nearly half (45.1%) of the respondents were married. About 7% had tertiary education, while 37% had completed the ordinary level of high school. Nearly half (47%) knew the name of the ART they were taking, while 17% did not. Less than a third (26.7%) did not know the name of the ART drug they were taking. A large proportion (93%) stated that ART prevents mother-to-child transmission of infection, while 7% reported that they did not know. Nearly all (96%) respondents knew HIV could be controlled by ART. The majority (87%) stated that taking ART prevents disease progression, and 63% opined that missing ART drugs can lead to transmission of the disease. Overall, adherence to ART was 39% while non-adherence was 61%. In conclusion, the study discovered a high degree of awareness but a low level of adherence to ART among patients living with HIV. Forgetfulness, financial level, employment status, and knowledge of the benefits of the intervention are all important factors in nonadherence among some HIV patients. As a result, ART clinics should increase the level of education provided to customers to encourage patients to take complete responsibility for their health status. Keywords: Adherence, Antiretroviral Therapy, HIV, AIDS

Intention to treat and per protocol analyses: differences and similarities

Randomized trials can take more explanatory or more pragmatic approaches. Pragmatic studies, conducted closer to real-world conditions, assess treatment effectiveness while considering factors like protocol adherence. In these studies, intention-to-treat (ITT) analysis is fundamental, comparing outcomes regardless of the actual treatment received. Explanatory trials, conducted closer to optimal conditions, evaluate treatment efficacy, commonly with a per protocol (PP) analysis, which includes only outcomes from adherent participants. ITT and PP are strategies used in the conception, design, conduct (protocol execution), analysis, and interpretation of trials. Each serves distinct objectives. While both can be valid, when bias is controlled, and complementary, each has its own limitations. By excluding nonadherent participants, PP analyses can lose the benefits of randomization, resulting in group differences in factors (influencing adherence and outcomes) that were present at baseline. Additionally, clinical and social factors affecting adherence can also operate during follow-up, that is, after randomization. Therefore, incomplete adherence may introduce postrandomization confounding. Conversely, ITT analysis, including all participants regardless of adherence, may dilute treatment effects. Moreover, varying adherence levels could limit the applicability of ITT findings in settings with diverse adherence patterns. Both ITT and PP analyses can be affected by selection bias due to differential losses and nonresponse (ie, missing data) during follow-up. Combining high-quality and comprehensive data with advanced statistical methods, known as g-methods, like inverse probability weighting, may help address postrandomization confounding in PP analysis as well as selection bias in both ITT and PP analyses.

Assessment of adherence to treatment recommendations among patients with heart failure: a cross-sectional study

BackgroundHeart failure (HF) is a chronic condition characterized by significant impairment of the cardiovascular system, leading to a decline in health-related quality of life, recurrent hospitalizations, and increased mortality risk. It poses a substantial challenge for modern medicine, particularly when patients fail to adhere to therapeutic recommendations. The primary aim of this study was to evaluate the level of adherence to therapeutic guidelines among patients with HF and identify factors influencing adherence levels.MethodsThe study comprised 105 HF patients admitted to the cardiology department. A diagnostic survey approach was utilized, employing the Adherence in Chronic Diseases Scale (ACDS) along with a self-developed questionnaire.ResultsThe findings revealed that 39.05% of participants exhibited a moderate level of adherence to therapeutic recommendations, while 34.29% reported high adherence and 26.67% displayed low adherence. Most of the patients (n = 66) had a rather good level of knowledge. Factors such as higher education (p < 0.001), engagement in mental work (p = 0.001), favorable socioeconomic status (p < 0.001), being in a stable relationship (p < 0.001), and residing with family (p < 0.001) were associated with increased adherence levels. The multivariable linear regression model indicated significant (p < 0.05) independent predictors that positively influenced the ACDS score, including being in a relationship, widowhood, and average or poor financial situation. Conversely, factors such as obesity and respiratory diseases were associated with a decrease in the ACDS score (p < 0.05).ConclusionsThis study underscores the moderate adherence level to therapeutic recommendations among HF patients. Sociodemographic factors including education level, relationship status, occupation, financial stability, and living arrangements significantly impact adherence. Conversely, patients with obesity, respiratory conditions, or frequent HF-related hospitalizations demonstrate lower adherence. Patient education emerges as a pivotal factor influencing adherence. Tailored interventions targeting these factors could enhance adherence and optimize HF management outcomes.

B/F/TAF forgiveness to non-adherence

BackgroundART forgiveness is the ability of a regimen to maintain HIV-RNA suppression despite a documented imperfect adherence. We explored forgiveness of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF).MethodsIn this retrospective cohort study pharmacy drug...