Adherence Support Research Articles

Ensuring universal access to quality care for persons with presumed tuberculosis reaching the private sector: lessons from Kerala.

More than half of the people with Tuberculosis (TB) symptoms in India seek care from the private sector. People with TB getting treatment from private sector in India are considered to be at a higher risk for receiving suboptimal quality of care in terms of incorrect diagnosis and treatment, lack of treatment adherence support with a high loss to follow-up rate that could eventually increase their risk of drug resistance. The current study aims at documenting the approach and efforts taken by the Kerala state to partner with theprivate health care delivery providers for ensuring quality TB care to the people with presumed TB reaching them. A case study approach was adopted with review of all available literature followed by five Key Informant Interviews to understand the case through a primary descriptive exploration. Grounded theory approach was used to generating the single theory of the case itself that explains it. Kerala state has taken a variety of interventions to ensure universal access to TB care for citizens reaching the private sector with documented improvement in the quality of TB care. Key learnings from these initiatives were (i) patients need to be at the centre of partnerships, (ii) good governance is essential for ensuring Universal Health Coverage in a mixed health system, (iii) data intelligence is required to guide partnerships, (iv) identification of the correct 'problems' is crucial for effective design of partnerships and (v) a platform for meaningful dialogue of key stakeholders is needed. Kerala experience demonstrated that if governments take a proactive role in engaging the private sector, in an informed and evidence-based way, they can leverage the advantages of the private sector while protecting the public health interest.

Exploring the relationship between school-supervised asthma therapy and social determinants of health in pediatric asthma care.

Social determinants of health (SDoH), including access to care, economic stability, neighborhood factors, and social context, strongly influence pediatric asthma outcomes. School-supervised asthma therapy (SST) is an evidence-based strategy that improves asthma outcomes, particularly for historically marginalized children, by providing support for daily medication adherence in school. However, little is known about the relationship between these programs and the adverse SDoH commonly affecting underrepresented minority and marginalized children with asthma. We examined qualitative data from interviews (n = 52) conducted between 2017 and 2020 with diverse multi-level partners involved in Asthma Link, a SST intervention. Participants included end-users (children and their parents), deliverers (school nurses and pediatric providers), and systems-level partners (e.g., insurers, legislators, and state officials). We used inductive coding to determine themes and subthemes and deductive coding using the Healthy People 2030 SDoH framework. Three themes emerged: (1) SST mitigates adverse SDoH (improves access to preventive healthcare and asthma health literacy), (2) SST benefits children experiencing specific adverse SDoH (provides a consistent medication routine to children with unstable family/housing situations) and (3) specific adverse SDoH impede SST implementation (economic instability, culture and language barriers). This study suggests an important relationship between SDoH and SST that warrants further evaluation in our future work on this community-based asthma intervention. Moreover, our findings underscore the importance of measuring SDoH in the implementation and evaluation of pediatric asthma interventions, particularly given the strong influence of these social factors on child health outcomes.

Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic.

Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. The aim of this study was to explore the participants' lived experiences of a treatment buddy support. A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.

Health-related quality of life in reproductive-age women on antiretroviral therapy: a cross sectional study in Ethiopia.

While numerous studies have explored the impact of gender on Health-Related Quality of Life (HRQOL), there is a lack of evidence specifically among reproductive-age women undergoing Antiretroviral Therapy (ART). Therefore, this study aims to investigate HRQOL and its associated factors among reproductive-age women receiving ART at Hiwot Fana Comprehensive Specialized Hospital in Eastern Ethiopia. A cross-sectional study included 418 women of ART. The World Health Organization quality of Life Questionnaire (WHOQOL-HIV BREF) was used to assess HRQOL. Binary logistic regression was used to determine the factors that could predict HRQOL. The study found that the median age of the participants was 37years, and the overall percentage of women with good HRQOL was 40.7%. Women who stayed on ART for more than 6years had higher odds of overall good HRQOL (AOR 6.73, 95% CI 3.31-13.71) compared to those with a duration of 6years or less. Besides, women having no child (AOR 25.03, 95% CI 4.93-127.06), one child (AOR 18.60, 95% CI 3.95-87.65), two children (AOR 12.89, 95% CI 3.66-45.37) and three children (AOR 3.77, 95% CI 1.06-13.34) had higher odds of overall good HRQOL compared to those with four/more children. The study found that the majority of women on ART had poor HRQOL. Factors such as longer duration of taking ART, higher CD4+ cell count, disclosure of HIV status, and receiving care from adherence support teams were associated with better quality of life. Thus, strengthening adherence support teams, promoting safe disclosure of HIV status, and providing comprehensive support for HIV-positive women are required to improve their overall HRQOL.

Low-Level Viremia among Adults Living with HIV on Dolutegravir-Based First-Line Antiretroviral Therapy Is a Predictor of Virological Failure in Botswana.

We evaluated subsequent virologic outcomes in individuals experiencing low-level virem ia (LLV) on dolutegravir (DTG)-based first-line antiretroviral therapy (ART) in Botswana. We used a national dataset from 50,742 adults who initiated on DTG-based first-line ART from June 2016-December 2022. Individuals with at least two viral load (VL) measurements post three months on DTG-based first-line ART were evaluated for first and subsequent episodes of LLV (VL:51-999 copies/mL). LLV was sub-categorized as low-LLV (51-200 copies/mL), medium-LLV (201-400 copies/mL) and high-LLV (401-999 copies/mL). The study outcome was virologic failure (VF) (VL ≥ 1000 copies/mL): virologic non-suppression defined as single-VF and confirmed-VF defined as two-consecutive VF measurements after an initial VL < 1000 copies/mL. Cox regression analysis identified predictive factors of subsequent VF. The prevalence of LLV was only statistically different at timepoints >6-12 (2.8%) and >12-24 (3.9%) (p-value < 0.01). LLV was strongly associated with both virologic non-suppression (adjusted hazards ratio [aHR] = 2.6; 95% CI: 2.2-3.3, p-value ≤ 0.001) and confirmed VF (aHR = 2.5; 95% CI: 2.4-2.7, p-value ≤ 0.001) compared to initially virally suppressed PLWH. High-LLV (HR = 3.3; 95% CI: 2.9-3.6) and persistent-LLV (HR = 6.6; 95% CI: 4.9-8.9) were associated with an increased hazard for virologic non-suppression than low-LLV and a single-LLV episode, respectively. In a national cohort of PLWH on DTG-based first-line ART, LLV > 400 copies/mL and persistent-LLV had a stronger association with VF. Frequent VL testing and adherence support are warranted for individuals with VL > 50 copies/mL.

Differentiated service delivery framework for people with multidrug-resistant tuberculosis and HIV co-infection.

For people living with HIV/AIDS, care is commonly delivered through Differentiated Service Delivery (DSD). Although people with multidrug-resistant tuberculosis (MDR-TB) and HIV/AIDS experience severe treatment associated challenges, there is no DSD model to support their treatment. In this study, we defined patterns of medication adherence and characterized longitudinal barriers to inform development of an MDR-TB/HIV DSD framework. Adults with MDR-TB and HIV initiating bedaquiline (BDQ) and receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa, were enrolled and followed through the end of MDR-TB treatment. Electronic dose monitoring devices (EDM) measured BDQ and ART adherence. Longitudinal focus groups were conducted and transcripts analyzed thematically to describe discrete treatment stage-specific and cross-cutting treatment challenges. 283 participants were enrolled and followed through treatment completion (median 17.8 months [IQR 16.5-20.2]). Thirteen focus groups were conducted. Most participants (82.7%, 234/283) maintained high adherence (mean BDQ adherence 95.3%; mean ART adherence 85.5%), but an adherence-challenged subpopulation with <85% cumulative adherence (17.3%, 49/283) had significant declines in mean weekly BDQ adherence from 94.9% to 39.9% (p<0.0001) and mean weekly ART adherence from 83.9% to 26.6% (p<0.0001) over 6 months. Psychosocial, behavioral, and structural obstacles identified in qualitative data were associated with adherence deficits in discrete treatment stages, and identified potential stage specific interventions. A DSD framework for MDR-TB/HIV should intensify support for adherence-challenged subpopulations, provide multi-modal support for adherence across the treatment course and account for psychosocial, behavioral, and structural challenges linked to discrete treatment stages.

Factors associated with compliance with weekly iron and folic acid supplementation among school adolescent girls in Debub Achefer district, northwest Ethiopia: school-based cross-sectional study.

Iron deficiency anemia is a public health problem among adolescents that could be addressed by weekly Iron Folic Acid Supplementation (IFAS). The Ethiopian government piloted weekly IFAS in schools, where itseffectiveness depends on compliance. We assessed the determinants of compliance with the weekly IFAS in Ethiopia. A school-based survey was conducted in 506 adolescent girls on weekly IFAS. Compliance was considered when girls reported WIFAS for at least three months without discontinuation. Bivariable and multivariable logistic regression models were modeled, with odds ratios reported. Out of 506, 25.8% had limited access to educational resources, and 79.4% had no information on IFAS. Among these, 47.9% (95% CI: 45.5-49.9%) had poor compliance with weekly IFAS. Non-compliance was mainly due to school absenteeism (55.9%). Important predictors of poor compliance were adolescent girls' marital status (AOR = 5.21; 1.55-17.6), academic standing (AOR = 4.37; 2.20-8.70), family income (AOR = 1.85; 1.09-3.15), access to health education materials (AOR = 1.57; 1.02-2.40), problems with IFAS (AOR = 2.44; 1.26-4.74), a discouraging home environment for the program (AOR = 2.27; 1.54-3.34), and a lack of knowledge of the IFAS program (AOR = 1.40; 0.97-2.03). Compliance with weekly IFAS is optimal, which could be improved via strong adherence support and feasible supplementation schedules.

The Role of the ICE Model in Doctor-Patient Shared Decision Making

The ICE model plays a crucial role in shared decision-making between patients and healthcare providers. Adequate information helps patients better understand their health conditions and make informed choices; effective communication facilitates building mutual trust and reaching consensus between providers and patients; and the demonstration of empathy can alleviate patients' anxiety and enhance their confidence in participating in decision-making. In recent years, the application of the ICE model in clinical practice has gained increasing attention. This article mainly explores and analyzes the application of the ICE model in medical practice and its impact on the quality of patient-provider interactions. The research aims to evaluate how the ICE model promotes effective bidirectional communication between patients and providers, and how providers' empathy can enhance psychological support for patients and treatment adherence. Through this study, the goal is to comprehensively understand the role of the ICE model in improving the quality of healthcare services, strengthening patient-provider relationships, and assisting providers in delivering more personalized, patient-centered care. Finally, current challenges are discussed, and future development directions are proposed.

Application the Cognitive-Behavioral Model of Relapse in Preventing Bipolar Relapse at RSI. Madinah Tulungagung

Background: Mental health has a low early mortality rate, but contributes the most to disability and recurrence is an indicator of successful treatment of mental disorders, including bipolar. Bipolar relapse is caused by many factors or high-risk situations. Purpose: The purpose of this study was to analyze the determinants of bipolar relapse from a cognitive-behavioral model of relapse. Method: This research was conducted at Islamic Hospital of Madinah Tulungagung used a correlational design with a cross sectional approach to 108 respondents who were taken using a simple random sampling technique. The exogenous variables were genetics, age of onset, gender, occupation, marriage, family support, social capital, stigma, self-efficacy, motivation, medication adherence and the endogenous variable was bipolar relapse, using a questionnaire and analyzed path analysis. Results: Genetics, occupation, social capital, self-efficacy, motivation, medication adherence, community stigma and family support have a direct effect on bipolar relapse with a p-value &lt;0.05. Community stigma has an indirect effect on bipolar relapse through medication adherence with a path coefficient (b) of 11.35. Family support has an indirect effect on bipolar relapse through medication adherence (b = 8.9), motivation (b = 11.89) and self-efficacy (b = 18.26). The most effective way to prevent bipolar relapse is family support which has an indirect effect on bipolar relapse through self-efficacy. Conclusion: Family support is expected to increase self-efficacy so that it is effective in preventing bipolar relapse.

Virologic outcomes with tenofovir-lamivudine-dolutegravir in adults failing PI-based second-line ART.

In South African antiretroviral guidelines, selected patients failing second-line protease inhibitor (PI)-based therapy qualify for genotypic resistance testing - those with PI resistance receive darunavir-based third-line regimens; those without PI resistance continue current regimen with adherence support. The Western Cape province, from September 2020, implemented a strategy of tenofovir-lamivudine-dolutegravir (TLD) for patients, provided there was no tenofovir resistance, irrespective of PI resistance. To evaluate virologic outcomes with TLD among adults failing second-line PI regimens with no tenofovir resistance. An observational cohort study comparing outcomes in patients switched to TLD with those continuing the same PI or switched to darunavir-based regimens. Follow-up was until virologic suppression (HIV-1 RNA < 400 copies/mL), or at the point of censoring. One hundred and thirty-three patients switched to TLD, 101 to darunavir-based regimens, and 121 continued with the same PI. By 12 months, among patients with PI resistance, 42/47 (89%) in the TLD group had HIV-1 RNA < 400 copies/mL compared to 91/99 (92%) in the darunavir group (hazard ratio, 1.11; 95% confidence interval, 0.77-1.60). In patients without PI resistance, 66/86 (77%) in the TLD group had HIV-1 RNA < 400 copies/mL compared to 42/120 (35%) in those continuing with the same PI (hazard ratio, 4.03; 95% confidence interval, 2.71-5.98). Two patients receiving TLD developed virologic failure with high-level dolutegravir resistance. Amongst patients failing second-line PI with no PI resistance, switching to TLD was associated with higher virologic suppression, likely due to improved adherence. Virologic outcomes were similar in patients with PI resistance switched to darunavir-based regimens or TLD.

Assessing the acceptability and usability of digital interventions for pregnancy health

Background: Despite the promising potential of digital interventions to enhance maternal health outcomes, there is a lack of comprehensive exploration into their real-world acceptability, usability, and effectiveness among pregnant women. This study was conducted to evaluate the acceptance and usability of digital interventions among pregnant women to gain insights into real-world applications. Methods: The study enrolled fifteen pregnant women (ages 20 to 40 years) using an online application between November 2022 and May 2023. Data collection comprised a usability survey, and statistical analysis employed descriptive statistics and Chi-square tests. Results: Significant variations in age (mean 29.33 years) and gestational age (mean 13.80 weeks) were observed (p&lt;0.001). Ease of use received positive ratings (73.3% found it easy; p=0.071), with no participants finding it difficult (p&lt;0.001). The introduction to the application was well-received (p=0.004). Monitoring utilities were deemed helpful by 73.3% (p=0.071), with strong agreement from 26.7%. App engagement was high, with 86.7% disagreeing it was boring and 13.3% strongly disagreeing with the same (p=0.020). Motivational impact for a healthy diet was endorsed by 80% (p=0.091), and medication adherence support by 93.3% (p=0.015). Recordkeeping ease was significant (80% agreement; p=0.247). Notably, 86.7% remained active users after 30 days, with no dropouts (p&lt;0.001). Conclusions: This pilot study suggests that digital interventions can positively influence maternal health, offering valuable insights for their integration into healthcare strategies.

The Synergistic Effects of Risk-Principle Adherence in the Supervision and Treatment of Individuals Who Have Sexually Offended.

Prior literature highlights the effectiveness of the Risk-Need-Responsivity (RNR) risk principle when providing community supervision and treatment to general justice-involved individuals and special populations such as individuals convicted of a sexual offense. Individuals deemed high-risk, per risk assessment, should receive the most intensive levels of community supervision and treatment, while individuals classified as low risk should receive the lowest intensity. Research in support for the risk principle finds adherence decreased recidivism rates and increased probation compliance. The current study assesses the effects of adhering (or not) to the risk principle in supervision levels and treatment dosage on the compliance of individuals on probation for a sexual offense (N = 133). Overall, results support risk principle adherence for individuals, with increasing adherence levels associated with significantly more compliance, and non-adherence resulting in adverse outcomes. Implications for policy and practice in the supervision and treatment of individuals with a sexual offense are discussed.

Successful Treatment of Cerebral Tuberculoma in Acquired Immune Deficiency Syndrome Patient a Case Report

Introduction: Tuberculosis (TB) remains a leading problem in developing and endemic countries. Cerebral tuberculosis is a rare but dangerous complication of tuberculosis infection in the central nervous system. The immunosuppressive condition in human immunodeficiency virus infection is a risk factor for severe tuberculosis. Case Report: An Indonesian man, 32 years old, married, came with complaints of headaches, dizziness, delirium, nausea and vomiting since 1 month before the examination. He had a history of TB treatment 1 year before the examination. The results of the neurological examination were within normal limits, the HIV test was reactive and there was a decrease in CD4. Head MRI examination with contrast showed multiple solid nodules in the thalamus with the largest size 2.3×2.7 cm, indicating cerebral tuberculoma. Chest x-ray was normal, GeneXpert MTB sputum was not detected. Next, primary treatment is given with anti-tuberculosis drugs, Highly Active Antiretroviral Therapy (HAART), co-trimoxazole, and dexamethasone. There was clinical, laboratory and radiological improvement after 12 months of treatment. Viral load is undetectable, CD4 is elevated. A head CT scan did not show tuberculoma. He became healthy and was able to return to work Discussion: Cerebral tuberculoma is a condition characterized by the presence of intracranial tuberculoma. The clinical manifestations are non-specific, such as headaches or seizures. This is caused by space occupying lesions and increase intracranial pressure. In this case, the diagnosis of cerebral tuberculoma was made through head MRI with contrast. TB therapy and co-trimoxazole are given as soon as the diagnosis is made, while antiretrovirals are given 2 weeks after he has tolerated the TB medication. The minimum duration of therapy for cerebral tuberculosis is 12 months. He require lifelong antiretroviral medication. Conclusion: Tuberculoma should be considered as differential diagnosis of space-occupying lesions in patients HIV/AIDS. Early diagnosis, adequate therapy, patient adherence and family support can cure severe tuberculosis.

MITIGATING THE STIGMA ASSOCIATED WITH TUBERCULOSIS

This article addresses the social stigma associated with tuberculosis (TB) and its influence on patients, their families, and communities, impacting the prevention, diagnosis, and treatment of the disease. It highlights the historical origins of stigma, stemming from a lack of understanding about the transmission and causes of the disease, associated with unfavorable socioeconomic conditions and representations in popular culture. Stigma manifests in various ways, including social isolation, discrimination, negative stereotypes, and delays in diagnosis and treatment. These manifestations have profound impacts on the quality of life and physical and emotional health of patients. To combat stigma, comprehensive strategies are proposed, such as public education, promotion of empathy, community engagement, universal access to healthcare, and psychosocial support. These approaches aim to challenge misconceptions, reduce social isolation, strengthen emotional support, and promote a more compassionate understanding of the disease. The article highlights the importance of treatment adherence and emotional support for patients, emphasizing that support from healthcare professionals, family, and the community is crucial in addressing treatment challenges and promoting better long-term health outcomes. It is concluded that mitigating tuberculosis stigma requires collective and ongoing effort, with an integrated, patient-centered approach. By promoting empathy, understanding, and support, it is possible to create a more inclusive and supportive environment, advancing towards a society where health and well-being are accessible to all.

Relationship between Social Support, Adherence to Pharmacological Treatment, and Quality of Life among Hemodialysis Patients

Social support and level of adherence to medications influences the quality of life among hemodialysis patients. The study aimed to investigate the relationship between social support, adherence to pharmacological treatment, and quality of life among hemodialysis patients. A correlational descriptive study was conducted on a convenience sample of 102 hemodialysis patients. Four tools were used to collect the required data: Demographic Data Sheet, Kidney Disease and Quality of Life, Perceived Social Support Scale, and Adherence to Pharmacological Treatment. Results of the study revealed that social support has a positive effect on adherence to pharmacological medications, and quality of life.

Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults

BackgroundHIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS.MethodologyThis cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure.ResultsClinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count < 200 cells/mm3, unemployment, being infected through sex, and the presence of symptoms were the predominant risk factors for virological failure. In addition, 55% of patients who experienced virological failure failed to experience immunological and/or clinical failure.ConclusionAs the first study in southern Iran and the second in Iran, Iranian policymakers should focus on intensive counseling and adherence support and emphasize more effective treatment regimens such as protease and integrase inhibitors (PIs and INTIs), to increase the chance of a treatment response to ART. The accuracy of identifying clinical and immunological criteria in resource-limited settings is not promising. The present findings can be used to determine effective measures to control HIV treatment failure and design efficient strategies for the ambitious 95–95–95 plan.

Digital Health Platforms for Breast Cancer Care: A Scoping Review.

Breast cancer is a significant global health concern affecting millions of women each year. Digital health platforms are an easily accessible intervention that can improve patient care, though their efficacy in breast cancer care is unknown. This scoping review aims to provide an overview of existing research on the utilization of digital health platforms for breast cancer care and identify key trends and gaps in the literature. A comprehensive literature search was conducted across electronic databases, including Ovid MEDLINE, Elsevier EMBASE, and Elsevier Scopus databases. The search strategy incorporated keywords related to "digital health platforms", "breast cancer care", and associated terminologies. After screening for eligibility, a total of 25 articles were included in this scoping review. The identified studies comprised mobile applications and web-based interventions. These platforms demonstrated various functionalities, including patient education, symptom monitoring, treatment adherence, and psychosocial support. The findings indicate the potential of digital health platforms in improving breast cancer care and patients' overall experiences. The positive impact on patient outcomes, including improved quality of life and reduced psychological distress, underscores the importance of incorporating digital health solutions into breast cancer management. Additional research is necessary to validate the effectiveness of these platforms in diverse patient populations and assess their impact on healthcare-resource utilization.

Behavioral Economic Incentives to Support HIV Care: Results From a Randomized Controlled Trial in Uganda.

This study tests behavioral economics incentives to improve adherence to antiretroviral treatment (ART), with 1 approach being low cost. Three hundred twenty-nine adults at Mildmay Hospital in Kampala, Uganda, on ART for at least 2 years and showing adherence problems received the intervention for about 15 months until the study was interrupted by a nation-wide COVID-19 lockdown. We randomized participants into 1 of 3 (1:1:1) groups: usual care ("control" group; n = 109) or 1 of 2 intervention groups where eligibility for nonmonetary prizes was based on showing at least 90% electronically measured ART adherence ("adherence-linked" group, n = 111) or keeping clinic appointments as scheduled ("clinic-linked"; n = 109). After 12 months, participants could win a larger prize for consistently high adherence or viral suppression. Primary outcomes were mean adherence and viral suppression. Analysis was by intention-to-treat using linear regression. This trial is registered with ClinicalTrials.gov, NCT03494777 . Neither incentive arm increased adherence compared with the control; we estimate a 3.9 percentage point increase in "adherence-linked" arm [95% confidence interval (CI): -0.70 to 8.60 ( P = 0.10)] and 0.024 in the "clinic-linked" arm [95% CI: -0.02 to 0.07 ( P = 0.28)]. For the prespecified subgroup of those with initial low adherence, incentives increased adherence by 7.60 percentage points (95% CI: 0.01, 0.15; P = 0.04, "adherence-linked") and 5.60 percentage points (95% CI: -0.01, 0.12; P = 0.10, "clinic-linked"). We find no effects on clinic attendance or viral suppression. Incentives did not improve viral suppression or ART adherence overall but worked for the prespecified subgroup of those with initial low adherence. More effectively identifying those in need of adherence support will allow better targeting of this and other incentive interventions.

Evaluation of a peer-support, ‘mentor mother’ program in Gaza, Mozambique; a qualitative study

BackgroundRetention in prevention of mother-to-child transmission of HIV programs is critical to reduce vertical transmission. To addresses challenges with retention, Mozambique launched a peer-support program in 2018, in which HIV-positive mothers provide adherence support as mentor mothers (MMs) for HIV-positive pregnant and lactating women and HIV-exposed and infected children.MethodsA descriptive qualitative evaluation was conducted across nine facilities in Gaza Province to assess the acceptability and barriers to implementation of the mentor mother program (MMP) among those receiving services and providing services. In-depth interviews and focus group discussions were conducted with MMs, MM supervisors, health care workers (HCWs), HIV-positive mothers enrolled in the MMP, HIV-positive mothers who declined MMP enrollment, and key informants involved in the implementation of the program. Thematic analysis identified emerging recurrent themes and patterns across the participants’ responses. Data were collected between November-December 2020.ResultsThere were initial challenges with acceptability of the MMP, especially regarding confidentiality concerns and MM roles. Sharing additional information about MMs and making small changes during the beginning of the MMP resulted in generally high acceptance of the MMP. HIV-positive mothers reported that counseling from MMs improved their understanding of the importance of anti-retroviral treatment (ART) and how to take and administer ART. HIV-positive mothers reported having reduced guilt and shame about their HIV-status, feeling less alone, and having more control over their health. MMs shared that their work made them feel valued and decreased their self-stigmatization. However, MMs also reported feeling that they had inadequate resources to perform optimal job functions; they listed inadequate transportation, insufficient stipends, and false addresses of clients among their constraints. Overall, HCWs felt that their workload was significantly reduced with MM support and wanted more MMs in the community and health facility.ConclusionsThis study found that the MMP was considered a substantive and highly valued support to HIV-positive mothers, resulting in increased ART literacy among patients, improved self-reported well-being and sense of community and reduced feelings of isolation. Recommendations include strengthening MM training, increasing financial and materiel resources, additional information provided to newly enrolled mothers and support for the male partners.

Relationship between Social Support, Adherence to Pharmacological Treatment, and Quality of Life among Hemodialysis Patients

Social support and level of adherence to medications influences the quality of life among hemodialysis patients. The study aimed to investigate the relationship between social support, adherence to pharmacological treatment, and quality of life among hemodialysis patients. A correlational descriptive study was conducted on a convenience sample of 102 hemodialysis patients. Four tools were used to collect the required data: Demographic Data Sheet, Kidney Disease and Quality of Life, Perceived Social Support Scale, and Adherence to Pharmacological Treatment. Results of the study revealed that social support has a positive effect on adherence to pharmacological medications, and quality of life.