Common Reason For Nonadherence Research Articles

Adherence to Antimicrobial Prophylaxis Guidelines for Elective Surgeries Across 825 US Hospitals, 2019-2020.

There are limited US data assessing adherence to surgical antimicrobial prophylaxis guidelines, particularly across a large, nationwide sample. Moreover, commonly prescribed inappropriate antimicrobial prophylaxis regimens remain unknown, hindering improvement initiatives. We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence. Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range: .61-1.61) and was significantly lower in 2020 compared with 2019 (aOR: .92; 95% CI: .91-.94; P < .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR: 1.19; 95% CI: 1.11-1.27; P < .001). Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.

Addressing adherence to guidelines on prevention of acute chemotherapy-induced nausea and vomiting in pediatric patients.

Chemotherapy-induced nausea and vomiting (CINV) is a distressing adverse effect in children receiving cancer treatment. There are evidence-based pediatric clinical practice guidelines (CPG) on chemotherapy emetogenicity and acute CINV prevention, but adherence to these guidelines is low. A quality improvement-based study was conducted at McMaster Children's Hospital. The SMART aim was to increase adherence to guidelines on prevention of acute CINV in hospitalized patients receiving high (HEC) and moderately emetogenic chemotherapy (MEC) from baseline 25% to more than 70% by June 2021. Barriers were identified by process mapping, and a series of interventions were implemented. Guideline adherence was assessed in 270 inpatient chemotherapy administrations (HEC, MEC). Data were collected on 131 charts pre interventions and 139 charts post interventions. Interventions included education, addition of guideline-recommended anti-emetics to the inpatient formulary, and implementation of a standardized CPG tool. Initial rates of total CINV guideline adherence were 25%, which improved to 72% post intervention (p<.001). In subgroup analysis, guideline adherence in the MEC group improved from 13% to 34% (p=.015), and in the HEC group from 32% to 93% (p<.001). The most common reason for nonadherence in the HEC group was failure to use aprepitant as anti-emetic, and in MEC was option for ondansetron monotherapy prophylaxis. Using quality improvement methodology, barriers to guideline adherence were identified and interventions implemented. Guideline adherence for prevention of CINV improved, particularly in the HEC group but less for the MEC group. Future steps will include sustainability of interventions and addressing adherence in the MEC group.

Abstract- Poster

Background: Antidepressant-induced excessive sweating (ADIES) is a common antidepressant-related side effect, and its prevalence is estimated to range from 4 - 22%. Adverse effects are a common reason for nonadherence and discontinuation of antidepressant medication, and alleviating these side effects may improve adherence and promote positive outcomesCase description: We report 2 cases who were on antidepressants (SSRI) for anxiety disorder and major depressive disorder. After using the drug both patients developed excessive sweating over a period of time, which was found to be independent of their pre-existing condition. Stopping the drug helped in relieving sweating but when the drug was given again sweating recurred. Later on they were given with benztropine and glycopyrrolate which helped their symptoms successfully.Discussion: Adrenergic actions of antidepressants are implicated in causing ADIES. Agents that have been reported successful in controlling the sweating include benztropine and glycopyrrolate.Conclusion: We recommend a patient-specific approach for the management of ADIES. First, consider dose reduction or a trial off antidepressant medication. If patients in whom this is inappropriate or ineffective, substitution of other antidepressant may be considered. If episodes of excessive sweating persist, consider treatment with benztropine or glycopyrrolate or terazosin in the absence of contraindications.

Sleep Variables as Predictors of Treatment Effectiveness and Side Effects of Stimulant Medication in Newly Diagnosed Children with Attention-Deficit/Hyperactivity Disorder.

There is a growing body of research on the impact of stimulant medication on sleep in children with attention-deficit/hyperactivity disorder (ADHD). Negative sleep side effects are a common reason for nonadherence or for discontinuing a course of treatment. However, there is no published evidence as to whether pretreatment sleep can predict responses to treatment and the emergence of side effects. In this study, baseline sleep variables were used to predict therapeutic effect (i.e., reduction of ADHD symptoms) and side effects (both sleep and global side effects) in a sample of newly diagnosed, medication-naive children (n = 50). The results of hierarchical regression analysis showed that parent-reported shorter sleep duration before medication treatment significantly predicted better response to treatment, independent of pretreatment ADHD symptoms. Baseline sleep features did not significantly predict global (nonsleep) side effects but did predict increased sleep side effects during treatment. These results indicate that baseline sleep variables may be helpful in predicting therapeutic response to medication and sleep disturbance as a side effect of stimulant medication.

Descriptive Cross-Sectional Study on Knowledge, Awareness, and Adherence to Medication among Hypertensive Patients at a Tertiary Care Centre in Colombo District, Sri Lanka

Objective This study was aimed to assess the patient's knowledge and awareness about hypertension and adherence to antihypertensive medication among hypertensive patients. Methods The descriptive cross-sectional study was conducted in three medical clinics of Colombo South Teaching hospital, Kalubowila, Sri Lanka, from April 2019 to September 2019. Total of 384 hypertensive patients were recruited by systematic randomized controlled sampling and interviewed with validated questionnaires to assess their knowledge about hypertension and adherence to antihypertensive medication. Data were analyzed using SPSS (version 21) analytical package, and the chi-squared test was performed. Results The total sample consisted of 384 hypertensive patients with a mean age of 59.32 (±12.34SD). This included 180 (46.9%) males and 204 (53.1%) females. The male : female ratio was approximately 9 : 10. Most of patients were with primary and ordinary educational status (65.9%), normal body mass index (54.9%), mild elevation of LDL cholesterol (76.3%), and coexistent ischemic heart disease (39.6%). The knowledge about hypertension among majority of patients was reasonable. However, they were unaware about normal values of blood pressure (69%, 95% of CI 1.92–2.09) and diagnostic values of hypertension (90.1%, 95% of CI 2.26–2.40). Moreover, they were unaware of their blood pressure values at time of diagnosis (75.3%, 95% of CI 2.09–2.25), at recent clinic visit (71.3%, 95% of CI 2.0-2.17), and target level (81.8%, 95% of CI 2.25-2.41). Most patients had adequate knowledge about the risk factors and complications of hypertension and were aware of their target organ damage (70.3%). Most patients believed that medication alone is not sufficient to control blood pressure (41.7%, 95% of CI 1.40-1.51) and adequate control of their blood pressure reduces complications (68.2%, 95% of CI 1.37-1.51). Most of the patients (71.8%) had reasonable good drug compliance. The forgetfulness was commonly attributed for nonadherence (69%, 95% of CI 1.26-1.36). Conclusions The knowledge about hypertension among majority of patients was reasonable. But, they were unaware about their disease status and their diagnosis, target, and recent blood pressure values. Most of patients had adequate knowledge about the risk factors and complications of hypertension. However, they were unaware about their target organ damage due to hypertension. The drug compliance was reasonable among them. The forgetfulness was common reason for nonadherence. Therefore, healthcare professionals should implement individualized educational programmes to increase the awareness of disease status, appropriate blood pressure levels, and adherence of treatment to improve the outcome of patients.

Assessing Nurses' Adherence to the See-and-Treat Guidelines of Botswana's National Cervical Cancer Prevention Programme.

The see-and-treat approach for cervical cancer screening [visual inspection with acetic acid (VIA) followed by immediate cryotherapy] was first pilot tested in Botswana in 2009. Botswana's Ministry of Health and the Botswana-UPenn Partnership collaborated to expand see-and-treat to five additional sites throughout the country in 2014. The purpose of this study was to evaluate whether nurses' adherence to guideline-based screening was maintained during scale-up. Therefore, we compared nurses' adherence between the pilot and scaled-up sites and determined main drivers of nonadherence across all sites. We conducted a retrospective review of 6,644 medical charts from Botswana's National Cervical Cancer Prevention Programme between February 2014 and October 2015. Using multivariable regression modeled with generalized estimating equations, we determined whether nurses' adherence to the see-and-treat guideline differed between the pilot and scale-up sites after controlling for significant covariates. Overall, adherence to the guideline was high (88.4%). Although the scaled-up sites had higher adherence compared with the pilot site (90.9% vs. 80.2%, respectively), the difference between sites was not statistically significant in the multivariable model (P = 0.221). Of the nonadherent clinical encounters, the three most frequent visit types were VIA not performed (178, 23.3%), VIA negative: HIV unknown (163, 21.3%), and VIA negative: HIV negative (144, 18.9%). The most common reason for nonadherence was misspecification of follow-up times. Despite known challenges of scaling-up health innovations in resource-limited settings, our study shows that nurses maintained guideline-adherent care in Botswana's national see-and-treat program. The successful scale-up may have been attributable to the program's intensive quality assurance monitoring.

Type 2 Diabetic Patients Adherence Towards Their Medications.

Given that type 2 diabetes mellitus (T2DM) has become a common noncommunicable disease that can begin in early life and has a significant effect on the quality of life, it is important to address treatment adherence. While various factors contribute to the development of T2DM, the primary cause is linked to unhealthy eating and lack of physical activity. Adhering to healthy eating and physical exercise is not generally well tolerated by patients with diabetes, and pharmacological treatments are often necessary. However, few studies exist that assess T2DM treatment adherence in Saudi Arabia. Therefore, we conducted a cross-sectional analytic study at Al Iskan, Al Waha, and Bahrah Primary Health Care Centers, National Guard Health Affairs, Jeddah, Saudi Arabia, to assess the adherence among patients with T2DM via a self-completed questionnaire after participant verbal and written consent. A total of 387 patients with T2DM were surveyed: 269 were males (69.5%) and 118 were female patients (30.5%). According to our findings, 265 (68.5%) participants reported adherence toward their medications, and 122 (31.5%) were not adherent. The most common reason for nonadherence was forgetting to take their medication. Nonadherence is associated with poor outcomes and lower quality of life. Therefore, additional studies and awareness campaigns are needed to identify and address the various causes of nonadherence to prevent further complications and decrease the overall burden of the disease.

Awareness, medication adherence, and diet pattern among hypertensive patients attending teaching institution in western Rajasthan, India.

Background and Objectives:Hypertension is an important disease of public health concern. Awareness and medication adherence with diet modification have an important effect on the control of blood pressure and its associated morbidity and mortality. Therefore, this study was conducted to assess the awareness of hypertension, medication adherence, and dietary pattern in hypertensive population of western Rajasthan.Materials and Methods:The study was hospital based cross-sectional. Blood pressure measurements were taken in a sitting position in right arm after a 5-min rest using nonmercury sphygmomanometer and required cuff size. A prevalidated and pretested questionnaire for the assessment of awareness of hypertension was used.Results:Out of the total 384 patients, the majority of the patients were males (62.5%). There was a statistically significant difference found in awareness of hypertension among rural and urban patients. Nonadherence to antihypertensive medications was seen more in males (60.0%) as compared to females (40.0%). The most common reason for nonadherence was found to be forgetfulness (27.6%) followed by poor knowledge about the hypertension and ignorance of long-term treatment (22.9%). Out of the total hypertensive patient studied, 54.9% were taking normal salt intake and 45.1% of the subjects were found to be taking excess intake of salt.Interpretation and Conclusions:In the present study, good awareness about hypertension was found with urban patients. Among all the variables, education and employment status showed a positive and significant association with awareness. The most common reason of poor adherence was found to be forgetfulness behavior followed by poor knowledge and lack of awareness about hypertension.

Factors affecting adherence to treatment in children living with HIV.

Background:With the successful introduction of ART, the life expectancy of children living with HIV (CLHIV) is substantially increased. However, strict compliance is a necessary step to begin with as noncompliance is again associated with its own demerits of incomplete suppression and decreasing the overall survival of the patients.Aims:The aim of this study was to measure factors associated with adherence to ART among CLHIV.Materials and Methods:This is a 1-year follow-up study conducted from November 2012 to December 2013. A total of 171 children between 18 months and 15 years living with HIV and on ART attending the two ART centers of Delhi were enrolled in the study. Adherence and factors affecting adherence were obtained from the study participants using a semi-structured interview schedule.Statistical Analysis Used:Collected data were transformed into variables and analyzed into SPSS. All observations were in terms of mean, median, standard deviations, percentages, and proportions. Tests of significance such as Chi-square test and t-test were applied wherever required.Results:In nearly 89% of the study participants, adherence to ART was ≥95% at the end of the study. The most common reason for nonadherence was forgetfulness (59%), and 57% of the parents/caretakers were facing monetary problems. Long distance, greater duration to reach center, and unavailability of the parents/caretakers were also quoted as problems.Conclusion:Adherence is genesis to successful treatment outcome and is strongly associated with availability of support by their parents/caretakers. Professional help along with guidance and encouragement is required not only at the caretaker level but also to the family as a whole.

Cost-related nonadherence to medicines in people with multiple chronic conditions

Multimorbidity is common and frequently associated with medicine nonadherence. Although cost is a common reason for nonadherence, very little research has quantified cost-related nonadherence (CRNA) to medicines specifically in people with multimorbidity, the prevalence of CRNA for different conditions nor the impact of cost when prioritising treatment between conditions. To determine the extent of CRNA in people with multimorbidity and the patient characteristics associated with these behaviours. People reporting two or more chronic conditions responding to a rapid response module regarding prescription drug affordability fielded between January 1 and June 30 2016 in the Canadian Community Health Survey, a cross-sectional household survey. Ordinal logistic regression, adjusted for key sociodemographic, clinical and treatment related variables, of weighted population estimates of self-reported CRNA within one group of conditions, across multiple groups of conditions, or no CRNA. 10.2% of 8420 Canadians with multimorbidity reported CRNA. The majority (61%) reported CRNA within one group of conditions, especially respiratory (16%) and mental health disorders (17%). CRNA was more common in younger adults, people without employer or association drug insurance plans, poorer health status, more chronic conditions, and increased out-of-pocket prescription costs. Having no prescription insurance was associated with a higher probability of CRNA across multiple groups of conditions. People with multimorbidity primarily forego medicines because of cost within one group of conditions. However, those without drug insurance extended these behaviours to multiple condition groups. Further work is needed to determine how people prioritise the conditions and treatments that are foregone because of cost, and how to best incorporate this information into treatment plans.

Knowledge, attitude and practice of insulin use and its adverse effects in adult diabetic population

Background: Diabetes is a disease when left untreated, leads to many complications. India is emerging as a diabetic capital of the world. Insulin is widely used as a therapeutic option, and hence this study was conducted to assess the awareness of Insulin use and its adverse effects in diabetic population.Methods: The study was a questionnaire survey conducted in adult patients with diabetes who are on Insulin therapy. The participants’ knowledge, attitude and practice were assessed by using a questionnaire consisting of 32 questions. Scores were allotted to each question, and evaluated after applying appropriate statistical tests.Results: The mean age of the participants was 57.26±11.24 years. About 54% were males. 46% belonged to rural areas. The mean knowledge score was 17.53±4.40, mean attitude score 7.42±4.85 and the mean practice score was 6.56±1.91. 40% responded that they will return the expired insulin vials to the pharmacy. The most common reason for non adherence was economical constraints (60%). The females had better knowledge (17.60±4.43 vs. 17.45±4.40, p&gt;0.88), attitude (8.21±3.84 vs. 6.58±5.56, p&gt;0.09) and practice (6.97±1.84 vs. 6.13±1.92, p&lt;0.02) of insulin use than males. Also, the urban population had better knowledge (17.58±3.64 vs. 17.32±4.97, p&gt;0.297), attitude (8.70±3.95 vs. 6.06±5.37, p &lt;0.002) and practice scores (6.92±1.89 vs. 6.38±1.92, p&gt;1.395) than the rural counterparts.Conclusions: There exists a gap between knowledge attitude and practice of insulin use. This can be overcome by conducting awareness programmes by health care providers, to sensitise people about the proper use, side effects and the methods of disposal of insulin vials.

Adherence to Antiretroviral Therapy in Turkey: Results from the ACTHIV-IST Study Group.

Maintaining optimal adherence to antiretroviral therapy (ART) is essential for optimizing the management of HIV infection. The aim of this study is to explore ART adherence rates in Turkey. Included in this study were a total of 263 HIV-infected patients followed up by the ACTHIV-IST (ACTion against HIV in Istanbul) Study Group affiliated with four tertiary hospitals. The study population included patients 18 years of age or older who were on ART for over 12 months. Adherence was assessed by the medication possession ratio (MPR) calculated for each patient using data (a list of all drugs dispensed within the previous year for that patient) obtained from pharmacy medication records. In addition, patients completed a self-report questionnaire addressing missed doses and the AIDS Clinical Trials Group (ACTG) adherence questionnaire. The study was reviewed and approved by the Ethics Committee of Cerrahpasa Medical Faculty. Patient ages ranged from 19 to 71 years. Two hundred and thirty-one patients were male (88%). Two hundred and twenty-four patients (85%) had optimal adherence (MPR ≥95%). During the course of ART, 236 patients (90%) reported no missed doses in the past 4 days of their treatment, whereas 206 patients (78%) reported no missed doses in the past month. Simply forgetting was the most common reason for nonadherence. MPR was associated with virologic rebound. Major factors affecting adherence were being female, taking antituberculosis drugs, having an opportunistic infection, being able to take all or most of the medication as directed, and being aware of the need to take medication exactly as instructed to prevent the development of drug resistance. Adherence to ART measured by MPR and self-report surveys is relatively high in Turkey when compared with other countries, which probably led to high ART success rates.

Nonadherence to first-line antiretroviral therapy among human immunodeficiency virus-1 infected children at the Jos University Teaching Hospital, Jos, Nigeria

Background: Nonadherence to antiretroviral therapy (ART) may encourage the development of resistance to antiretroviral drugs (ARVs). Poor adherence is known to be associated with ART failure which could compromise the benefits of ART in children. Therefore, it is important to identify the reasons why children on ART may fail to take their ARVs. In this study, we described the characteristics of human immunodeficiency virus-1 (HIV-1) infected children with ART nonadherence as well as the reasons for their nonadherence.Methodology: A retrospective cohort study in which data on 580 HIV-1 infected children enrolled on ART between February 2006 and December 2010 at the pediatric HIV clinic of the Jos University Teaching Hospital, Jos, was analyzed. Subjects were aged 2 months to 15 years. Information on adherence was obtained by child or caregiver self-report. They also had repeated adherence counseling during each clinic follow-up visit and were taught the use of alarm clocks daily for reminding them of when the next ARV dose will be due.Results: There were 30 (5.2%) children with non-adherence to ART. Among children with nonadherence, majority were: Children aged 1-10 years (76.7%), males (53.3%) and did not know their diagnosis of HIV (90.9%). The odds of nonadherence was two times higher among children who failed first-line ART compared with those who did not (odds ratio [95% confidence interval], 2.28 [1.03-5.02], P = 0.04). The most common reason for nonadherence was: Forgot to take medications (46.7%).Conclusion: The low rate of nonadherence to ART in this study could be attributed to repeated adherence counseling during each clinic follow-up visit and the use of alarm clocks daily for reminders on when the next ARV dose will be due.

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic.

Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people. To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia. The study sample was selected from an existing database that included sociodemographic, health-related information, and medication-related problems identified during a pharmacist-provided medication review conducted during October 2008-September 2009. Patients experiencing or at risk of homelessness who were ≥18 years old with at least one behavioral health condition who had a medication review were eligible for the study. A qualitative content analysis of the pharmacist documentation describing the patient's reason(s) for medication nonadherence was conducted. The Behavioral Model for Vulnerable Populations was the theoretical framework. The outcome variable was self-reported medication nonadherence. Descriptive and multivariate (logistic regression) statistics were used. A total of 426 individuals met study criteria. The mean age was 44.7±10.2 years. Most patients were African-American (60.5%) and female (51.6%). The content analysis identified patient-related factors (74.8%), therapy-related factors (11.8%), and social or economic factors (8.8%) as the most common reasons for patients' medication nonadherence. Patients with post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI: 0.19-0.87) were less likely to have a medication adherence problem identified during the medication review. The content analysis identified patient-related factors as the most common reason for nonadherence with behavioral health medications. In the quantitative analysis, patients with a PTSD diagnosis were less likely to have nonadherence identified which may be related to their reluctance to self-report nonadherence and their diagnosis, which warrants further study.

Noncompliance with glaucoma medication in Korean patients: a multicenter qualitative study

To investigate the common side effects of topical antiglaucoma medication, factors affecting compliance, and the utilization of herbal medicine for glaucoma treatment in South Korea. A cross-sectional multicenter hospital-based study. In-depth interviews using a structured questionnaire were conducted with 581 individuals diagnosed with glaucoma. Additional eligibility requirements were: all participants were diagnosed with glaucoma in one or both eyes and prescribed eye drops at least one month before the start of the study, and were in a suitable condition for an interview. The frequency of response for each category in the interview questionnaire was analyzed. Conjunctival injection, a stinging sensation, and blurred vision were the most frequently reported side effects, among which blurred vision was the most unbearable. Patient knowledge of glaucoma was the only factor associated with the patient's self-evaluation of compliance. Forgetfulness was the most common reason for nonadherence. Only 2.9 % of patients were taking herbal medicine. Physicians should address a patient's complaint of blurred vision resulting from medication. Complete initial explanation of the consequences of nonadherence and of the potential vision loss from glaucoma are critical elements in improving patient adherence in Asian populations.

Adherence to First-Line Disease-Modifying Therapy for Multiple Sclerosis in Kuwait

The aim of this retrospective study was to determine the rate of nonadherence to disease-modifying therapies (DMTs) among multiple sclerosis (MS) patients in Kuwait and to identify reasons for patient discontinuation of long-term therapy. Using a newly established MS registry at our institution, we collected data on MS patients' demographics, clinical characteristics, disability measures, and continuation or discontinuation of first-line DMTs. Reasons for nonadherence were divided into four categories: adverse events, inconvenience, perceived lack of efficacy, and physician-documented disease progression. Of 212 eligible patients, 40.1% were found to be nonadherent to first-line DMTs. In the nonadherent group, the female-to-male ratio was 1.75:1 and the mean age at disease onset was 26.8 years. Of this group, 69.4% of patients had a relapsing-remitting course, 18.8% had a secondary progressive course, and 11.8% had clinically isolated syndrome. Compared with the adherent group, the nonadherent group had a shorter mean disease duration (P = .014) and a greater likelihood of having Expanded Disability Status Scale (EDSS) scores of 3 or lower (67.1% vs. 48.0%; P = .007). Inconvenience was the most common reason for nonadherence (32.9%), followed by perceived lack of efficacy (25.9%), adverse events (23.5%), and physician-documented disease progression (17.7%). In summary, the rate of nonadherence to first-line DMTs in MS patients at our institution is considered high. Most nonadherent patients had a short disease duration and low EDSS scores. Inconvenience and perceived lack of efficacy were the most common reasons for nonadherence. The results demonstrate a need to improve treatment adherence among MS patients in Kuwait through providing better patient education, improving communication between patients and health-care providers, defining therapy expectations, and instituting new therapeutic techniques.

Pattern and Determinants of Antiretroviral Drug Adherence among Nigerian Pregnant Women

Background. The need for a high level of adherence to antiretroviral drugs has remained a major hurdle to achieving maximal benefit from its use in pregnancy. This study was designed to determine the level of adherence and identify factors that influence adherence during pregnancy. Method. This is a cross-sectional study utilizing a semistructured questionnaire. Bivariate and multiple logistic regression models were used to determine factors independently associated with good drug adherence during pregnancy. Result. 137 (80.6%) of the interviewed 170 women achieved adherence level of ≥95% using 3 day recall. The desire to protect the unborn child was the greatest motivation (51.8%) for good adherence. Fear of being identified as HIV positive (63.6%) was the most common reason for nonadherence. Marital status, disclosure of HIV status, good knowledge of ART, and having a treatment supporter were found to be significantly associated with good adherence at bivariate analysis. However, after controlling for confounders, only HIV status disclosure and having a treatment partner retained their association with good adherence. Conclusion. Disclosure of HIV status and having treatment support are associated with good adherence. Maternal desire to protect the child was the greatest motivator for adherence.

Medication adherence in pediatric and adolescent liver transplant recipients.

Nonadherence to medications is a leading cause of morbidity in children and adolescents who have had a transplant, yet there are no published data about the use of different methods for detecting whether these children are taking their medications. There are also no published data about the age of transition at which a child assumes responsibility over taking the medications. This information is important if interventions to improve adherence are contemplated. We present an analysis of data obtained in the first year of the implementation of an adherence assessment protocol at a pediatric liver transplant clinic in a tertiary medical care center. Data were obtained for children and adolescents who had a liver transplant at least 1 year before the assessments took place. We used 5 adherence detection methods. The 4 subjective methods were self-reported, scaled questionnaires answered by nurses, physicians, caregivers, and patients. For the objective method, a standard deviation (SD) was calculated for tacrolimus blood levels obtained from each patient over time. A higher SD suggests increased variation among patients' blood levels and hence more erratic medication taking. We also asked the patients and caregivers who is responsible for taking the medications and what are the reasons for not taking them. The medical outcome measures were biopsy-proven rejection episodes, number of biopsies regardless of the results, number of hospital admissions, and number of in-patient days. An analysis of 81 cases (258 assessments) revealed that the only method that predicted the medical outcome variables (biopsy-proven rejection and number of biopsies) was the SD of medication blood levels. Patients', clinicians', and caregivers' reports were not predictive. Clinicians' ratings of adherence were not correlated with patients' or caregivers'. The transition of responsibility for medication taking occurred approximately at the age of 12 years. Forgetfulness was cited as the most common reason for nonadherence by patients and caregivers; medication side effects were not frequently cited. Our results indicate that clinical impression is not sufficient to determine whether children and adolescents are taking their medications after they have had a liver transplant. An objective assessment method should be used. Interventions targeting adherence should address the child's increasing role beginning in early adolescence. A clinical protocol incorporating objective assessments of adherence could potentially be implemented in other settings. It could form the basis for the evaluation of efficacy of interventions seeking to improve adherence to medications.