High Levels Of Treatment Adherence Research Articles

Non-adherence to ivermectin in onchocerciasis-endemic communities with persistent infection in the Bono Region of Ghana: a mixed-methods study

BackgroundThe World Health Organization has proposed that onchocerciasis elimination (interruption) of transmission be verified in 12 (approximately a third) endemic countries by 2030. The strategy to reach this goal is based on ivermectin Mass Drug Administration (MDA) with high geographical and therapeutic coverage. In addition to coverage, high levels of treatment adherence are paramount. We investigated factors associated with ivermectin intake in an area of Ghana with persistent Onchocerca volvulus infection.MethodsIn August 2021, a cross-sectional mixed-methods study was conducted in 13 onchocerciasis-endemic communities in the Bono Region of Ghana. Individuals aged ≥ 10 years were invited to participate in a questionnaire survey. A total of 48 focus group discussions and in-depth interviews with 10 community drug distributors and 13 community leaders were conducted.ResultsA total of 510 people participated in the study [median age: 32, interquartile range 30 (20‒50) years]; 274 (53.7%) were females. Of the total, 320 (62.7%) declared that they adhered to each treatment round and 190 (37.3%) admitted they had not taken ivermectin during at least one MDA round, since becoming eligible for treatment. Of 483 participants with complete information, 139 (28.8%) did not take ivermectin during the last round (March 2021), and 24 (5.0%) had never taken ivermectin (systematic non-adherers). Reasons for not taking ivermectin included previous experience/fear of side-effects, being absent during MDA, pregnancy, the desire to drink alcohol, and drug distribution challenges. Being male, having good knowledge and perception of the disease, and not having secondary or higher level of formal education were significantly associated with higher odds of ivermectin intake.ConclusionsA relatively high level of non-adherence to ivermectin treatment was documented. There is a need for targeted educational and behavioural change campaigns to reverse these trends and ensure a steady course toward meeting onchocerciasis elimination targets in Ghana.

A 7 day inpatient diabetes education program improves quality of life and glycemic control 12 months after discharge

For long-term management of diabetes, patients with type 2 diabetes mellitus require a high level of treatment adherence, which is associated with treatment satisfaction and their quality of life (QOL). To achieve it, patient education about diabetes self-management is essential. We routinely conduct a 7 day inpatient diabetes education program and administer the diabetes treatment-related (DTR)-QOL questionnaire to all participants, both before admission and at discharge. Here, we investigated whether our program improves QOL and post-discharge glycemic control. This retrospective study utilized data from patients with type 2 diabetes mellitus who participated in our program between July 2017 and March 2020 and who had been treated in our outpatient department for more than 1 year. We evaluated the relationship between at admission and at discharge diabetes treatment-related quality of life scores and glycemic control after discharge. Data from 140 patients were analyzed in this study, which showed a significant improvement in the total, 'Anxiety and dissatisfaction with treatment', and 'Satisfaction-with-treatment' scores. A significant improvement was evident in HbA1c at 12 months after discharge. Multiple regression analysis showed that HbA1c after 12 months was independently associated with gender, duration of diabetes, and HbA1c at admission. Our program effectively improves quality of life and post-discharge glycemic control in patients with type 2 diabetes mellitus. It is particularly effective in patients of the male gender, with a shorter duration of diabetes mellitus and higher HbA1c at admission.

Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD): Toward improving the adherence of the patients with drug-sensitive tuberculosis in Nashik, Maharashtra.

Adherence to tuberculosis (TB) medication is one of the critical challenges to tuberculosis elimination in India. Digital adherence technologies (DAT) have the potential to facilitate medication adherence and monitor it remotely. Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD) is one such DAT piloted in Nasik, Maharashtra, from April 2020 to December 2021. The study aims to assess the adherence and cost-effectiveness of TMEAD compared to the standard of care among patients with drug-sensitive tuberculosis (DSTB) residing in the urban areas of Nasik, Maharashtra, India. A quasi-experimental study was conducted among new cases of TB as per the National TB Elimination Programme (NTEP) residing in the urban geography of Nasik. The intervention and control arms were purposively selected from non-contaminating TB units (TUs). A total of 400 DSTB patients (200 in the intervention group and 200 in the control group) were enrolled. After enrolment, patients in the intervention arm were provided with the TMEAD device and followed for 24 weeks to assess treatment outcomes. Adherence was measured as those patients who have completed 80% of prescribed doses, as reported during patient follow-up, and further validated by analyzing the trace of rifampicin in urine among 20% of patients from both arms. A budget impact analysis was done to assess the impact of the TMEAD program on the overall state health budget. Out of 400 enrolled DSTB patients, 261 patients completed treatment, 108 patients were on treatment, 15 patients died, and 16 patients were defaulters over the study period. The study reported overall treatment adherence of 94% among those who completed treatment. Patient reports indicated high levels of treatment adherence in the intervention group (99%) as compared to the control group (90%). Adherence assessed through analyzing trace of rifampicin in the urine sample for the intervention arm was 84% compared to the control arm (80%). Per beneficiary (discounted) cost for TMEAD was Indian rupees (INR) 6,573 (USD 83). The incremental cost-effectiveness ratio of the intervention is INR 11,599 (USD 146), which shows that the intervention is highly cost-effective. This study revealed that patient-reported treatment adherence was high in TMEAD when compared to standard therapy of care for DSTB patients and the intervention is cost-effective. TMEAD could complement the national strategy to end TB by improving adherence to the treatment regimen in India.

Treatment fidelity monitoring, reporting and findings in a complex aphasia intervention trial: a substudy of the Very Early Rehabilitation in SpEech (VERSE) trial

BackgroundTreatment fidelity is inconsistently reported in aphasia research, contributing to uncertainty about the effectiveness of types of aphasia therapy following stroke. We outline the processes and outcomes of treatment fidelity monitoring in a pre-specified secondary analysis of the VERSE trial.MethodsVERSE was a 3-arm, single-blinded RCT with a 12-week primary endpoint comparing Usual Care (UC) to two higher intensity treatments: Usual Care-Plus (UC-Plus) and VERSE, a prescribed intervention. Primary outcome results were previously reported. This secondary analysis focused on treatment fidelity. Video-recorded treatment sessions in the higher intensity study arms were evaluated for treatment adherence and treatment differentiation. Treatment components were evaluated using a pre-determined fidelity checklist. Primary outcome: prescribed amount of therapy time (minutes); secondary outcomes: (i) adherence to therapy protocol (%) and (ii) treatment differentiation between control and high intensity groups.ResultsTwo hundred forty-six participants were randomised to Usual Care (n=81), Usual Care-Plus (n=82), and VERSE (n=83). One hundred thirty-five (82%) participants in higher intensity intervention arms received the minimum prescribed therapy minutes. From 10,805 (UC 7787; UC-Plus 1450; VERSE 1568) service events, 431 treatment protocol deviations were noted in 114 participants. Four hundred thirty-seven videos were evaluated. The VERSE therapists achieved over 84% adherence to key protocol elements. Higher stroke and aphasia severity, older age, and being in the UC-Plus group predicted more treatment deviations.ConclusionsWe found high levels of treatment adherence and differentiation between the intervention arms, providing greater confidence interpreting our results. The comprehensive systems for intervention fidelity monitoring and reporting in this trial make an important contribution to aphasia research and, we argue, should set a new standard for future aphasia studies.Trial registrationACTRN 12613000776707

Effectiveness of Video Games as Physical Treatment in Patients with Cystic Fibrosis: Systematic Review.

Physical training at home by making individuals play active video games is a new therapeutic strategy to improve the condition of patients with cystic fibrosis (CF). We reviewed studies on the use of video games and their benefits in the treatment of CF. We conducted a systematic review with data from six databases (PubMed, Medline, Scopus, Web of Science, PEDro, and Cochrane library plus) since 2010, according to PRISMA standards. The descriptors were: “Cystic Fibrosis”, “Video Game”, “Gaming Console”, “Pulmonary Rehabilitation”, “Physiotherapy”, and “Physical Therapy”. Nine articles with 320 participants met the inclusion criteria and the study objective. Patients who played active video games showed a high intensity of exercise and higher ventilatory and aerobic capacity compared to the values of these parameters in tests such as the cardiopulmonary stress test or the six-minute walk test. Adequate values of metabolic demand in these patients were recorded after playing certain video games. A high level of treatment adherence and satisfaction was observed in both children and adults. Although the quality of the included studies was moderate, the evidence to confirm these results was insufficient. More robust studies are needed, including those on evaluation and health economics, to determine the effectiveness of the treatment.

Predictors of low antiretroviral adherence at an urban South African clinic: A mixed-methods study.

BackgroundLow adherence to antiretroviral treatment (ART) in people living with HIV (PLHIV) remains a critical issue, especially in vulnerable populations. Although ART is responsible for greatly reducing the mortality and morbidity associated with HIV, low treatment adherence continues to impact the effectiveness of ART. Considering that a high level of adherence to ART is required for the excellent clinical outcomes with which ART is often associated, understanding the complex contextual and personal factors that limit high levels of treatment adherence remains paramount. Poor adherence remains an issue in many South African communities many years after the introduction of ART.ObjectivesOur study sought to understand the specific factors and the interactions among them that contribute to non-adherence in this patient population in order to devise successful and contextually appropriate interventions to support ART adherence in PLHIV.MethodsThis mixed-methods study employed a study-specific questionnaire (N = 103) and semi-structured interviews (N = 8) to investigate the factors linked to non-adherence at the Heideveld Community Day Centre in Cape Town, South Africa.ResultsOver half (57.3%) of participants were ART non-adherent. Non-adherence was correlated with younger age, negative self-image and a low belief in the necessity of ART (P < 0.05). In patient interviews, alcohol use, treatment fatigue and stigmatisation emerged as contributors to suboptimal adherence.ConclusionThe results suggest that there remains a need for context-sensitive interventions to support PLHIV in South African communities. Future research needs to ensure that these targeted interventions take these factors into consideration.

Chronic gastritis and functional dyspepsia. Unity and struggle of two opposites

The review article describes the epidemiology, clinical picture, pathogenesis, approaches to the diagnosis and treatment of chronic gastritis and functional dyspepsia. Chronic gastritis is an unreasonably common diagnosis in our clinical practice, which is diagnosed in patients with disturbing dyspeptic complaints. According to the agreement documents, chronic gastritis is primarily a morphological concept. Chronic gastritis has no pathognomonic clinical signs and should be diagnosed during the histological examination of the gastric mucosa. Functional dyspepsia is a diagnosis that reflects the presence of a certain symptom complex (pain or burning sensation in the epigastrium, a feeling of fullness or early satiety) in the absence of diseases that could explain the symptoms. Secondary dyspepsia is diagnosed in patients with organic diseases of the upper gastrointestinal tract, metabolic or systemic diseases that cause dyspeptic syndrome. In the process of examining a patient with disturbing dyspeptic complaints, it is advisable for the doctor to use the diagnosis “unspecified dyspepsia” – a preliminary diagnosis before laboratory and instrumental examination aimed at identifying the cause of the dyspeptic syndrome. Dyspepsia associated with H. pylori is diagnosed in patients with H. pylori infection. The diagnosis is revised over time and is competent if complaints have been relieved within 6 months after effective H. pylori eradication.The main drugs for the treatment of patients with dyspeptic complaints are proton pump inhibitors and prokinetics. Omeprazole with domperidone sustained release (SR) in a fixed dose combination is characterized by optimal efficacy and a good safety profile in patients with both functional and secondary dyspepsia and ensures a high level of treatment adherence.

Continuum of hepatitis C care cascade in prison and following release in the direct-acting antivirals era

BackgroundPeople with criminal justice involvement contribute remarkably to the rising hepatitis C virus (HCV) burden; however, the continuum of care is a major barrier to prison-based programs. We aimed to evaluate a comprehensive HCV care model in an Iranian provincial prison.MethodsBetween 2017–2018, in the Karaj Central Prison, newly admitted male inmates received HCV antibody testing and venipuncture for RNA testing (antibody-positive only). Participants with positive RNA underwent direct-acting antiviral (DAA) therapy (Sofosbuvir/Daclatasvir). Sustained virological response was evaluated at 12 weeks post-treatment (SVR12).ResultsOverall, from 3485 participants, 182 (5.2%) and 117 (3.4%) tested positive for HCV antibody and RNA, respectively. Among 116 patients who were eligible for treatment, 24% (n = 28) were released before treatment and 72% (n = 83) initiated DAA therapy, of whom 81% (n = 67/83) completed treatment in prison, and the rest were released. Of total released patients, 68% (n = 30/44) were linked to care in community, and 70% (n = 21/30) completed treatment, including 60% (n = 12/20) and 90% (n = 9/10) among those who were released before and during treatment, respectively. The overall HCV treatment uptake and completion were 89% (n = 103/116) and 85% (n = 88/103), respectively. From people who completed treatment, 43% (n = 38/88) attended for response assessment and all were cured (SVR12 = 100%).ConclusionsIntegrated HCV care models are highly effective and can be significantly strengthened by post-release interventions. The close collaboration of community and prison healthcare systems is crucial to promote high levels of treatment adherence. Future studies should investigate the predictors of engagement with HCV care following release.

Epidemiological description of 529 families referred for French transcultural psychotherapy: A decade of experience.

Transcultural psychotherapy (TPT) is an original therapeutic method developed in various forms in France and several other countries in Europe as well as North America to address issues of migrant mental health care when psychosocial, economic, or cultural barriers hinder its accessibility and effectiveness. This study aims to describe the patients referred for TPT in Paris and its suburbs over the past decade, to examine intercultural differences and associations with social, demographic, and clinical variables, and to assess TPT in terms of patient adherence, attendance, and duration of care. Retrospective study of 529 patients referred for TPT care, classified in three categories-no treatment, initiated treatment, engaged and continuing treatment. Collection and analysis of social, demographic, cultural, and clinical data, as well as of country of origin, duration of treatment, number of sessions attended (adherence), and number of sessions scheduled. In all, 301 patients from 45 countries participated in an 11-month course of care lasting an average of 8 sessions. Most were children, accompanied by their families. The main psychiatric symptoms at the beginning of treatment were depressive, and the main cultural problem identified was the existence of a traditional theory explaining the illness in the family's culture. Patients kept 80% of their appointments for sessions, and attendance was not associated with socio-cultural or clinical variables. The high level of treatment adherence and attendance over time suggest that TPT is an effective method for addressing complex symptoms experienced by migrant families. Results highlighted the potential richness and originality of studies based on retrospective medical data.

Objective Measures of Vest Therapy Adherence Among Pediatric Subjects With Cystic Fibrosis.

Airway clearance techniques (ACTs), including high-frequency chest wall oscillation (vest therapy), are important for maintaining lung function for patients with cystic fibrosis, but daily completion of ACTs is time-consuming and cumbersome. Patient adherence is a persistent challenge, and adherence data are largely patient reported, which may reduce accuracy. To provide definitive adherence data, this study utilized a Bluetooth-enabled vest therapy system to remotely collect objective adherence data from a cohort of pediatric subjects. Vest usage data were collected over a 12-month period and compared to each subject vest prescription. Because vest prescriptions are multifaceted, we developed metrics to examine adherence to the various facets (eg, daily treatment, treatments per day, treatment duration, frequency settings, and frequency and pressure settings combined) as well as an overall adherence metric. Among the 73 enrolled subjects, 62 (50% male, age range 2-19 y) completed the study. Among adolescent subjects age 13-19 y, average adherence to daily vest therapy (44.0%) was significantly lower than that among subjects 0-6 y old (77.8%) and subjects 7-12 y old (89.5%). As more prescribed therapy components were combined into a single adherence metric, all age groups declined in mean adherence rates, with overall adherence a decreasing function of age. Employing new technology to remotely collect vest usage data allows for a granular examination of vest therapy adherence. While maintaining high levels of treatment adherence becomes increasingly difficult as children age, we also found substantial reductions in adherence rates among all age groups when more complex aspects of therapy prescriptions, such as frequency and pressure settings, were examined. These data illustrate areas providers and care teams can focus on to improve patient adherence to vest prescriptions.

649-P: The 7-Day Diabetes Education Hospitalization Program Improves Quality of Life and Treatment Satisfaction

Essentials to achieving the goal of diabetes treatment are diabetes self-management education, medical nutrition therapy, and physical activity. In addition, patients with type 2 diabetes mellitus (T2DM) require a high level of treatment adherence, which is associated with treatment satisfaction and patients’ overall perception of quality of life (QoL). In our institute, we are routinely conducting a 7-day diabetes education hospitalization program using general strategy. For the patients participated in our program, we conducted diabetes treatment-related (DTR)-QoL questionnaire before admission and at discharge to evaluate treatment satisfaction and QoL with the effectiveness of our program. In this study, we investigated whether our program improves QoL and treatment satisfaction. In this retrospective study, we recruited the patients with T2DM who participated in a 7-day diabetes education hospitalization program in our institute from July 2017 to November 2019. We assessed the effect of our diabetes education hospitalization program on the QoL and treatment satisfaction by comparing the DTR-QoL scores before admission and at discharge. A total of 244 patients with T2DM were enrolled in this study. Patients’ baseline characteristics were (means ± SD) age: 60.3 ± 12.2 years, BMI: 26.4 ± 4.4 kg/m2, HbA1c: 8.6 ± 1.6%. During hospitalization, the number of types of glucose-lowering drugs per patient increased from 2.2 ± 1.4 to 2.9 ± 1.4 (P &amp;lt; 0.001). However, the DTR-QoL total score improved from 66.6 ± 13.0 to 69.5 ± 12.4 (P &amp;lt; 0.001). According to elements that constitute QoL, “Anxiety and dissatisfaction with treatment” score improved from 54.2 ± 19.8 to 59.2 ± 19.4 (P &amp;lt; 0.001) and “Satisfaction with treatment” score improved from 45.9 ± 18.6 to 59.3 ± 17.0 (P &amp;lt;0.001). In conclusion, our 7-day diabetes education hospitalization program could be and effective tool to improve QoL and treatment satisfaction and maintain high level of treatment adherence in patients with T2DM. Disclosure M. Kurita: None. H. Satoh: None. S. Kadowaki: None. H. Watada: Advisory Panel; Self; Abbott, Ajinomoto, Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Fuji Film, Janssen Pharmaceuticals, Inc., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Research Support; Self; Astellas Pharma Inc., Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Shionogi &amp; Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Yakult. Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited.

T42. HIGH ADHERENCE TO CURRENT ANTIPSYCHOTIC AND ADJUNCTIVE PIMAVANSERIN IN THE ENHANCE STUDY, A PHASE 3 TRIAL TO EVALUATE THE TREATMENT OF SCHIZOPHRENIA IN PATIENTS WITH AN INADEQUATE RESPONSE TO ANTIPSYCHOTIC TREATMENT

BackgroundIndividuals with schizophrenia experience an inadequate response to antipsychotic (AP) treatment at a high rate, up to 70% in some cases (McEvoy et al. 2006). Possible reasons for this include subtherapeutic AP blood levels and medication ineffectiveness. Although patient self-report and clinician opinion are commonly used to identify non-adherence, they are unreliable. AP polypharmacy for inadequate response remains widespread despite a lack of supportive evidence. Few completed trials offer guidance on the optimal trial design and procedures to establish inadequate response at screening/baseline.Adequate treatment is defined as an AP taken at a therapeutic dose for a sufficient duration (Taylor et al. 2012). Confirming treatment stability and adherence, both prior to enrollment and during the trial, is necessary to ensure sufficient exposure to an AP prior to deeming a response inadequate and justifying augmentation. Measuring adherence during the trial is necessary to ensure correct interpretation of trial results.We present the trial design and adherence data from a recently completed Phase 3 clinical trial of an adjunctive therapy in inadequately responding patients with schizophrenia. The trial did not meet the primary endpoint (Bugarski-Kirola, et al. 2019).MethodsENHANCE was a 6-week, randomized, double-blind study of adjunctive pimavanserin (PIM; a 5-HT2A inverse agonist) versus placebo to evaluate the treatment of schizophrenia in patients with an inadequate response to their prescribed AP (aripiprazole, olanzapine, risperidone, and others). During screening, patients provided documentation showing treatment stability for at least 8 weeks prior to screening, a blood sample was tested for adherence, and a telemedicine interview was completed with an independent clinician. After randomization, blood sampling occurred at Baseline, Week 1, Week 3, and Week 6 for pharmacokinetic (PK) assessments of the AP and adjunctive PIM.ResultsENHANCE screened 633 patients with 35 rescreens for a total of 668 screenings. Adherence to background AP was high for all patients screened as background AP levels were detected in 90.6% of patients. However, the most common reason for screen failure was still a failure to detect background AP (16.9% of all screen failures). Other common reasons for screen failure included lack of prescription stability/appropriate dosing, investigators determining the patient was inappropriate for the study, and withdrawal of consent, the latter of which often reflected the rigorous screening process required for the study. Proactively screen failing non-adherent patients led to higher levels of adherence at Baseline compared to screening with 94.9% of patients demonstrating adherence at Baseline. Moreover, this is a substantial improvement over the theoretical adherence rate of 84.5% had non-adherent patients been randomized. The high rate of adherence at Baseline for background AP was maintained at Weeks 1, 3 and 6. High adherence was also found for adjunctive PIM. 198 patients were randomized to the PIM treatment arm, 190 had a blood sample at Week 1 with 187 (98.4%) showing measurable levels of PIM, and 182 had a blood sample at Week 3 with 180 (98.9%) showing measurable levels of PIM. Patients leaving the study (either at Week 6 of treatment or as a result of early termination) showed a 96.8% adherence rate.DiscussionBy employing rigorous screening procedures, including testing for AP treatment adherence, the ENHANCE study enrolled a representative sample of patients with a confirmed inadequate response to their current AP and achieved a high level of treatment adherence (both to patient’s AP treatment and study drug).

Online cognitive behavior therapy for adolescents with excessive worry: a multiple baseline design feasibility study.

One in twenty adolescents experience excessive worry and evidence-based psychological therapies are not sufficiently widespread to reach most of those affected. In this multiple baseline evaluation, we assess the feasibility and preliminary efficacy of a scalable, online cognitive-behavioral intervention for adolescents with excessive worry (BIP worry). Thirteen adolescents (age 13-17) with excessive worry underwent the 10-week online BIP worry intervention. The treatment also included an online intervention for parents. Completion rates, treatment satisfaction, and adverse events were measures of feasibility. Clinical outcomes included worry severity, symptoms of other anxiety and depression, and general functioning. To control for time and spontaneous fluctuations in symptoms, adolescents were randomized to a 2-, 6-, or 10-week baseline phase prior to treatment. A short measure of worry severity was administered weekly during the baseline and treatment phases. Outcomes were assessed before the baseline-phase, at pre-treatment, post-treatment, and at 1- and 3-month follow-ups. Twelve of 13 included adolescents, together with their parents, participated in BIP worry, with a mean completion rate of 9.8 of the 10 treatment modules. Adolescents reported an average of 4.4 exposures per week as homework during treatment. High levels of treatment adherence, credibility, and satisfaction, and no serious adverse events were reported. Therapists averaged 21 min per week communicating with each family. Linear mixed effects models indicated significant improvements in worry, anxiety, and general functioning from pre- to post-treatment, with these gains maintained at 1- and 3-months follow-up. Reductions in worry severity during treatment were significantly larger than during the baseline phase. The results from the multiple baseline evaluation suggested an association between the introduction of the BIP worry intervention and subsequent symptom change for some but not all adolescents. BIP worry is a feasible and potentially effective treatment. As the treatment is scalable and involves limited therapist contact, it represents a low-cost method for treating adolescents with excessive worry and anxiety. Further investigation under randomized controlled trial (RCT) conditions is warranted.

Удовлетворенность лечением пациентов с неоваскулярной возрастной макулярной дегенерацией, получающих антиангиогенную терапию

Objective: clinical testing of original ophthalmologic survey to assess treatment satisfaction (TS) in patients getting antiangiogenic therapy for neovascular macular diseases. Methods . Tested group consisted of 38 people (31 women, 9 men) aged from 51 to 93 y.o. with neovascular age-related macular degeneration, they got antiangiogenic therapy (ranibizumab, aflibercept). Ptients were divided into subgroups with high (n=20) and low (n=18) compliance levels. We conducted a single survey with a questionnaire which included standard validated questionnaire on treatment satisfaction in macular diseases (MacTSQ) and questions assessing aspects of antiangiogenic therapy composed by authors. Results. We determined significant direct correlation between and high level of compliance, and patients with high level of treatment adherence were more willing to return to therapy and were less dependent on outside help. The survey took 7 minutes in average. Despite elderly age patients did not struggle with understanding of questions and answering them. Conclusions . We developed a method of TS level detection in patients with macular pathology who received antiangiogenic therapy. The method is based on scoring the answers to survey questions. The analysis of survey results can contribute to effectiveness of the therapy due to customized dosing schedule.

Parent tutoring, instructional hierarchy, and reading: A case study

Parents of three second-grade students identified as at-risk readers were trained to tutor their children. The reading interventions were either accuracy (i.e., modeling and phrase drill) or proficiency (i.e., repeated reading and reward). Intervention selection was based on predicted level of the instructional hierarchy. Students reading below 32 words correct per minute (WCM) or below 85% accuracy were provided with the accuracy intervention. Students exceeding both of these criteria were provided with the proficiency intervention. This study was conducted over 30 weeks of the academic year. Progress monitoring data were collected using DIBELSNext. Parent tutors provided the interventions with high levels of treatment adherence and exposure. Parents were very satisfied with the tutoring experience.

HIV Treatment Adherence - A Shared Burden for Patients, Health-Care Providers, and Other Stakeholders

Successful HIV treatment is contingent on sustained high levels of treatment adherence. Several barriers to optimal adherence have been documented. In this article, we first review the global burden of non-adherence among HIV/AIDS positive individuals on a public health scale. Second, we synthesized available evidence from different study designs and stratified across the European, African, and Asian literature to determine the factors influencing adherence to scheduled clinic appointments and medication non-adherence. Third, we discuss common measurement techniques that quantify the magnitude of non-adherence, their relative advantages and limitations in current practice. From January to May 2018, we reviewed guidelines, standard operating procedures, journal articles, and book chapters on treatment adherence among HIV patients receiving adherence to antiretroviral therapy (ART) globally. We searched PubMed, Medline, Google Scholar, and Cochrane Database of Systematic Reviews with the search terms "adherence," "adherence behavior," "medication adherence," and "HIV patients," or "HIV/AIDS," and "Antiretroviral Therapy" or "ART" or "ARVs" or "highly active ART " from 2000 to 2017. We also identified articles through searches of authors' files and previous research on HIV. We included only papers published in English in this review. We then generated a final list of reference on the basis of originality and the broad scope of this review. We found rich literature evidence of research findings and best practice recommendations on the importance of adherence in HIV/AIDS management, a general understanding of factors associated with non-adherence and approaches to investigating non-adherence behavior among different populations. We observed significant contextual differences exist with regard to barriers and burden of non-adherence among these populations.

The benefits of a public pharmacist service in chronic hepattis C treatment: The real-life results of sofosbuvir-based therapy.

In Brazil, the sofosbuvir-based therapy was introduced in the public health system (SUS) in 2015 to treat Chronic Hepatitis C (CHC). This drug and other direct-acting antiviral agents (DAAs) represent a major advance in the HCV-infection treatment due to their high effectiveness and tolerability. However, the drug safety profile is limited by significant drug interactions and its use is restricted for their high cost. Pharmacists have the opportunity to improve patient care by monitoring the therapy, recommending strategies to guarantee treatment adherence, effectiveness and safety, preventing complications of the disease, and drug-related problems, thus reducing the cost for patients and payers. This study aimed to assess the results of the one of the first patient group treated with sofosbuvir in Brazil and their opinions about the benefits of clinical pharmacist services in the achievement of the cure for CHC and in the management of their therapy difficulties. This cohort study (November 2015-January 2017) enrolled 240 patients followed up by the clinical pharmacists at the University Pharmacy (UPh) of the Federal University of Santa Catarina, Brazil, during the CHC treatment. The therapeutic schemes used were sofosbuvir+daclatasvir or+simeprevir associated or not with ribavirin. At the end of the therapy, the patients provided qualitative feedback about the clinical pharmacist services. The study demonstrated high levels of treatment adherence (99.2% of completion rates) and effectiveness rates (Sustained Virological Response rates) (92.1%). Patients reported high levels of satisfaction with the care provided on account of the good rapport built with their pharmacist, the counseling and education on HCV-infection and on sofosbuvir-based therapy utilization, motivation for adherence, and convenient access to the pharmacist. The clinical pharmacist services provided by the UPh was beneficial to patients treated for CHC with the sofosbuvir-based therapy.

MONITORING OF LIFE QUALITY, PSYCHOLOGICAL STATUS AND TREATMENT ADHERENCE AT PREVENTION EVENTS IN LOCAL POLYCLINICS

Aim. Comparative analysis of life quality (LQ), psychological status and treatment adherence in patients before and after prevention events in local polyclinics. Material and methods. In the study, both gender persons participated (n=1082), age 21-70 y.o., registered as dispensary in the polyclinics of MBHI “Clinical Consulting-Diagnostical Center” of Kemerovo. During 6 months, two groups were followed up, comparable by the mean level of the main modifiable risk factors. Main group patients underwent primary risk measurement and further investigation with innovative approach to medical prevention, based on differential group training. All participants, before and after the prevention events were assessed for LQ, psychological status, treatment adherence. Results. In patients under dispensary follow up in local polyclinics, there were revealed: predominance of middle level of physical component and low level of psychological component of LQ; high level of chronic psychoemotional stress, anxiety and depression; high level of treatment adherence. The efficacy shown, of the performed prevention events. In intervention group there was significant positive dynamics almost in all scales of SF-36. Self-rating increased for the health self-evaluation and for treatment perspectives — GH (p=0,0001), psychoemotional background improved — RE (p=0,0001), social — SF (p=0,001) and life activity — VT (p=0,0089), the levels of situational and trait anxiety decreased (p=0,001 and p=0,0047 respectively), treatment adherence increased (p=0,00043). Conclusion. By the results of the study, the differences revealed in LQ, psychoemotional status and treatment adherence in the main patients group, who were managed with an innovative clinical organizational approach, and in comparison group. LQ of the main group patients by all SF-36 scales significantly improved, levels decreased of psychoemotional stress, anxiety and depression. Innovative methods of prevention work in local polyclinics facilitate improvement of LQ, patient’s responsibility for self-health care; shape rational and active attitude towards the disease, motivation to be healthier, treatment adherence and compliance to clinician recommendations.

Pharmacokinetic drug evaluation of daclizumab for the treatment of relapsing-remitting multiple sclerosis

ABSTRACT Introduction: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. Despite the availability of several disease-modifying therapies for relapsing MS, there is a need for highly efficacious targeted therapy with a favorable benefit–risk profile and a high level of treatment adherence. Daclizumab is a humanized monoclonal antibody directed against CD25, the α subunit of the high-affinity interleukin 2 (IL-2) receptor, that reversibly modulates IL-2 signaling. Areas covered: Daclizumab blocks the activation and expansion of autoreactive T cells that plays a role in the immune pathogenesis of MS. As its modulatory effects on the immune system, daclizumab’s potential for use in MS was tested extensively showing a high efficacy in reducing relapse rate, disability progression and the number and volume of gadolinium-enhancing lesions on brain magnetic resonance imaging. Moreover, phase II and III trials showed a favorable pharmacokinetic (PK) profile with slow clearance, linear pharmacokinetics at doses above 100 mg and high subcutaneous bioavailability, not influenced by age, sex or other clinical parameters. Expert opinion: Among the new emerging drugs for MS, daclizumab also, thanks to a favorable PK profile, may represent an interesting and promising therapeutic option in the wide MS therapies armamentarium.

Satisfaction and quality of life of allergic patients following sublingual five-grass pollen tablet immunotherapy in Spain.

BackgroundFive-grass pollen tablet is an effective and well-tolerated therapy for patients with allergic rhinoconjunctivitis (ARC). This trial sought to determine the satisfaction and health-related quality of life (HRQoL) of patients undergoing this treatment.MethodsThis was a cross-sectional, multicentre, observational, naturalistic study, following a discontinuous pre- and co-seasonal five-grass pollen regimen over two seasons in Spain (2012, 2013). The HRQoL of the patients was measured with the specific Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) for adults, adolescent (AdolRQLQ), or paediatric (PRQLQ) patients. Treatment satisfaction was assessed by the Satisfaction Scale for Patients Receiving Allergen Immunotherapy (ESPIA) questionnaire. Patients/investigators were surveyed on beliefs and attitudes towards the five-grass pollen tablet. ARC evolution according to allergic rhinitis and its impact on asthma (ARIA) criteria and treatment adherence were evaluated.ResultsAmong the 591 ARC patients included, the mean (SD) HRQoL scores were 1.40 (1.1) in adults, 1.33 (1.1) in adolescents, and 1.15 (1.1) in children, indicating low levels of impairment (scale 0–6). ESPIA answers showed high levels of satisfaction, with an average score of 69.2 (scale 0–100). According to ARIA criteria, 88.2% of patients reported improvement of ARC. Moreover, this was accompanied by a reduced use of symptomatic medication. Adherence to treatment was estimated at 96.8%. In general, both patients and specialists exhibited a positive attitude towards five-grass pollen tablet treatment.ConclusionARC patients treated with five-grass pollen tablet showed favourable levels of HRQoL and treatment satisfaction, with concomitant improvements in ARC and symptomatic medication use, which translated into high levels of treatment adherence and a positive attitude towards five-grass pollen tablet.