Inadequate Medication Adherence Research Articles

Relationship between social capital and medication adherence among frail and pre-frail older people: a cross-sectional study from China

BackgroundThe number of frail older people is increasing. To alleviate poor health and improve quality of life, pre-frail and frail older people need to adhere to their medication. Yet, studies examining the connection between social capital (including six dimensions) and medication adherence are currently scarce. Therefore, this study aims to examine their relationship in older individuals with pre-frailty and frailty, respectively.MethodsInformation concerning the socio-demographics, frailty, social capital, and medication adherence of 4218 participants was collected through a structured questionnaire during November and December 2020. This study employed descriptive analysis and binary logistic regression to fit their relationship.ResultsAmong the pre-frail respondents, those with lower social participation (AOR 0.55 [95% CI 0.44–0.69]) had less risk of inadequate medication adherence; while lower social connection (AOR 1.91 [95% CI 1.54–2.36]), lower trust (AOR 2.80 [95% CI 2.25–3.47]), lower cohesion (AOR 2.04 [95% CI 1.65–2.53]), and lower reciprocity (AOR 2.32 [95% CI 1.87–2.88]) were all related to higher odds of inadequate medication adherence. Also, lower social participation (AOR 0.54 [95% CI 0.40–0.74]) was linked to less risk of inadequate medication adherence, while lower trust (AOR 1.89 [95% CI 1.41–2.54]), lower cohesion (AOR 1.68 [95% CI 1.24–2.26]), and lower reciprocity (AOR 1.52 [95% CI 1.14–2.04]) were all found to have a greater odds of inadequate medication adherence in frail respondents.ConclusionBy enhancing the relationship between social capital and medication adherence in this challenging community and offering educational programs that promote medication adherence from the perspective of social capital, our findings emphasize the relevance of social capital in improving medication adherence in later life, especially for frail and pre-frail older adults.

P-1420. Tracking Shadows: Loss to Follow-up in Persons Living with HIV

Abstract Background During the year 2020, HIV viral suppression was 89.4% in clients throughout the United States who receive care through the Ryan White HIV/AIDS program (RYHAP). This was a significant increase compared to 69.5% in 2010. Likewise, Wayne State University (WSU) Tolan Park Infectious Disease Clinic, which is also funded by RYHAP noted a 5% increase in the rate of viral suppression in 2020 compared to the previous year. Eighty-six percent of Tolan Park clients across all Ryan White programs were virally suppressed, eighty-seven percent of women and youth were virally suppressed. However, there was a decline in the overall patient pool in 2019. The goal of this study was to locate those lost-to-care as part of the WSU Tolan Park clinic. Methods Clinicians reviewed a list of clients who were lost-to-care during 2019. These clients were individually called by nurse practitioners, patient advocates or early intervention staff (EIS) to re-engage in medical care. The quality improvement team then discussed feedback from staff and clients regarding barriers to medical care. Results We contacted a total of 310 clients. Out of these, 40 (13%) were lost-to-care. Among the remaining clients, 95 (31%) were deceased, 64 (21%) were in-care at other clinics, 63 (20%) were currently in-care at Tolan park clinic, 41 (13%) had confirmed clinic appointments and 7 (2%) were out-of-state or incarcerated. Of the 40 clients returned to care at the Tolan Park clinic, route cause analysis revealed the main barriers to care including poor mental health, lack of transportation, schedule conflicts, relocation, poor financial resources, inadequate medication adherence and clinic fatigue. Conclusion We report a significant number of patients who were lost-to-care at the WSU Tolan Park clinic. Our patients continue to experience poor mental health, poor medication adherence and several socioeconomic barriers that limit their access to continuity of care. Our results highlight the need for better tracking services and strategies to minimize the loss to follow-up in HIV clinics. Disclosures All Authors: No reported disclosures

Factors associated with medication adherence among children with rheumatic diseases.

Introduction: Failure to take medications regularly leads to poorer health outcomes. The Pediatric Rheumatology Adherence Questionnaire (PRAQ) is an effective tool for assessing medication adherence in rheumatic patients. Therefore, we aimed to determine the factors associated with poor medication adherence among children with rheumatic diseases. Methods: This was a cross-sectional study. Patients with rheumatic diseases who had taken at least one medication and had been followed up at our pediatric rheumatology clinic were included in the study, together with their caregivers. Patients with poor medication adherence were characterized as those who had taken less than 80% of their prescribed drugs, as determined using the pill count method. The original PRAQ was translated and validated in Thai language and was completed by caregivers and literate patients over age 13years. Interviewing for additional problems with taking medications was conducted. We performed descriptive and logistic regression analyses. Results: From 210 patients, 52.86% had juvenile idiopathic arthritis (JIA), and 46.19% had connective tissue diseases. The mean patient age was 14.10 ± 4.74years, with a median (interquartile range) disease duration of 4.33 (2.08-6.98)years. PRAQ scores in the group with poor adherence were significantly higher than scores in the group with good adherence (11.00 ± 3.47 vs. 9.51 ± 3.16, p = 0.004). Enthesitis-related arthritis (ERA) (odds ratio [OR] 9.09, 95% confidence interval [CI] 1.25-66.18; p = 0.029) and polyarticular JIA (OR 6.43, 95% CI 1.30-31.75; p = 0.022) were associated with poor treatment adherence. Disease duration ≥5years (OR 3.88, 95% CI 1.17-12.87; p = 0.027), active disease (OR 6.49, 95% CI 1.76-23.99; p = 0.005), PRAQ scores ≥12 (OR 6.48, 95% CI 1.76-23.82; p = 0.005), forgetting to take medications (OR 14.18, 95% CI 4.21-47.73; p < 0.001), and unawareness about the importance of the medicines (OR 44.18, 95% CI 11.30-172.73; p < 0.001) were predictors of poor drug adherence. Conclusion: In the present study, poor medication adherence was found in one-fourth of children with rheumatic illnesses, particularly those with ERA, polyarticular JIA, longer disease duration, active disease, and high PRAQ scores. The most frequent reasons for inadequate medication adherence were forgetfulness and unawareness about the importance of disease control and consistency with treatment.

Factors Associated with Medication Adherence among Community-Dwelling Older People with Frailty and Pre-Frailty in China

Frail and pre-frail older people often need to take medications. However, factors related to medication adherence among this population remain unclear, warranting further research. This study aims to identify correlates of medication adherence among frail and pre-frail older adults. From November 2020 to December 2020; a total of 4218 community-dwelling residents aged ≥ 60 years were interviewed by a cross-sectional survey in China. Data on subjects' general information; medication adherence; and frailty status was obtained via the face-to-face structured questionnaire. Logistic regression models were fitted; separately; to examine these factors linked to medication adherence. We found that 36.2% (n = 1527) and 18.8% (n = 792) of respondents were classified as pre-frail and frail. According to the Morisky scale scores, 66.74% (n = 2815) were found to have adequate medication adherence, and 33.26% (n = 1403) were found to have inadequate medication adherence. Among the pre-frail respondents, age (adjusted odds ratio (AOR) = 1.64; 95% confidence interval (CI): 1.18-2.29, P = 0.003), marital status (AOR = 1.52; 95% CI: 1.04-2.21, P = 0.030), smoking status (AOR = 0.61; 95% CI: 0.37-0.99, P = 0.044), and functional ability (AOR = 0.72; 95% CI: 0.58-0.91, P = 0.006) were significantly related to medication adherence. Among them, advanced age and single were risk factors, which were positively related to the medication adherence of subjects in pre-frailty, while quitting smoking and limited functional ability contributed to improving their medication adherence. In contrast, only age (AOR = 1.77; 95% CI: 1.16-2.69, P = 0.008) was significantly associated with medication adherence among frail subjects. Influencing factors to medication adherence of old people in pre-frailty and frailty have been enriched, which provides a certain reference for promoting medication adherence in this population. Future adherence intervention methods should be designed based on these factors.

Postnatal Supplement for Women using Natofer Kit Package

A mother requires rich source of vitamins and minerals in an extraordinary journey of giving birth to a new offspring. A perfect post-partum plan can support replenishing the nutrient stores in the body that a mother needs to thrive. The postnatal vitamin and mineral supplements provide adequate nutrition and ensure good health of mother and baby. The two incredibly demanding physiological processes such as recovery from the pregnancy and delivery and the lactation process for the newborn demands a good supply of vitamins and minerals. The fluctuating hormone levels make them feel more emotional and stressed during this time. However, full recovery from childbirth may take 6-8 weeks or even a few months. Breast milk composed of proteins, carbohydrates, lipids and all essential vitamins and minerals provides a complete nutrition for the newborn. Hence breastfeeding mothers should consume a balanced nutritious diet to meet these daily requirements. However, mothers benefit by the use of appropriate supplement that supply various required components to the mother as well as to the baby. This review aims at explaining the significance of the combination of minerals and vitamins that are prescribed as a nutritional supplement especially as a postnatal care. The role of each mineral and vitamins and their daily recommended intake are discussed. The Unique formulation named Natofer Kit meets the demand of the postnatal care. This cost effective unique packaging technique also overcomes the inadequate medication adherence with improved patient compliance. This review is an attempt to explain the significance of the vitamins and minerals being prescribed as a nutritional supplement named “Natofer Kit” for women during their postnatal care. : , , ,,

Acute Cellular Rejection at Long-Term Follow-Up After Heart Transplantation: A Single Center Experience in Japan

<h3>Purpose</h3> Acute cellular rejection (ACR) is a major cause of death within 1-3 years after heart transplantation (HTx). However, recipients are usually asymptomatic in the early stages of ACR, and it is difficult to obtain specific findings of ACR using non-invasive tests. Therefore, regular endomyocardial biopsy plays an important role in monitoring for ACR. Although mortality from ACR decreases in the long term after HTx, there is no strong evidence of screening methods such as the appropriate frequency of biopsies. We retrospectively analyzed the outcome of ACR in our institution. <h3>Methods</h3> We enrolled 136 patients who underwent HTx at our hospital from May 1999 to April 2020. 7 Recipients under the age of 18 at the time of HTx were excluded. The current myocardial biopsy schedule is 1,2,3,5,7,11 weeks, 4.5,6,9 months, twice a year from 1 to 2 years, and once a year until 10 years after HTx. After that, it is once every two years. Tacrolimus (cyclosporine before 2005), mycophenolate mofetil, and prednisolone were used as first immunosuppressive therapies. Basiliximab was administered in patients with impaired renal function, elderly patients, and anti-donor antibody-positive patients. <h3>Results</h3> 129 HTx recipients (74% male, age at transplantation 41.8 ± 12.9 years) were analyzed. Grade 2R or higher grade of ACR were observed in 19 times in 13 patients during a mean follow-up period of 7.4 ± 5.0 years. Only one case with Grade 2R (3.5 years after HTx) combined with antibody-mediated rejection developed heart failure. All recipients with ACR recovered with steroid pulse therapy, and no deaths due to ACR were observed. The frequency of ACR of Grade 2R or higher in less than 1 year, 1-3 years, 3-5 years, 5-10 years, and 10 years or more after HTx was 4.0, 2.1, 2.2, 0.7, and 0 %/patients/years, respectively. The incidence of ACR was significantly higher in 15 patients who took cyclosporine as the first calcineurin inhibitor after HTx than in 114 patients who took tacrolimus (40% vs 6.1%, p <0.05). Late recurrence of ACR after HTx was seen in a patient with poor medication adherence and in a patient after immunosuppressive drug changes. <h3>Conclusion</h3> The frequency of developing ACR decreased over the years after HTx. Careful observation is still required in cases with a high risk of recurrence, such as inadequate medication adherence even long after HTx.

Patterns of drug therapy, glycemic control, and predictors of escalation- non-escalation of treatment among diabetes outpatients at a tertiary care center.

The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM). This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients' prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed. A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81±10.42years and duration of disease of 9.15±6.3years were analyzed. Approximately half of the patients (n=450) came for≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03±1.71 and 4.17±1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA's and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times. Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored.

Factors Associated with Anticoagulation Adherence in Chinese Patients with Non-Valvular Atrial Fibrillation.

PurposeInadequate medication adherence among patients with non-valvular atrial fibrillation (NVAF) will directly affect the efficacy and safety of anticoagulation therapy, leading to a considerable increase in the risk of ischemic stroke and death. In this study, we aim to investigate medication adherence and identify the influencing factors, including social-demographic, disease-related information and self-efficacy.Patients and MethodsWe recruited 170 patients with NVAF from a tertiary hospital atrial fibrillation outpatient clinics and cardiology ward from June 2020 to September 2020. Patients who had been taking oral anticoagulation medication for at least 3 months were included. And Morisky medication adherence scale (MGL) was used to assess the adherence to anticoagulants, which scores <4 were considered as low adherence.ResultsFifty (29.4%) NVAF patients had a MGL score<4. Monthly income, types of comorbidities, number of drugs, and self-efficacy were determinants of anticoagulation adherence. Binomial logistic regression showed that patients had been prescribed more durgs (OR: 3.51, p=0.002), had high monthly income (OR: 7.87, p=0.001), without other diseases (OR: 8.00, p=0.005), and with higher self-efficacy (OR: 1.42, p=0.001) showed high adherence.ConclusionNumber of drugs, types of comorbidities, monthly income, and self-efficacy were associated with the adherence of non-vitamin K antagonist oral anticoagulants (NOACs).

Abstract P185: Using Electronic Health Records To Identify Patients With Apparent Treatment Resistant Hypertension

Introduction: Apparent treatment resistant hypertension (aTRH) affects 10-20% of hypertensive adults and increases risk of cardiovascular events and mortality. Fewer than half of these patients have true resistant hypertension. The majority experience pseudo-resistant hypertension due to inadequate medication adherence, white coat hypertension, and secondary causes of hypertension. We hypothesize that electronic health records can be leveraged to identify aTRH patients who would benefit from targeted counseling, medication reconciliation, and screening for secondary causes of hypertension. Methods: We studied electronic health record (EHR) data from 395 hypertensive adults in our primary care population who received longitudinal care between 2007 and 2017. Patients who met the 2008 AHA definition of resistant hypertension by chart review were considered to have aTRH. We also included 100 patients identified by heuristics targeting secondary hypertension. We extracted from the EHR demographics, vitals, laboratory results, diagnosis codes, and medications. Results outside of physiologic range were excluded and median imputation was used to handle missing data. Random forest model performance was assessed by 5-fold cross validation. Model discrimination was evaluated at an estimated positive predictive value of 75%. Results: The prevalence of aTRH in our randomly selected and full cohorts was 20.3% (n=295) and 25.8% (n=395), respectively. In cross-validation, the random forest model demonstrated a median sensitivity of 65% (IQR: 60% - 65%) and a median AUROC of 0.92 (IQR: 0.90 - 0.92). The most influential variables were related to the prescription of three or more hypertension medications; number of days on diuretics, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers; systolic blood pressure measurements; and hypertension or diabetes diagnosis codes. Conclusion: EHR data can be used to accurately identify patients with aTRH. We expect the implementation of a clinical decision support system leveraging such models could lead to the improved care for aTRH patients.

Depression in Youth-Onset Type 2 Diabetes.

The current review summarizes extant knowledge regarding the prevalence of depression in youth-onset type 2 diabetes (T2D) and how depression might impact glycemic control through stress-related behavioral and physiological mechanisms. The current review also discusses depression intervention studies in adult-onset T2D, as there are no such studies in youth-onset T2D, and provides recommendations for clinical research. The prevalence of elevated depression symptoms in youth-onset T2D is approximately 20%. Some studies suggest depression may negatively impact glycemic control through inadequate medication adherence and disordered eating, but there is a dearth of studies investigating associations with depression and physical activity/sedentary time, sleep, and stress-related physiological mechanisms. In adult-onset T2D, evidence-based behavioral interventions tailored to address diabetes-related issues have shown positive effects for depression and glycemic control. Future research is needed to characterize the epidemiology of depression in youth-onset T2D and test interventions to improve depression, glycemic control, and health outcomes in this specific pediatric population.

Relationship between untimed plasma lopinavir concentrations and virological outcome on second-line antiretroviral therapy.

Resource constraints in low and middle-income countries necessitate practical approaches to optimizing antiretroviral therapy outcomes. We hypothesised that an untimed plasma lopinavir concentration (UPLC) at week 12 would predict loss of virological response in those taking lopinavir as part of a second-line antiretroviral regimen. We measured plasma lopinavir concentration at week 12 on stored samples from the SECOND-LINE study. We characterized UPLC as: detectable and optimal (≥1000 μg/l); detectable but suboptimal (≥25 to < 1000 μg/l); and undetectable (<25 μg/l). We used Cox regression to explore the relationship between UPLC and loss of virological response over 48 weeks and backwards stepwise logistic regression to explore the relationship between UPLC and other predictors of virological failure at week 48. At week 48, we observed virological failure in 15/32 (47%) and 53/485 (11%) of patients with undetectable and detectable UPLC, respectively, P < 0.001. Both suboptimal [adjusted hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.54-5.62; P = 0.001], and undetectable (adjusted HR 3.55; 95% CI 1.89-6.64; P < 0.001) UPLC were associated with higher rates of loss of virological response over 48 weeks. In multivariate analysis, an independent association with virological failure at week 48 and undetectable UPLC was observed after adjustment (odds ratio 5.48; 95% CI 2.23-13.42; P < 0.01). In low and middle-income countries implementing a public health approach to antiretroviral therapy treatment, an untimed plasma drug concentration may provide a practical method for early identification of patients with inadequate medication adherence and facilitate timely corrective interventions to prevent virological failure.

Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis.

Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. Data were extracted from 53 reports of studies involving 8243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found for interventions that linked medication taking with existing habits compared to interventions that did not (0.574 vs. 0.222). Effect sizes were largest among studies that measured adherence by pill counts or electronic event monitoring systems. Analysis of study design features identified several potential risks of bias. Statistically significant publication bias was detected, but adherence effect sizes were not significantly associated with other risks of bias. These findings document that interventions targeting individuals with medication adherence problems can have modest but significant effects on medication-taking behavior. The findings support the use of behavioral strategies such as prompts and linking medications to habits to increase medication adherence in adults with adherence challenges. Face-to-face interventions appear to be critical for patients who have experienced past problems with medication adherence.

The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: A randomized pilot study.

Inadequate medication adherence reduces optimal health outcomes and can lead to increased costs, particularly in patients with diabetes. Efforts to improve adherence have resulted in limited effects; approaches leveraging mobile technology have emerged, but their focus has mainly been limited to simple reminder messages. The purpose of this pilot study was to test the effectiveness of tailored text messages focusing on improving medication adherence and health beliefs in adults with diabetes. Adults aged 21-64, with uncontrolled diabetes, and taking at least one anti-diabetic medication were recruited and randomized into 2 study arms: daily tailored text messaging for 90 days or standard care. Comparing baseline and endpoint survey responses, changes in theory-driven health beliefs and attitudes were assessed. The impact on medication adherence was evaluated using pharmacy claims by calculating the percent of days covered (PDC). A total of 75 subjects were consented, and 48 were randomized. Mean PDC at baseline were comparable between cohorts (84.4% and 87.1%, respectively). Declines in adherence were observed in both groups over time but no significant differences were observed between groups or from baseline to the end of the active study period. Unadjusted tests suggested that perceived benefits and competence might have improved in the intervention arm. Tailoring mobile phone text messages is a novel way to address medication nonadherence and health beliefs; further investigation to this combined technique is needed to better understand its impact on behavior change in adults with diabetes.

Feasibility of using audio computer-assisted self-interview (ACASI) screening in routine HIV care

We evaluated the feasibility of implementing audio computer-assisted self-interviews (ACASI) as part of routine clinical care at two community hospital-based HIV clinics in New York City. Between June 2003 and August 2006, 215 patients completed 1001 ACASI sessions in English or Spanish prior to their scheduled clinical appointments. Topics covered included antiretroviral therapy adherence, depression symptoms, alcohol and drug use, and condom use. Patients and providers received feedback reports immediately after each session. Feasibility was evaluated by quantitative analysis of ACASI responses, medical chart reviews, a brief patient questionnaire administered at the conclusion of each computer session, patient focus groups, and semi-structured provider interviews. ACASI interviews frequently identified inadequate medication adherence and depression symptoms: at baseline, 31% of patients reported ≤95% adherence over the past three days and 52% had symptoms of depression (CES-D score ≥16). Substance abuse problems were identified less frequently. Patients were comfortable with the ACASI and appreciated it as an additional communication route with their providers; however, expectations about the level of communication achieved were sometimes higher than actual practice. Providers felt the summary feedback information was useful when received in a timely fashion and when they were familiar with the clinical indicators reported. Repeated ACASI sessions did not have a favorable impact on adherence, depression, or substance use outcomes. No improvements in HIV RNA suppression were observed in comparison to patients who did not participate in the study. We conclude that it is feasible to integrate an ACASI screening tool into routine HIV clinical care to identify patients with inadequate medication adherence and depression symptoms. Repeated screening was not associated with improved clinical outcomes. ACASI screening should be considered in HIV clinical care settings to assist providers in identifying patients with the greatest need for targeted psychosocial services including adherence support and depression care.

How Does Depression Influence Diabetes Medication Adherence in Older Patients?

Using various measures (electronic monitoring, patient/provider report, pharmacy data), the authors assessed the association between depression and diabetes medication adherence among older patients with Type 2 diabetes. Patients completed a baseline survey on depression (Patient Health Questionnaire) and were given electronic monitoring caps (EMCs) to use with their oral hypoglycemic medication. At the time of the patient baseline survey, providers completed a survey on their patients' overall medication adherence. Upon returning the caps after 30 days, patients completed a survey on their overall medication adherence. EMC adherence was defined as percent of days out of 30 with correct number of doses. Using pharmacy refill data from the patient baseline through 1 year later, they defined adherence as the percentage of days with adequate medication, based on days' supply across refill periods. Of 203 patients (mean age: 67 years), 10% (N=19) were depressed. Depressed patients were less likely to self-report good adherence and had a lower median percentage of days with adequate medication coverage (on the basis of pharmacy refill data). After adjustment for alcohol use, cognitive impairment, age, and other medication use, depression was still negatively associated with adequate adherence, according to patient report and pharmacy data. Depression showed no associated with adherence on the basis of provider or EMC data. Depression was independently associated with inadequate medication adherence on the basis of patient self-report and pharmacy data.

How Does Depression Influence Diabetes Medication Adherence in Older Patients?

Using various measures (electronic monitoring, patient/provider report, pharmacy data), the authors assessed the association between depression and diabetes medication adherence among older patients with Type 2 diabetes.Patients completed a baseline survey on depression (Patient Health Questionnaire) and were given electronic monitoring caps (EMCs) to use with their oral hypoglycemic medication. At the time of the patient baseline survey, providers completed a survey on their patients' overall medication adherence. Upon returning the caps after 30 days, patients completed a survey on their overall medication adherence. EMC adherence was defined as percent of days out of 30 with correct number of doses. Using pharmacy refill data from the patient baseline through 1 year later, they defined adherence as the percentage of days with adequate medication, based on days' supply across refill periods.Of 203 patients (mean age: 67 years), 10% (N=19) were depressed. Depressed patients were less likely to self-report good adherence and had a lower median percentage of days with adequate medication coverage (on the basis of pharmacy refill data). After adjustment for alcohol use, cognitive impairment, age, and other medication use, depression was still negatively associated with adequate adherence, according to patient report and pharmacy data. Depression showed no associated with adherence on the basis of provider or EMC data.Depression was independently associated with inadequate medication adherence on the basis of patient self-report and pharmacy data.

Incidence and Impact of Posttraumatic Stress Disorder and Comorbid Depression on Adherence to HAART and CD4+Counts in People Living with HIV

Recent research suggests that the presence of posttraumatic stress disorder (PTSD) and depressive symptoms is independently related to abnormal hormone levels, inadequate medication adherence, and faster HIV disease progression. Although PTSD and depression occur comorbidly at high rates, the impact of both disorders on adherence and disease progression has not been examined. The present study examined the impact of PTSD and comorbid depression on CD4 cell counts and medication adherence in 58 male and 11 female (36% African American) HIV-positive individuals recruited from an AIDS service organization. Results revealed that participants high in depressive symptoms had lower CD4 cell counts and were less likely to adhere to their medication regimens than participants high in PTSD symptoms and those high in comorbid symptomatology. The present results suggest that the presence of depressive symptoms may be responsible for the observed impact of PTSD on people living with HIV (PLWH), and that failure to examine comorbid disorders may not adequately address the impact of clinical symptoms on people living with HIV.

HIV therapy in 2003: consensus and controversy.

HIV therapy has well-established and substantial clinical benefits. Awareness of these benefits has brought many infected persons into care. Many more infected persons would be treated were it not for the frequent side effects associated with antiretroviral drugs. All antiretroviral agents can cause both short-term and long-term toxicities. This is a particularly vexing problem as current data does not allow accurate predictions of treatment toxicities and, in many cases, side effects are only partially reversible. Moreover, therapy is frequently associated with the selection of drug-resistant viral isolates and incomplete viral suppression. This is commonly caused by inadequate medication adherence and leads to increasingly severe virologic failure. The present review will address both the striking advantages of HIV therapy as well as the ongoing challenges in its application.

Addition of Cyclophosphamide to Antiretroviral Therapy Does Not Diminish the Cellular Reservoir in HIV-Infected Persons

The chronically HIV-infected cellular reservoir in lymphoid tissue (LT) represents a formidable obstacle to the long-term success of antiretroviral therapy. Cytoreductive chemotherapy with cyclophosphamide (CTX) reduces cells in LT, and we hypothesized that coadministration of antiretroviral therapy with CTX may diminish the cellular reservoir over time. Ten antiretroviral treatment-naive subjects were recruited, and they received stavudine, lamivudine and nelfinavir (antiretroviral therapy, ART) until 2 consecutive plasma HIV RNA levels measured < 50 copies/ml (step 1). Five subjects then received ART alone, whereas five subjects received ART plus three escalating doses of CTX (step 2). Viral DNA was measured in LT obtained by excisional lymph node biopsy and peripheral blood mononuclear cells (PBMCs), using quantitative polymerase chain reaction at three time points in both groups (before steps 1 and 2, and after CTX). Viral DNA declined in both groups after the initiation of ART alone in step 1. During step 2 both groups experienced a modest decline compared with step 1. However, no significant differences were observed in viral DNA in LT or PBMCs between the ART alone and the ART plus CTX groups. Suppression of plasma HIV RNA levels < 50 copies/ml was not maintained in the ART plus CTX group, perhaps because of inadequate medication adherence. The group receiving ART plus CTX had lower CD4(+) lymphocyte counts and absolute total lymphocytes compared with the ART alone group. We conclude that the addition of CTX to ART did not diminish the cellular reservoir in HIV-infected persons.