Low Drug Adherence Research Articles

Socio-demographic and genetic risk factors for drug adherence and persistence across 5 common medication classes

Low drug adherence is a major obstacle to the benefits of pharmacotherapies and it is therefore important to identify factors associated with discontinuing or being poorly adherent to a prescribed treatment regimen. Using high-quality nationwide health registry data and genome-wide genotyping, we evaluate the impact of socio-demographic and genetic risk factors on adherence and persistence for 5 common medication classes that require long-term, regular therapy (N = 1,814,591 individuals from Finnish nationwide registries, 217,005 with genetic data from Finland and Estonia). Need for social assistance and immigration status show a notable negative effect on persistence and adherence across the examined medications (odd ratios between 0.48 and 0.82 for persistence and between 1.1% to 4.3% decrease in adherence) while demographic and health factors show comparably modest or inconsistent effects. A genome-wide scan does not identify genetic variants associated with the two phenotypes, while some pharmacogenes (i.e. CYP2C9 and SLCO1B1) are modestly associated with persistence, but not with adherence. We observe significant genetic correlations between medication adherence and participation in research studies. Overall, our findings suggest that socio-economically disadvantaged groups would benefit from targeted interventions to improve the dispensing and uptake of pharmacological treatments.

Long-term secondary prevention and outcome following acute coronary syndrome: real-world results from the Swedish Primary Care Cardiovascular Database.

Most studies of treatment adherence after acute coronary syndrome (ACS) are based on prescribed drugs and lack long-term follow-up or consecutive data on risk factor control. We studied the long-term treatment adherence, risk factor control, and its association to recurrent ACS and death. We retrospectively included 3765 patients (mean age 75 years, 40% women) with incident ACS from 1 January 2006 until 31 December 2010 from the Swedish Primary Care Cardiovascular Database of Skaraborg. All patients were followed until 31 December 2014 or death. We recorded blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), recurrent ACS, and death. We used data on dispensed drugs to calculate the proportion of days covered for secondary prevention medications. Cox regressions were used to analyse the association of achieved BP and LDL-C to recurrent ACS and death. The median follow-up time was 4.8 years. The proportion of patients that reached BP of <140/90 mm Hg was 58% at Year 1 and 66% at Year 8. 65% of the patients reached LDL-C of <2.5 mmol/L at Year 1 and 56% at Year 8; however, adherence to statins varied from 43% to 60%. Only 62% of the patients had yearly measured BP, and only 28% yearly measured LDL-C. Systolic BP was not associated with a higher risk of recurrent ACS or death. Low-density lipoprotein cholesterol of 3.0 mmol/L was associated with a higher risk of recurrent ACS {hazard ratio [HR] 1.19 [95% confidence interval (CI) 1.00-1.40]} and death HR [1.26 (95% CI 1.08-1.47)] compared with an LDL-C of 1.8 mmol/L. This observational long-term real-world study demonstrates low drug adherence and potential for improvement of risk factors after ACS. Furthermore, the study confirms that uncontrolled LDL-C is associated with adverse outcome even in this older population.

Adherence to levothyroxine treatment among patients with hypothyroidism in Oman: a national cross-sectional study

Objective Hormone replacement therapy with levothyroxine is considered the treatment of choice for hypothyroidism; however, non-adherence is a major contributor to poor treatment outcomes. This study aimed to evaluate levels of drug adherence (DA) to levothyroxine therapy among Omani adults with hypothyroidism and to explore related sociodemographic and clinical factors. Methods A national, multi-center, cross-sectional survey was carried out from August to December 2021 at 18 primary healthcare centers across all governorates of Oman. A total of 415 Omani adults were recruited. Data were collected using a pre-tested, Arabic-language questionnaire completed by trained researchers during face-to-face interviews with the participants. Level of DA was determined using the 8-item Morisky Medication Adherence Scale (MMAS-8). Results A total of 400 Omani adults participated in the study (response rate: 96.4%). The mean age was 41.9 ± 12.4 years old (range: 18–78 years) and 90.3% were female. According to their MMAS-8 scores, 157 (39.2%), 139 (34.8%), and 104 (26.0%) participants demonstrated low, medium, and high DA, respectively. No significant correlations were observed between level of DA and any sociodemographic or clinical characteristics, including age, gender, education, duration of treatment, and family history of thyroid disease (p > 0.050). Conclusions Only a quarter of Omani patients with hypothyroidism reported high levels of adherence to levothyroxine treatment, likely as a result of lack of awareness of the disease and the importance of maintaining an euthyroid state. Further studies using more objective measures of DA are recommended to determine correlates of non-compliance to levothyroxine therapy among Omani patients.

Reliability and Validity of Persian Translation of Morisky Medication Adherence Scale (4-Item Version) in Asthmatic Patients

Background: Non-adherence to medication is a significant health problem that affects disease control and increases hospitalization and mortality. One method of evaluating patients’ medication adherence is utilizing standard questionnaires, such as the Morisky Medication Adherence Scale (MMAS). Objectives: This study evaluated the reliability of the Persian-translated version of the MMAS among asthma patients. Methods: After the English to Persian translation, back-translation was done, examining the word appropriateness to Iranian culture. A panel of experts in related fields evaluated the questionnaire. The final questionnaire was assessed in 62 asthma patients. Results: The participants’ mean age was 49.62 ± 11.39 years (range: 30 - 72), and the mean duration of asthma was 9.05 ± 6.79 years (range: 1 - 35). The reliability of the questionnaire for four items was 0.637 (95% confidence interval: 0.465 - 0.765; P &lt; 0.001). A significant percentage (29.03%) of the subjects had low drug adherence, and only 30.6% had high adherence. There was no significant correlation between drug adherence and asthma duration (P = 0.441). Conclusions: This study shows that drug adherence is linked to asthma control and the quality of life in asthma patients. The Persian translation of the 4-item MMAS is valid to assess adherence to treatment in asthma patients.

PCR153 Factors Associated with Glucose-Lowering Drug Adherence Among U.S. Adults with Type 2 Diabetes

Approximately 75–90% of people with type 2 diabetes (T2D) are treated with glucose-lowering drugs (GLDs) and Low drug adherence has been a persisting challenge in diabetes management. we aimed to identify factors associated with adherence to GLDs and investigate if these factors vary by class.

MO821: Quality of Life and Depression in Hemodialysis Patients

Abstract BACKGROUND AND AIMS End-stage renal disease (ESRD) has certainly an impact on patients’ health-related quality of life (HRQoL). Depression is, also, highly prevalent in hemodialysis patients. This study aimed to evaluate HRQoL, the prevalence of depression, its associated factors, and its impact on quality of life in our population. METHOD This was a cross-sectional study including 70 hemodialysis patients in Monastir, Tunisia. Depression was evaluated using the Beck Depression Inventory (BDI). Quality of life was assessed with the Short-Form 36. Data were also collected on sociodemographic, laboratory (albumin, parathormone, hemoglobin and phosphorus) and dialysis (dialysis vintage, vascular access and hemodialysis adequacy) characteristics. The analysis was performed with descriptive and analytical statistics. RESULTS Among 70 patients, 64.3% were men. The mean age was 49 ± 15.7 years old. High blood pressure, diabetes and dyslipidemia were the most common comorbidities. Low drug adherence was frequent. The global average score according to the SF-36 was 38.2. The QOL was impaired in 64.2% of the cases. We have identified five variables correlated with impaired QOL: lack of autonomy, a dialysis rhythm of 3 times a week, an age &amp;gt;60 years, low social economic level and living in rural areas. Depression was present in 14.2% of the sample. Depressed patients presented poor quality of life, lower serum albumin and higher parathormone levels. CONCLUSION Our study highlights the high frequency of QOL impairment in patients on hemodialysis. Actions aimed at changing some factors associated with reduced QOL can promote well-being.

Quality of life and associated factors among patients with epilepsy at specialized hospitals, Northwest Ethiopia; 2019.

Epilepsy is a chronic non-communicable brain disorder and the second most burdensome disease in terms of disability-adjusted life years which is characterized by recurrent epileptic seizures, and a constant threat to the quality of life of the patient. Nearly 80% of people with epilepsy live in low- and middle-income countries and the risk of premature death in people with epilepsy is up to three times higher than for the general population. In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination. This study was aimed to assess the quality of life and associated factors among adult people living with epilepsy using the world health organization quality of life assessment tool. Institution-based cross-sectional study design was conducted on 419 epileptic patients using a systematic random sampling technique. The data were collected using the WHOQOL-BREF questionnaire. The data were entered into EpiData version 3.1 and exported to SPSS version 25 software for further analysis and bivariate and multivariable binary logistic regression analyses were done to identify factors associated with the dependent variable. The level of significance was declared as P value <0.05. A total of 402 epileptic patients with a median age of 28 years were involved in the study. The result of this study was revealed that 47.8% (95% CI: 42%, 52%) of the respondents had poor quality of life. Respondents who were in the middle age group (AOR = 0.36, 95% CI: 0.19, 0.70), lower educational level (AOR = 3.11, 95%CI: 1.35, 7.15), those who had low drug adherence (AOR = 8.36, 95%CI: (2.41, 28.98) comorbid anxiety, (AOR = 3.63, 95% CI: 2.55, 8.42) and depression (AOR = 3.85, 95% CI: 2.16, 6.82) were found to be significantly associated with poor quality of life of epilepsy patients. This study revealed that almost one in two epileptic patients had poor quality of life. Age of the respondents, lower educational level, comorbid anxiety and depression, and lower adherence to drugs were significantly associated with poor quality of life. Therefore, health institutions and clinicians should not focus only on the treatment of the disease itself rather they should address diseases' impact on the quality of life of patients.

Assessment of Risk Factors and Consequences of Mental Health Problems Among Mental Health Patients Admitted in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia

Introduction Mental health problem is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Objective To assess the risk factors and consequence of mental health problems among patients admitted in Felege Hiwot Referal Hospital in Bahir Dar, Ethiopia. Methodology: Phenomenological research design was used to conduct this study. Using available sampling, a total of 10 participants were involved. Interview was used as a means of collecting the data. The data was analyzed by thematic and narration techniques of analysis. Result Early life experience, social crises, economic problem, biological causes like brain damage and injury, heredity, drug use, and traditional believes such as sin, curse, witchcraft, evil spirit, herbal medicine are found to be the risk factors. Low self esteem, loneliness, hopelessness, economic problem, suicidal attempt, unable to detect the need of the patients, history taking challenge, low level of patience, low drug adherence, and counter transference are found to be the consequence of mental health problem. Conclusion People with mental health problem in the long run are highly prone to suicidal attempt and commitment as a result mental health problem. Recommendations: Concerned government bodies/Health Bureau/and the people shall work on the problems proactively and minimize the consequences through intensive follow up of people with mental health problems.

The Potential of mHealth as a Game Changer for the Management of Sickle Cell Disease in India.

Sickle cell disease (SCD) is a chronic genetic disease that requires lifelong therapy and monitoring. Low drug adherence and poor monitoring may lead to an increase in morbidities and low quality of life. In the era of digital technology, various mobile health (mHealth) apps are being tested for their potential in increasing drug adherence in patients with SCD. We herewith discuss the applicability and feasibility of these mHealth apps for the management of SCD in India.

Quality of life of chronic kidney patients on hemodialysis and related factors.

Objective:to verify the association between the health-related quality of life of chronic renal patients on hemodialysis with sociodemographic, clinical, depression and medication adherence characteristics.Method:a cross-sectional study with 183 chronic renal patients undergoing hemodialysis in the state of Rio Grande do Sul, Brazil. A sociodemographic and clinical questionnaire, Kidney Disease and Quality of Life Short-Form, Beck Depression Inventory and Morisky Medication Adherence Scale - eight items were used. Among the variables, comorbidities, complications of kidney disease and intercurrences during and after hemodialysis were evaluated. The analysis was performed with descriptive and analytical statistics.Results:55.2% of the patients were 60 years old or older, 35.0% were hypertensive, with regular quality of life, average of 62.61. Scores below average in the dimensions of quality of life were mainly associated with repetitive infections and edema as complications of the disease, pain during hemodialysis and weakness afterwards. Low drug adherence resulted in a worse quality of life, impacting ten of the 20 dimensions evaluated and depression in all, except for patient satisfaction.Conclusion:reduced quality of life in this population is associated with depressive symptoms, complications such as repetitive infections, pain and anemia, weakness after the dialysis session and low medication adherence. Actions aimed at changing these factors can promote well-being.

Characterization of low adherence population in asthma patients from Japan using Adherence Starts with Knowledge-12

BackgroundAdherence Starts with Knowledge-12 (ASK-12) is a useful indicator of drug adherence. In this study, we analyzed patient background including social and psychological factors in a low-adherence group of patients with asthma defined using ASK-12. MethodsFrom a questionnaire survey for patients with asthma from the Niigata Prefecture, Japan, conducted in the fall of 2016, we enrolled patients who answered all ASK-12 items and underwent a measured respiratory function test within 1 year. The low-adherence group (ASK-12 ≥ 28) was compared with the control group (ASK-12 < 28), and we conducted a cluster analysis of the low-adherence group. ResultsThere were 170 patients in the low-adherence group and 402 patients in the control group. There was a significant difference between age, gender, working status, smoking history, the percentage of forced expiratory volume in one second (%FEV1), asthma control test (ACT), and Patient Health Questionnaire-9 (PHQ-9) score between the two groups. Logistic analysis revealed that working status (working), % FEV1 (<90%), and PHQ-9 score (>5) were independent factors for the low-adherence group. The cluster analysis identified three clusters in the low-adherence group. Among these, one cluster was characterized by elderly males with chronic obstructive pulmonary disease and another by middle-aged nonsmoking females with a depression tendency, had problems with asthma control. ConclusionsSeveral factors were considered to be attributed to low drug-adherence. There were several phenotypes in the low-adherence population correlated with incomplete asthma control. Intervention with drug adherence should be a future goal for asthma treatment.

Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study

BackgroundUnderstanding the determinants associated with prediabetes and type 2 diabetes in coronary patients may help to individualize treatment and modelling interventions. We sought to identify sociodemographic, medical and psychosocial factors associated with normal blood glucose (HbA1c < 5.7%), prediabetes (HbA1c 5.7–6.4%), and type 2 diabetes.MethodsA cross-sectional explorative study applied regression analyses to investigate the factors associated with glycaemic status and control (HbA1c level) in 1083 patients with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records at the index event and from a self-report questionnaire and clinical examination with blood samples at 2–36 months follow-up.ResultsIn all, 23% had type 2 diabetes, 44% had prediabetes, and 33% had normal blood glucose at follow-up. In adjusted analyses, type 2 diabetes was associated with larger waist circumference (Odds Ratio 1.03 per 1.0 cm, p = 0.001), hypertension (Odds Ratio 2.7, p < 0.001), lower high-density lipoprotein cholesterol (Odds Ratio 0.3 per1.0 mmol/L, p = 0.002) and insomnia (Odds Ratio 2.0, p = 0.002). In adjusted analyses, prediabetes was associated with smoking (Odds Ratio 3.3, p = 0.001), hypertension (Odds Ratio 1.5, p = 0.03), and non-participation in cardiac rehabilitation (Odds Ratio 1.7, p = 0.003). In patients with type 2 diabetes, a higher HbA1c level was associated with ethnic minority background (standardized beta [β] 0.19, p = 0.005) and low drug adherence (β 0.17, p = 0.01). In patients with prediabetes or normal blood glucose, a higher HbA1c was associated with larger waist circumference (β 0.13, p < 0.001), smoking (β 0.18, p < 0.001), hypertension (β 0.08, p = 0.04), older age (β 0.16, p < 0.001), and non-participation in cardiac rehabilitation (β 0.11, p = 0.005).ConclusionsAlong with obesity and hypertension, insomnia and low drug adherence were the major modifiable factors associated with type 2 diabetes, whereas smoking and non-participation in cardiac rehabilitation were the factors associated with prediabetes. Further research on the effect of individual tailoring, addressing the reported significant predictors of failure, is needed to improve glycaemic control.Trial registrationRetrospectively registered at ClinicalTrials.gov: NCT02309255, December 5th 2014.

Patient centred care for the medical treatment of lower urinary tract symptoms in patients with benign prostatic obstruction: a key point to improve patients\u2019 care \u2013 a systematic review

BackgroundEven though evidence based medicine, guidelines and algorithms still represent the pillars of the management of chronic diseases (i.e: hypertension, diabetes mellitus), a patient centred approach has been recently proposed as a successful strategy, in particular to improve drug adherence. Aim of the present review is to evaluate the unmet needs in LUTS/BPH management and the possible impact of a patient centered approach in this setting.MethodsA National Center for Biotechnology Information (NCBI) PubMed search for relevant articles published from January 2000 until December 2016 was performed by combining the following MESH terms: patients centred medicine, patient centered care, person centered care, patient centered outcomes, value based care, shared decision making, male, Lower Urinary Tract Symptoms, Benign Prostatic Hyperplasia, treatment. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). All studies reporting on patient centred approach, shared decision making and evidence-based medicine were included in the review. All original article, reviews, letters, congress abstracts, and editorials comments were included in the review. Studies reporting single case reports, experimental studies on animal models and studies not in English were not included in the review.ResultsOverall 751 abstracts were reviewed, out of them 87 full texts were analysed resulting in 36 papers included. The evidence summarised in this systematic review confirmed how a patient centred visit may improve patient’s adherence to medication. Although a patient centred model has been rarely used in urology, management of Low Urinary Tract Symptoms (LUTS) and Benign Prostatic Obstruction (BPO) may represent the perfect ground to experiment and improve this approach. Notwithstanding all the innovations in LUTS/BPO medical treatment, the real life picture is far from ideal.ConclusionsRecent evidence shows a dramatical low drug adherence and satisfaction to medical treatment in LUTS/BPH patients. A patient centred approach may improve drug adherence and some unmet needs in this area, potentially reducing complications and costs. However further well designed studies are needed to confirm this data.

Physician's Perception Versus Patient's Actual Incidence of Drug Non-adherence in Chronic Illnesses.

ObjectivesTreatment adherence is crucial to the success of a management plan. The objectives of this study are (i) to assess medication adherence in patients with chronic diseases, (ii) to assess if physicians correctly perceive medication adherence among said patients, and (iii) to investigate the factors associated with low drug adherence.Materials & methodsThis observational cross-sectional study included 283 patients and 208 physicians from various hospitals in Karachi, Pakistan. The participants in the “patient group” completed the eight-item Morisky Medication Adherence Scale form. The participants in the “physician group” completed a questionnaire with questions related to their perception of their patients’ characteristics of adherence to medical prescriptions. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) for Windows, Version 22.0. (IBM Corp., Armonk, NY).ResultsThe actual incidence of low drug adherence among patients with chronic diseases is 85%. However, the perceived incidence by physicians is 40%. Low adherence was common in women, individuals aged 35 to 50 years, and individuals who were single and illiterate. Adherence decreased with an increasing number of pills, duration of treatment, and increasing average expense of medications. The actual most common barrier to adherence among patients is medication cost; however, physicians perceive forgetfulness to be the more common barrier.ConclusionPatients with chronic illnesses have low medication adherence levels. Physicians, however, misinterpret the frequency of low adherence. Our findings will help physicians have a more real and accurate understanding of the challenges their patients face in long-term adherence to treatment regimens. It may ultimately lead to improved treatment adherence and quality of management once patients’ actual challenges are addressed and necessary steps are taken.

Unsuccessfully Treated Hypertension: A Major Public Health Problem With a Potential Solution.

About one-half of all hypertensive adults do not have their blood pressure controlled. They are often prescribed medications that conform to national guidelines but they continue to have elevated blood pressure. This public health problem might be improved by applying plasma renin guided therapy. A contributor to the public health problem of unsuccessfully treated hypertension is that the circulating renin-angiotensin system (RAS) is not recognized in treatment guidelines as clinically relevant for the treatment of hypertension or as important as the body salt status for determining blood pressure levels. Another contributor to the problem is the lack of specificity in the package inserts for antihypertensive drugs. They do not specifically state under the heading "Indications" that RAS blockers are primarily most effective in hypertensive subjects with medium and high plasma renin levels; by contrast, natriuretic drugs are most effective in those with low plasma renin levels. Literature review. To address the problem of unsuccessfully treated hypertension, we recommend that the "Indications" section of package inserts for antihypertensive drugs be more specific. The primary indication for RAS blockers ought to be hypertension with medium and high plasma renin levels, and natriuretic agents for those with low plasma renin levels. Similar language ought to be added to treatment guidelines. Additionally, 3 other reasons for lack of blood pressure control also need to be addressed-failure to prescribe antihypertensive drugs to hypertensive subjects, failure of patients to fill prescriptions, and low drug adherence.

Evaluation of Adherence Should Become an Integral Part of Assessment of Patients With Apparently Treatment-Resistant Hypertension.

Since the publication of the first Symplicity studies in 2009 to 2010, renal sympathetic denervation gained acceptance as a novel treatment of drug-resistant hypertension. The latter has been defined as a blood pressure (BP) >140/90 mm Hg, despite appropriate lifestyle measures plus a diuretic and 2 other antihypertensive drugs belonging to different classes at adequate doses.1 According to the US definition, patients with controlled BP on ≥4 antihypertensive drugs are also considered as resistant hypertensives.2 However, a substantial proportion of patients with apparently resistant hypertension are in fact poorly adherents to drug treatment. The highly variable BP response to renal denervation (RDN)3–5 prompted to a more rigorous evaluation of eligible patients, with the goal to exclude false resistant hypertension, because of poor adherence to drug treatment.6–8 In particular, several publications documented a high proportion of low drug adherence in patients with apparently resistant hypertension (23%–66%), using witnessed drug intake9 or plasma/urine drug determinations10–18 (Figure 1). Figure 1. Proportion of poor or nonadherence according to drug monitoring in different cohorts of patients with apparently resistant hypertension. Black indicates total nonadherence, whereas gray indicates partial adherence. Partial adherence was defined as the presence of at least one undetectable drug10–12,14,16–18 or as the presence of fewer medications than prescribed.13,15 Furthermore, RDN studies shed the light on the dynamic character of drug adherence. Inclusion in RDN trials may influence drug adherence in various, unpredictable directions.6 In some patients, close follow-up and massive attention devoted to them may lead to improved adherence to lifestyle measures and drug treatment, particularly in the RDN arm (Hawthorne effect). Other patients may stop their medications after RDN according to their perception that the intervention cured their …

Interventions do not enhance medication persistence and compliance in patients with overactive bladder: a 24 weeks, randomised, open-label, multi-center trial.

Anticholinergics are currently the mainstay for the management of overactive bladder (OAB). However, low drug adherence has been noted with these medications. The aim of this study was to determine whether a health education intervention (HEI) could improve drug persistence with anticholinergics in OAB patients. We enrolled 682 OAB patients who were randomly distributed into either the HEI plus fesoterodine (HEI) group or the fesoterodine alone (control) group. The HEI consists of four education sections: understanding OAB disease, dietary control, bladder training and understanding anticholinergics. The primary end-point was the difference in drug persistence between the HEI and control groups at 24 weeks. Persistence was defined as a gap ≤ 30 days between successive prescription pills. Among the 682 patients, 210 (30.8%) completed 24 weeks of study. Persistence of the HEI group at 6 months was not statistically higher than that of the control group (40.4% vs. 34.9%, p = 0.181). Compliance at 6 months was also similar between the two groups (38.5% vs. 32.5%, p = 0.128). Using OAB symptom score questionnaire, the efficacy of the two groups was not different at each follow-up (p > 0.05). The global response was similar between the two groups. However, the HEI group was more satisfied with treatment than the control group (p = 0.034). The most common reason for discontinuation was satisfaction with the treatment so that they did not need to follow-up, followed by inadequate efficacy in both groups. Adverse events were reported in 12.3% of patients. The health education intervention was not effective to increase drug persistence in OAB patients on anticholinergics.

Assessing the Gender Differences of Adverse Effects in HIV Infection Treatment Based on FDA AERS Database.

Adverse effects of HIV infection treatment cannot be ignored because the occurrences of undesired adverse effects will result in low drug adherence and influence the outcome of HIV treatment. Adverse effects are significantly associated with gender. However, the role of gender in the occurrences of adverse effects has not been clearly explored. In order to provide additional guidance to prescription, we analyzed the adverse effects in HIV treatment aiming to find some gender-based differences using FDA AERS database. Interestingly, women and men performed differently in almost all the HIV-therapy adverse effects, among which adverse effects associated with skin and subcutaneous tissues occurred more frequently in male among younger adults while more frequently in female among older adults. The different occurrences of skin and subcutaneous adverse effects in men and women indicated that estrogen and androgen might function differently on skin during HIV therapy. Gender differences exist in both inter-groups and intra-groups of HIV medications. The drug NNRTI induced more adverse effects in female, but PI and INI more in male. Two NNRTI medications, namely efavirenz and nevirapine, caused different adverse effects between the two genders. Efavirenz induced more adverse effects in males and mainly affected nervous system whereas nevirapine caused more adverse effects in females and mainly affected skin and subcutaneous tissues. The gender of female is a risk factor for nevirapine, which is closely related to adverse effects associated with skin. Therefore, the recognition of gender differences in adverse effects may be helpful in prescribing medications to HIV-infected patients, e.g. greater caution should be taken when prescribing nevirapine to women. Keywords: Adverse effect, AERS, efavirenz, gender difference, HIV infection, nevirapine.

Mapping Geographic Areas of High and Low Drug Adherence in Patients Prescribed Continuing Treatment for Acute Coronary Syndrome After Discharge

ABSTRACT STUDY OBJECTIVE: To determine the feasibility of using geographic information system (GIS) technology to identify geographic areas of high and low adherence to cardiovascular drug therapy for treatment of acute coronary syndrome (ACS) in patients discharged from a university-affiliated hospital. Design. Retrospective analysis. A registry of patients admitted to and discharged from a large university-affiliated medical center for the treatment of ACS. Patients. A total of 1081 adults distributed over 300 census tracts who were discharged between April 1999 and December 2004 with a diagnosis of an ACS event of unstable angina or acute myocardial infarction. Data were collected on patient demographics, home addresses, and adherence to four classes of drugs - statins, angiotensin-converting enzyme inhibitors, β-blockers, and aspirin - at 6-12 months after discharge for the ACS index event. A GIS program was used to map patient addresses and adherence data to geographic coordinates. Hot Spot Analysis was used to determine the existence of any spatial clustering patterns in adherence rates. The analysis was performed at the census tract level by using the percentage of nonadherent patients within a census tract to represent adherence for the people living within that tract, standardized by the number of residents in a census tract aged 40 years or older. Hot Spot Analysis identified unique geographic areas of high, neutral, and low adherence in the southeast area. Highly adherent census tracts were primarily located in and around the city where the university hospital and clinics are located. Areas of low adherence were located to the west, southwest, and southeast of the city. All other census tracts were considered neutral in adherence rates. Mapping geographic areas of drug adherence is feasible with use of GIS technology, with spatial mapping able to detect areas of varying levels of adherence. Future research should examine local-level factors associated with low adherence, which can be used to derive tailored, locally relevant interventions to improve long-term drug adherence.

Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania

BackgroundSince 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania.Methods and FindingsA cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold.ConclusionsAchieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis.