Perfect Adherence Research Articles

Quality care in epilepsy: Women's counseling and its association with folic acid prescription or recommendation

ObjectiveThis study aimed to determine if annual counseling about contraception and pregnancy in the setting of treatment for epilepsy is associated with increased recommending or prescribing of folate. MethodsThis is a retrospective cohort study with medical record abstraction. We selected records from 77 women of childbearing age who had two or more visits for epilepsy at a neurology clinic. The assessment included a review of documentation from the first three visits for epilepsy within a 24-month follow-up window. We defined perfect adherence to annual counseling about the impact of epilepsy treatment on contraception or pregnancy as defect-free care for women (DFCW). A recommendation that the patient take over-the-counter folate or a prescription for folate was independently abstracted from the chart at each visit. ResultsThe group of patients who received DFCW (N=28, 36.36%) and the group who did not receive DFCW (N=49, 63.63%) were comparable with respect to age, disease duration, baseline history of drug-resistant epilepsy (DRE), presence of concurrent psychiatric disease, epileptologist involvement, number of antiepileptic drugs (AEDs) prescribed, seizure type, and etiology.Twenty (71.4%) patients in the DFCW group and 42 (85.7%) in the non-DFCW group were not recommended or prescribed folic acid (p=0.12). ConclusionsEven with annual documentation of counseling about how epilepsy treatment may affect contraception and pregnancy, the “action” of prescribing or recommending folic acid during the ensuing 24months is frequently omitted.

Potential Impact of Incorporating a Patient-Selected Support Person into mHealth for Depression.

Although telephone care management improves depression outcomes, its implementation as a standalone strategy is often not feasible in resource-constrained settings. Moreover, little research has examined the potential role of self-management support from patients' trusted confidants. To investigate the potential benefits of integrating a patient-selected support person into automated mobile health (mHealth) for depression. Patient preference trial. Depressed primary care patients who were at risk for antidepressant nonadherence (i.e., Morisky Medication Adherence Scale total score > 1). Patients received weekly interactive voice response (IVR) telephone calls for depression that included self-management guidance. They could opt to designate a lay support person from outside their home to receive guidance on supporting their self-management. Patients' clinicians were automatically notified of urgent patient issues. Each week over a period of 6 months, we used IVR calls to monitor depression with the Patient Health Questionnaire-9 (PHQ-9; with total < 5 classified as remission), adherence (single item reflecting perfect adherence over the past week), and functional impairment (any bed days due to mental health). Of 221 at-risk patients, 61% participated with a support person. Analyses were adjusted for race, medical comorbidity, and baseline levels of symptom severity and adherence. Significant interaction effects indicated that during the initial phase of the program, only patients who participated with a support person improved significantly in their likelihood of either adhering to antidepressant medication (AOR = 1.31, 95% CI: 1.16-1.47, p < 0.001) or achieving remission of depression symptoms (AOR = 1.24, 95% CI: 1.14-1.34, p < 0.001). These benefits were maintained throughout the 6-month observation period. Incorporating the "human factor" of a patient-selected support person into automated mHealth for depression self-management may yield sustained improvements in antidepressant adherence and depression symptom remission. However, this needs to be confirmed in a subsequent randomized controlled trial.

A Gelatin-Based Prophylactic Sealant for Bowel Wall Closure, Initial Evaluation in Mid-rectal Anastomosis in a Large Animal Model

Background: Leakage is the most significant complication of gastrointestinal surgery and advanced endoscopic procedures. Sealants applied over the closure lines may help in the prevention of leakage by reinforcing the anastomosis during the initial susceptible healing period, allowing the natural healing process additional time by mechanically supporting the bowel edges. Objective: To evaluate the safety and performance of a gelatin-based sealant in a porcine model. Design: A prospective double arm, randomized study of 21 pigs, 12 in the sealant study group and 9 controls. Setting: Animal laboratory Main Outcome Measurements: Animal wellbeing, radiological contrast studies, gross intra-abdominal pathology and histological evaluation at post-operative days 5, 7, and 10. Intervention: Transection and re-anastomosing of the mid-rectum Results: In all 12 sealant arm animals, bowel motility was restored within 24 hours. No adverse effects were detected. No significant difference was noted in type or severity of adhesions. All but one demonstrated a full staple line coverage, transparency, flexibility and perfect adherence of the sealant. Contrast studies did not show leakage. The local wound healing process in both groups was identical, as assessed by histology. The tissue reaction to the sealant was characterized by a capsular formation on the outer surface, mimicking a serosal layer. Limitation: Differences between porcine and human colorectal anatomy Conclusions: A gelatin-based liquid sealant is safe to use on colorectal closure in a swine model and shows a favorable performance profile. Clinical studies are required in order to evaluate its efficacy in reducing the rate of gastrointestinal anastomotic leakage.

Educational Intervention to Improve Adherence to Anti Retro-viral Therapy (ART) among People Living with Human Immunodeficiency Virus (PLHIV) - A Randomized Controlled Trial

Background: Anti-retro-viral therapy (ART) has changed human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) from fatal disease to chronic illness, it does however requires almost perfect adherence for the medication to be therapeutically effective. Methodology: A study will be conducted among people living with Human Immunodeficiency Virus (PLHIV) aged 18 years and above, who are on ART at the ART center of Kasturba Medical College Hospital (KMCH), Attavar, Mangalore, India. Study consists of two phases: Phase I cross sectional study: A cross sectional study (n=409), has already been done to find out the level of adherence to ART using Adult AIDS Clinical Trials Group adherence follow-up questionnaire and the pre-testing for HIV related knowledge of the participants was done using HIV Knowledge Questionnaire. We observed the prevalence of non-adherence to be 27.1% (n=121) and HIV related knowledge was high among 127 (31.1%) and low among 282 (68.9%) PLHIV. Among the 121 non-adherents, 110 PLHIV will be included in the 2nd phase of the study using block randomization. Phase II randomized controlled trial (RCT): A sample size of 110 will be included in this study, which was calculated based on the statistical formula. Randomization of the participants will be done using block randomization method into intervention and control groups. HIV educational intervention will be provided for six months to the intervention group along with the standard patient care available at the hospital, whereas the control group will receive only the standard patient care available at the hospital for duration of six months. This will be followed by conduction of the first post-test at the end of 6th months among both the groups. The participants will be followed up for next 6 months and second post-test will be done at the end of 12th month for the assessment of study outcomes.

Human immunodeficiency virus/acquired immune deficiency syndrome: Using drug from mathematical perceptive.

Entry of acquired immune deficiency syndrome virus into the host immune cell involves the participation of various components of host and viral cell unit. These components may be categorized as attachment of the viral surface envelope protein subunit, gp120, to the CD4(+) receptor and chemokine coreceptors, CCR5 and CXCR4, present on T cell surface. The viral fusion protein, gp41, the second cleaved subunit of Env undergoes reconfiguration and the membrane fusion reaction itself. Since the CD4(+) T cell population is actively involved; the ultimate outcome of human immunodeficiency virus infection is total collapse of the host immune system. Mathematical modeling of the stages in viral membrane protein-host cell receptor-coreceptor interaction and the effect of antibody vaccine on the viral entry into the susceptible host cell has been carried out using as impulsive differential equations. We have studied the effect of antibody vaccination and determined analytically the threshold value of drug dosage and dosing interval for optimum levels of infection. We have also investigated the effect of perfect adherence of drug dose on the immune cell count in extreme cases and observed that systematic drug dosage of the immune cells leads to longer and improved lives.

Determinants of Non-Adherence to Antiretroviral Therapy and Modeling Progression of Adherence Level: At Yirgalem Regional Hospital, Ethiopia; January, 2012

Non-adherence is a global problem and has been seen in all diseases. According to WHO, adherence to long-term therapies in chronic illnesses averages 50% in developed countries? Adherence to HAART is challenging, because patients need almost perfect adherence of at least 95 percent to keep viral load at undetectable levels as long as possible and maintain the functionality of the immune system. Poor adherence to antiretroviral therapy increases the risk of incomplete viral suppression, disease progression and death. The purpose of this study was to assess the level and factors associated with non-adherence to antiretroviral therapy. A random sample of 368 patients were taken from the ART clinic at Yirgalem Regional Hospital from September 2006 to July 2011.Adherence levels were measured using methods pill count, pill identification test, and self-report. Descriptive statistics and both Bivariate and multivariate Logistic Regression were used to analyzed the data. Homogeneous Semi-Markov Stochastic Model was used to reveal the conditional probability of staying in non-adherence. The Multivariate Logistic Regression Method showed that the gender (sex), family size, social support available to the patients, ART knowledge of the patients, time on ART in month, and baseline CD4 counts/mm3 were significant factors associated with non-adherence to ART medications. The conditional probability of staying in non-adherence, until a given time in month was higher than staying in adherence. Thus, it is suggested that health-care providers need to be watchful about adherence levels of patients. Specifically males, who have been on ART for several months, living in large family members, lack of social support, having high baseline CD4 counts/mm3, and having poor knowledge of ART.

Medication adherence among men who have sex with men at risk for HIV infection in the United States: implications for pre-exposure prophylaxis implementation.

Pre-exposure prophylaxis (PrEP) is a promising HIV prevention approach for men who have sex with men (MSM), however non-adherence could limit its effectiveness. Understanding the experiences of HIV-uninfected MSM taking routine medications can provide valuable insights into open label PrEP adherence in real world settings and guide development of PrEP adherence interventions. In this study, we examined self-reported medication-taking experiences and facilitators and barriers of medication adherence among a geographically-diverse online sample of HIV-uninfected US MSM. Among 1480 participants, 806 (54%) reported taking medications regularly, of whom 80% reported taking medications for treatment and 55% for prevention purposes. Facilitators of medication adherence included establishing a routine, keeping medication visible, and using a pill-box; barriers included forgetting, changes in routine, and being busy or away from home. Only 45% rated their medication-taking ability as excellent, and 36% reported not missing any doses in the past 30 days. In multivariable analyses, older men and those not reporting any adherence barriers were more likely to report excellent adherence, and men willing to use PrEP were more likely to report perfect 30-day adherence. Counseling strategies to build pill-taking routines and support younger MSM are suggested to maximize the public health impact of PrEP.

Medical and psychosocial associates of nonadherence in adolescents with cancer.

The current study examined adherence to medication regimens among adolescents with cancer by applying the Pediatric Self-Management Model. Adolescents and their parents reported on adherence to medication, reasons for nonadherence, and patient-, family-, and community-level psychosocial variables. Adolescent- and parent-reported adherence were significantly correlated, with about half of the sample reporting perfect adherence. The majority reported "just forgot" as the most common reason for missed medication. Patient-, family-, and community-level variables were examined as predictors of adherence. With regard to individual factors, adolescents who endorsed perfect adherence reported a greater proportion of future-orientated goals and spent fewer days in outpatient clinic visits. For family factors, adolescents who endorsed perfect adherence reported greater social support from their family and were more likely to have a second caregiver who they perceived as overprotective. The community-level variable (social support from friends) tested did not emerge as a predictor of adherence. The results of this study provide direction for intervention efforts to target adolescent goals and family support in order to increase adolescent adherence to cancer treatment regimens.

Impact of adherence and anthropometric characteristics on nevirapine pharmacokinetics and exposure among HIV-infected Kenyan children.

There are insufficient data on pediatric antiretroviral therapy (ART) pharmacokinetics (PK), particularly for children in low- and middle-income countries. We conducted a prospective nevirapine (NVP) PK study among HIV-infected Kenyan children aged 3-13 years initiating an NVP-based ART regimen. NVP dose timing was measured through medication event monitors. Participants underwent 2 inpatient assessments: 1 at 4-8 weeks after ART initiation and 1 at 3-4 months after ART initiation. Allometric scaling of oral clearance (CL)/bioavailability (F) and volume of distribution (Vd)/F values were computed. Nonlinear mixed-effects modeling using the first-order conditional estimation with interaction method was performed with covariates. The impact of adherence on time below minimum effective concentration was assessed in the final PK model using medication event monitors data and model-estimated individual parameters. Among 21 children enrolled, mean age was 5.4 years and 57% were female. CL/F was 1.67 L/h and Vd/F was 3.8 L for a median child weighing 15 kg. Participants' age had a significant impact on CL/F (P < 0.05), with an estimated decrease in CL of 6.2% for each 1-year increase in age. Total body water percentage was significantly associated with Vd/F (P < 0.001). No children had >10% of time below minimum effective concentration when the PK model assumed perfect adherence compared with 10 children when adherence data were used. Age and body composition were significantly associated with children's NVP PK parameters. ART adherence significantly impacted drug exposure over time, revealing subtherapeutic windows that may lead to viral resistance.

Antiretroviral therapy in Zambia: do partners on ART enhance adherence?

Adherence to antiretroviral therapy (ART) is essential to optimize HIV treatment outcomes. Among individuals on ART, targeted peer support has been found to support adherence. This study of Zambian heterosexual couples living with HIV examined whether partners would exert a positive influence on each other's adherence, and compared adherence between couples in which either one or both members were on ART. Couples (n = 446 participants), in which either or both member were on ART were assessed at baseline, 6 and 12 months. Most participants (64%, n = 263) were on ART; overall, uptake of ART increased to 74% at 12 months. At baseline, 76% reported near perfect adherence; at 6 and 12 months, 66% and 70% were adherent, respectively. A regression analysis indicated that the decline in adherence did not differ between those couples in which one or both partners were on ART [F (2, 624) = 0.37, p = .692]. Pairwise comparison indicated that adherence primarily decreased between baseline and 6 months (t = 2.72, p = .007), and was stable 6 to 12 months. This study of couples in Zambia found adherence was not enhanced by having a partner on ART, and that adherence declined over time. Partners on ART may not necessarily provide support for adherence to each other. Partners may represent an untapped resource for optimizing adherence; results highlight the need for provider guidance and structured adherence interventions targeting partner adherence support.

Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru

As international guidelines increase access to antiretroviral therapy (ART) globally, ART adherence becomes increasingly important to achieve HIV treatment as prevention (TasP) goals. In the concentrated HIV epidemic among men who have sex with men (MSM) and transgendered women (TGW) in Lima, Peru, the independent correlates of ART nonadherence were examined to inform treatment intervention priorities. Cross sectional survey of HIV-infected MSM and TGW who are engaged in clinical care in Lima, Peru. From June to August 2012, 302 HIV-infected Peruvian MSM/TGW from three clinical care sites were recruited using convenience sampling to participate in a cross-sectional computer-assisted adherence survey. Several standardized screening measures associated with ART nonadherence were examined in order to determine the independent correlates of optimal (≥90%) and perfect (100%) adherence, which were assessed using logistic regression. Of the 302 participants recruited, 263 (87.1%) were prescribed ART. Among those prescribed ART, 229 (87.1%) reported optimal and 146 (55.5%) reported perfect adherence. The prevalence of alcohol use disorders (AUD; 43.2%), alcohol dependence (5.3%), recent drug use (6.0%), and depression (44.5%) was high, and most participants had some evidence of neurocognitive impairment. Meeting criteria for having an AUD and depression were collinear (p < 0.001). On multivariate analysis, having an AUD was inversely related and the only independent correlate of optimal (AOR = 0.427; 95% CI = 0.187–0.976) and perfect (AOR = 0.552; 95% CI = 0.327–0.930) ART adherence. AUDs are highly prevalent among Peruvian HIV-infected MSM and contribute significantly to ART nonadherence. These findings support the need for screening and treating underlying AUDs. In order to meet HIV TasP goals, evidence-based strategies targeting AUDs are likely to directly improve ART adherence and indirectly improve overall individual health, HIV treatment engagement, and reduce transmission to sexual partners among this vulnerable and disproportionally affected population.

A Qualitative Assessment of Barriers to Antiretroviral Therapy Adherence Among Adolescents in Western Kenya

Antiretroviral therapy (ART) requires nearly perfect adherence to be effective. This study aims to identify key factors identified by HIV-infected adolescents on ART as contributing to medication adherence in western Kenya. Using a qualitative study design, three adolescent focus groups discussions were conducted at an urban and rural clinic site in western Kenya. The study population included HIV-infected adolescents receiving ART through the USAID-AMPATH HIV care system. A trained facilitator conducted groups in Kiswahili using a semistructured interview guide probing multiple aspects of experience of taking medicines. Transcribed focus group dialogs were analyzed using constant comparison, progressive coding, and triangulation. The adolescents described a context of negative societal beliefs about HIV, necessitating a lifestyle of secrecy and minimizing the information shared about HIV or ART. Assessing and addressing adolescents’ fears and behaviors regarding medication secrecy and disclosure may enable more accurate monitoring of adherence and development of intervention strategies.

Multidrug punch cards in primary care: a mixed methods study on patients' preferences and impact on adherence.

Background: Multidrug punch cards are frame cards with 28 plastic cavities filled with a patient's oral solid medication. They are used in primary care to facilitate medication management and to enhance adherence. Main criticism concerned handling difficulties and fading knowledge about medication of patients using them. This study aimed at exploring daily use, preferences, and adherence of primary care patients using multidrug punch cards.Methods: Community pharmacies in Switzerland recruited primary care patients using multidrug punch cards. A mixed methods approach was applied with quantitative interviews performed by telephone and qualitative interviews face-to-face.Results: Of 149 eligible patients from 21 community pharmacies, 22 participated 2011 in the quantitative and 11 participated 2013/14 in the qualitative interview. Patients were very satisfied with the multidrug punch cards and stated increased medication safety. All considered adherence as very important. Self-reported adherence was 10 (median) on a visual analog scale (0 = no intake, 10 = perfect adherence). The absence of package inserts and predefined handling difficulties e.g., tablets spiking at removal were not perceived as problems.Conclusions: Patients are satisfied with the multidrug punch cards, feel safe, mostly have no handling problems and adhere to their treatment. Trust in health-care professionals and patients' experiences emerged as key variables for initiating multidrug punch card use and for medication adherence. This mixed methods study invalidates previous concerns about disadvantages of multidrug punch cards. Health-care professionals should actively recommend them for primary care patients with polypharmacy and poor adherence.

An evaluation of cataract surgery clinical practice guidelines

PurposeThis study used the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument to evaluate the methodological quality of clinical practice guidelines (CPG) published by the American Academy of...

What happens when we routinely give doxycycline to medical abortion patients?

ObjectivesRoutine provision of antibiotics following medical abortion is common yet practitioners and professional societies differ on its utility. Our study compares the side effects experienced by women who were prescribed doxycycline following medical abortion to those who were not and assesses the adherence to one prescribed regimen. Study designThis was a prospective, observational, open-label study from a convenience sample. Women seeking medical abortion were enrolled in nine study sites, including four clinics that routinely prescribe a seven-day course of doxycycline (Doxycycline arm) and five clinics that do not routinely prescribe any antibiotics (No Doxycycline arm). Seven to fourteen days following the administration of mifepristone, women were asked to self-administer a computer-based survey. The survey asked about side effects experienced (both arms) and adherence to the regimen (Doxycycline arm only). ResultsFive hundred eighty-one women were enrolled (278 in the Doxycycline arm and 303 in the No Doxycycline arm). There was a trend toward increased nausea in the Doxycycline arm (47.8% vs. 40.9%; p=.056) and a statistically significant difference in vomiting (25.2% vs. 18.5%; p=.032). Almost all women in the Doxycycline arm reported taking at least one pill, however only 28.3% reported “perfect adherence.” The most common reasons reported for taking fewer pills than instructed were that participants were still taking them (beyond 7 days) or that they forgot to take them. ConclusionWomen who were prescribed doxycycline following medical abortion reported moderate adherence and experienced significantly more vomiting than their counterparts. ImplicationsIn the absence of robust evidence that prescribing 7 days of doxycycline following medical abortion is effective at reducing serious infections, these data can assist the public health community with deciding whether routine provision is the most appropriate strategy.

Antiretroviral therapy adherence measurement in non-clinical settings in South India

Optimal adherence to antiretroviral therapy (ART) is key to viral suppression, but may be impeded by psychosocial consequences of HIV-infection such as stigma and depression. Measures of adherence in India have been examined in clinic populations, but little is known about the performance of these measures outside clinical settings. We conducted a cross-sectional study of 151 Tamil-speaking people living with HIV/AIDS (PLHA) in India recruited through HIV support networks and compared single item measures from the Adult AIDS Clinical Trial Group (AACTG) scale, a visual analog scale (VAS), and a question on timing of last missed dose. Depression was measured using the Major Depression Inventory (MDI) and HIV-related stigma was measured using an adaptation of the Berger Stigma Scale. Mean age was 35.6 years (SD ± 5.9); 55.6% were male; mean MDI score was 11.9 (SD ± 9.1); and mean stigma score was 67.3 (SD ± 12.0). Self-reported perfect adherence (no missed doses) was 93.3% using the AACTG item, 87.1% using last missed dose, and 83.8% using the VAS. The measures had moderate agreement with each other (kappa 0.45–0.57). Depression was associated with lower adherence irrespective of adherence measure used, and remained significantly associated in multivariable analyses adjusting for age and marital status. Stigma was not associated with adherence irrespective of the measure used. The VAS captured the greatest number of potentially non-adherent individuals and may be useful for identifying PLHA in need of adherence support. Given the consistent and strong association between poorer adherence and depression, programs that jointly address adherence and mental health for PLHA in India may be more effective than programs targeting only one.

Glucose control and medication adherence among veterans with diabetes and serious mental illness: does collocation of primary care and mental health care matter?

Persons with serious mental illness (SMI) may benefit from collocation of medical and mental health healthcare professionals and services in attending to their chronic comorbid medical conditions. We evaluated and compared glucose control and diabetes medication adherence among patients with SMI who received collocated care to those not receiving collocated care (which we call usual care). We performed a cross-sectional, observational cohort study of 363 veteran patients with type 2 diabetes and SMI who received care from one of three Veterans Affairs medical facilities: two sites that provided both collocated and usual care and one site that provided only usual care. Through a survey, laboratory tests, and medical records, we assessed patient characteristics, glucose control as measured by a current HbA1c, and adherence to diabetes medication as measured by the medication possession ration (MPR) and self-report. In the sample, the mean HbA1c was 7.4% (57 mmol/mol), the mean MPR was 80%, and 51% reported perfect adherence to their diabetes medications. In both unadjusted and adjusted analyses, there were no differences in glucose control and medication adherence by collocation of care. Patients seen in collocated care tended to have better HbA1c levels (β = -0.149; P = 0.393) and MPR values (β = 0.34; P = 0.132) and worse self-reported adherence (odds ratio 0.71; P = 0.143), but these were not statistically significant. In a population of veterans with comorbid diabetes and SMI, patients on average had good glucose control and medication adherence regardless of where they received primary care.

Once-Daily MeltDose Tacrolimus (Envarsus) Offers Dosing Flexibility and Maintains Therapeutic Activity When Make-Up Dose Is Taken Outside of Schedule.

Tacrolimus (Tac) is considered a Narrow Therapeutic Index drug and non-adherence may be an issue in transplant patients. Missed or delayed doses may result in subtherapeutic drug levels resulting in rejection-associated morbidity/mortality. Missed dose guidance is important to helping patients maintain therapeutic Tac levels. Envarsus is a novel once-daily, MeltDose formulation of Tac with greater bioavailability, less peak and trough-to-peak fluctuations, and similar efficacy and safety vs. twice-daily Tac (Prograf). Envarsus' pharmacokinetic (PK) profile is similar whether dosed morning or evening (Nigro V., et al. Flexible Dosing Of Once-daily LCP-Tacro Tablets: Morning Vs. Evening Chronopharmacokinetic Study, AST/ESOT Joint Meeting 2012). We evaluated the impact of non-adherence on PK of Envarsus vs. Prograf using a System Dynamics model inspired by physiologically based PK models and data from kidney transplant recipients (KTR). A “what if” analysis of various non-adherence simulated scenarios, based on varying trough levels from 12ng/ml to 6ng/ml in the presence of perfect adherence, no make-up dose, missed dose, double-dose, and makeup doses at 21, 18 and 15hrs after missed dose was conducted. (Figure) Results showed: a double dose 24h after missed dose results in higher blood concentration vs. perfect adherence; the concentration peak is highest when the Envarsus make-up dose is taken 18 or 21 hours after the missed dose (vs. 15); and taking an Envarsus make-up dose never results in peak blood concentration that exceeds Prograf normal peak. Based on the observations, it is recommended that if KTR miss a dose, a make-up dose be taken as soon as possible, followed by the next regularly scheduled dose; a double dose can be taken although it is not recommended. In addition to the lack of diurnal variation, Envarsus maintains Tac levels and offers dosing flexibility beyond a 24 hour dosing window.Figure: No Caption available.DISCLOSURES:Nachtrieb, R.: Other, Veloxis Pharmaceuticals, Paid consultant. Nigro, V.: Employee, Veloxis Pharmaceuticals.

Early-onset group B streptococcal disease in the United States: potential for further reduction.

To describe lapses in adherence to group B streptococcus (GBS) prevention guidelines among cases of early-onset GBS disease in term and preterm neonates and to estimate the potential for further reduction in disease burden under current prevention strategies. We reviewed labor and delivery and prenatal records of mothers of neonates with early-onset GBS disease (aged younger than 7 days with GBS isolated from a normally sterile site) identified at population-based surveillance sites in 2008-2009. We interviewed prenatal care providers about GBS screening practices and obtained relevant laboratory records. We evaluated the data for errors in prenatal screening, laboratory methods, communication of results, and intrapartum antibiotic prophylaxis. Using published data on screening sensitivity and intrapartum prophylaxis effectiveness, we estimated the potential reduction in cases under optimal prevention implementation. Among 309 cases, 179 (57.9%) had one or more implementation errors. The most common error type in term and preterm case-patients was prenatal screening (80 of 222 [36.0%]) and intrapartum prophylaxis (46 of 85 [54.1%]), respectively. We estimated that under optimal implementation, cases of early-onset GBS disease could be reduced by 26-59% with the largest benefit from a single intervention coming from improved use of intrapartum prophylaxis (16% decrease). Further reduction of early-onset GBS disease burden is possible under current prevention strategies, particularly with improved implementation of antibiotic prophylaxis. However, even with perfect adherence to recommended practices, the decline in cases may be modest. Therefore, novel prevention approaches such as improved intrapartum assays and vaccines are also needed.

Stimulant use and HIV disease management among men in same-sex relationships

BackgroundResearch conducted to date has focused primarily on identifying individual-level, psychological determinants of stimulant use and HIV disease management. The present cross-sectional study examined relationship factors as correlates of stimulant use and HIV disease management among men who have sex with men (MSM). MethodsIn total, 266 male couples completed a baseline assessment for a cohort study examining the role of relationship factors in HIV treatment. A computer-based assessment of relationship factors, self-reported alcohol and substance use, and self-reported anti-retroviral therapy (ART) adherence was administered. All HIV-positive participants also provided a blood sample to measure viral load. ResultsAfter controlling for demographic characteristics and relationship factors, men in a primary relationship with a stimulant-using partner had more than six-fold greater odds of reporting any stimulant use in the past three months. Among HIV-positive participants on ART (n=371), having a stimulant-using partner was independently associated with 67% lower odds of reporting perfect 30-day ART adherence and more than two-fold greater odds of displaying a detectable HIV viral load. In contrast, more partner-level alcohol use was independently associated with greater odds of reporting perfect 3-day ART adherence and lower odds of displaying a detectable HIV viral load. ConclusionsPartner-level stimulant use is an important risk factor for individual-level stimulant use and difficulties with HIV disease management among MSM. To optimize the effectiveness of HIV treatment as prevention, clinical research is needed to develop couples-based interventions targeting stimulant use as a potential driver of detectable HIV viral load.