Poor Adherence Research Articles

Association of ART regimen and adherence to viral suppression: an observational study of a clinical population of people with HIV

Adherence to antiretroviral therapy (ART) is essential for the effective management of HIV, which includes keeping the HIV viral load undetectable. This study aimed to determine whether certain ART medications are more “forgiving” of poor adherence in achieving viral suppression. We identified subgroups of ART medication usage and determined the extent to which ART adherence is associated with viral suppression across those subgroups. Data came from claims and clinical records (2017–2019) of 3,552 HIV-positive adult members of a Medicaid managed care plan. Pharmacy fill data were examined to characterize ART medications using latent class analysis (LCA), which captures the complexity of real-world ART usage (i.e., multiple medications, ART switching). LCA yielded five ART medication patterns over three years, mostly characterized by recent medications and formulations of ART, though they varied in number of tablets and in medication class. Mixed effects logistic regression models were estimated to determine whether odds of viral suppression differed by ART adherence level. After adjusting for covariates, those with at least 90% adherence (i.e., 90 to < 95%) did not significantly differ from those with 95% adherence or greater in terms of viral suppression, which corroborates existing clinical recommendations. These findings can inform provider-patient communication for people with HIV, especially those who have difficulty maintaining adherence. This includes those experiencing unstable housing, mental health conditions, or substance use.

Topical Steroids Are Effective and Safe in Patients With Eosinophilic Esophagitis Over a Median of 6.5 Years of Chronic Use.

To determine long-term efficacy and safety of tCS for treatment of EoE. Maintenance therapy with topical corticosteroids (tCS) is recommended for eosinophilic esophagitis (EoE), but data for long-term use are still needed. This retrospective cohort study assessed newly diagnosed patients with EoE who were treated with a tCS and had a follow-up endoscopy with biopsy after at least 5 years. Histologic symptomatic and endoscopic responses were extracted from medical records. Patients who did and did not have long-term tCS treatment were compared at baseline, and outcomes for patients were assessed at their last endoscopy while on tCS. Of 431 patients with EoE treated with tCS, 104 met inclusion criteria for long-term use. For patients with long-term tCS use, the median time (IQR) on tCS was 6.5 years (5.4 to 8.8y). At the last endoscopy, 54% had histologic response (<15eos/hpf), but those with excellent adherence had a histologic response of 64%. Endoscopic severity also decreased with improved adherence which was strongly associated with EREFS (1.7 vs. 2.8 vs. 4.0 for excellent, good, and poor adherence; P<0.001). Symptomatic response was 68% overall, but only 40% in those with poor adherence (P=0.07). Complications of taking tCS were uncommon (adrenal insufficiency: 1%; osteopenia: 1%; and esophageal candidiasis: 4% at final endoscopy). Long-term tCS (median 6.5y) were generally effective, especially with better adherence, and also safe, with only rare serious complications. These data can be used to help patients make clinical decisions about chronic tCS use in EoE.

Longitudinal study on peak expiratory flow monitoring and its impact on quality of life in childhood asthma

Objective To evaluate the impact of peak expiratory flow (PEF) monitoring using a smart peak flow (SPF) device on the quality of life (QoL) and satisfaction among children with asthma. Methods This 3-month prospective cohort study enrolled 71 children aged 7 to 17 years with physician-diagnosed asthma. Participants used the SPF device twice daily, with measurements recorded automatically. Quality of life was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and asthma control was assessed using the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Adherence to PEF measurements and satisfaction with the device were evaluated. Results Seventy-one children (mean age 11.4 years) completed the study. Adherence to twice-daily PEF measurements decreased significantly over three months (from 50.0% at 1 month to 39.9% at 3 months, p < 0.001). Children with good adherence (38.0%) showed significant improvements in PAQLQ scores, while those with poor adherence (62.0%) did not. COVID-19 infection resulted in a significant decrease in %PEF rate and increased peak flow variability. Despite device-related issues, overall satisfaction was high (85.19% for good adherence users vs. 88.64% for poor adherence users, p = 0.671). Conclusion Regular PEF monitoring improves QoL in children with asthma by enabling early detection of symptom changes and better management. However, maintaining adherence to regular PEF monitoring is challenging. Further research with control groups is needed to validate these findings.

Magnitude of multiple drug use and determinants of vulnerability among chronic kidney disease inpatients in Ethiopia: a multi-center study

BackgroundPatients with chronic kidney disease frequently face various nutritional and metabolic problems that necessitate the use of multiple medications. This multiple drug use can lead to several drug-related problems including adverse drug events, hospital admissions, poor medication adherence, harmful drug interactions, inadequate therapeutic outcomes, and death. Despite these challenges, there is a notable lack of studies on the extent of multiple drug use and its determinants among patients with chronic kidney disease in Ethiopia. This study aims to assess the magnitude of multiple drug use and identify the determinants of vulnerability among patients with chronic kidney disease in Ethiopia.MethodA hospital-based cross-sectional study was conducted among patients with chronic kidney disease. Eligible participants were selected using a simple random sampling technique. Frequency and percentage calculations were performed for categorical variables, while means and standard deviations were used for continuous variables. The chi-square test and t-test were used to compare the proportions and means, respectively. Binary logistic regression was used to identify the determinants of multiple drug use, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval. Guidelines and previous literature were utilized to assess the magnitude of multiple drug use.ResultsA total of 230 patients were enrolled, with more than half being male. The overall magnitude of multiple drug use was 83.0%. Diuretics being the most frequently prescribed medication class followed by angiotensin converting enzyme inhibitors. Patients aged 65 years and above (AOR = 4.91 (95% CI 1.60-15.03)), CKD stage five (AOR) = 5.48 (95% CI 1.99–15.09)), and the presence of comorbid conditions (AOR) = 3.53 (95% CI 1.55–8.06)) were significantly associated with multiple drug use.ConclusionChronic kidney disease patients exhibited a high rate of multiple drug use. The presence of comorbid conditions, disease progression and older age are significant determinates of this vulnerability. Health care providers should pay particular attention to these factors to manage and mitigate the risks associated with multiple drug use.

Diagnosis and Treatment of Acute Heart Failure: A Retrospective Observational Study and Medical Audit.

Background: Acute Heart Failure (AHF) is a leading cause of hospitalizations and remains a significant socioeconomic burden. Despite advances in medical care, mortality and rehospitalization rates remain high. Previous AHF audits have revealed regional differences and a poor adherence to guidelines. This study aimed to assess guideline adherence in a public teaching hospital to identify areas for improvement. Methods: This retrospective observational study examined clinical routine data of patients hospitalized for AHF at a Swiss public teaching hospital between 2018 and 2019. AHF management was evaluated against the relevant guidelines of the European Society of Cardiology. Results: The study included 760 AHF cases of 726 patients (median age 84 years, range 45-101, 50% female). NT-pro-BNP levels were measured in 92% of the cases. Electrocardiography was performed in 95% and chest X-rays in 90% of cases. Echocardiography was conducted in 54% of all cases and in 63% of newly diagnosed AHF cases. Intravenous furosemide was initiated in 76%. In the subgroup of cases with reduced ejection fraction (HFrEF), 86% were discharged with beta-blockers and 69% with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Among cases with left ventricular ejection fraction ≤ 35%, mineralocorticoid receptor antagonists were prescribed in 55%. Conclusions: We observed generally good adherence to guideline recommendations. However, several improvements are needed in initial assessment and documentation, diagnostic procedures such as echocardiography, discharge medication, and lifestyle recommendations. Compared to other studies, our diagnostic workup was more aligned with guidelines, the use of intravenous diuretics was similar, and the duration of hospital stay and mortality rates were comparable.

EFFECTS OF SOCIOECONOMIC AND CLINICAL FACTORS ON TREATMENT ADHERENCE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASES PATIENT: FOCUS ON INHALATION THERAPY

Objective: Chronic obstructive pulmonary disease (COPD) refers to a persistent blockage of airflow that requires bronchodilator medication for the rest of one’s life. The goal of the treatment can only be met when the patient is adhering to the prescribed medicine. This study identifies and analyzes how clinical and socioeconomic factors affect COPD patients’ drug adherence to given therapy. The impact of our findings will reduce socioeconomic inequality in COPD management which will improve adherence to drugs and overall physical well-being. Methods: The hospital-based cross-sectional studies were conducted at the Department of TB and CD for 6 months in a tertiary care hospital. A total of 55 patients diagnosed with COPD participated in the study after signing the informed constant. The individual patients were interviewed using MMAS-8 and Kuppuswamy scale questionnaires. The data were analyzed by Chi-square test to determine the correlation between medication adherence and socioeconomic status in patients with COPD. Results: Among 55 COPD patients included in the study, their mean age was 62.2(+10.76) years. Out of the total participants: Significant associations between the medication adherence scale (MMRS-8) scores and the Kuppuswamy scale were found as p&lt;0.0001, indicating that medication adherence was influenced by the patient’s socioeconomic status. In addition, the BORG scale which is used to measure exercise tolerance in COPD that found to have a significant correlation with an MMAS-8 score of p=0.03. Conclusion: Our study found that a person with low socioeconomic levels will have poor adherence to inhaler therapy, leading to poor health outcomes like exacerbation and low physical activity due to shortness of breath.

Individualized treatment of diabetes mellitus in older adults.

The population of older adults with diabetes mellitus is growing but heterogeneous. Because geriatric syndromes, comorbidity or multimorbidity, the complexity of glucose dynamics, and socioeconomic conditions are associated with the risk of severe hypoglycemia and mortality, these factors should be considered in individualized diabetes treatment. Because cognitive impairment and frailty have similar etiologies and risk factors, a common strategy can be implemented to address them through optimal glycemic control, management of vascular risk factors, diet, exercise, social participation, and support. To prevent frailty or sarcopenia, optimal energy intake, adequate protein and vitamin intake, and resistance or multi-component exercise are recommended. For hypoglycemic drug therapy, it is important to reduce hypoglycemia, to use sodium glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, taking into account the benefits for cardiovascular disease and the risk of adverse effects, and to simplify treatment to address poor adherence. Glycemic control goals for older adults with diabetes should be set according to three categories, based on cognitive function and activities of daily living, using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items. This categorization can be used to determine treatment strategies for diabetes when combined with the Comprehensive Geriatric Assessment (CGA). Based on the CGA, frailty prevention, treatment simplification, and social participation or services should be implemented for patients in Category II and above. Measures against hypoglycemia and for the prevention of cardiovascular disease and chronic kidney disease should also be promoted. Treatment based on categorization and CGA by multidisciplinary professionals would be an individualized treatment for older adults with diabetes. Geriatr Gerontol Int 2024; ••: ••-••.

Discrepancy between Subjective and Objective Measurements for the Evaluation of Medication Adherence-A Cross-Sectional Study in Patients with Cardiovascular Diseases.

Medication adherence is important for the appropriate drug-based treatment in patients with chronic diseases, especially those with cardiovascular diseases (CVDs). The purpose of the present study was to evaluate medication adherence among patients with CVDs using subjective and objective measurements. We enrolled outpatients who visited Fukuoka University Chikushi Hospital from June to December 2022. As a subjective measurement, we used a self-reported questionnaire developed by Ueno et al., which consists of 12 questionnaire items grouped into the following four domains: medication compliance (subjective compliance), collaboration with health care providers (collaboration), willingness to access and use information about medication (willingness), and acceptance to take medication and how taking medication fits a patient's lifestyle (acceptance). The pill counting method was used as an objective measurement to calculate the medication adherence rate; Poor Adherence was defined as a medication adherence rate of <100%. Ninety-four patients were analyzed. No statistically significant differences were observed between the patients in the Good and Poor Adherence groups classified by pill counting, an objective indicator; in the subjective evaluation index Ueno scale scores of subjective compliance, collaboration, willingness, and acceptance domains; and in the total score. A multivariate analysis revealed that obesity (odds ratio, 3.527; 95% confidence interval, 1.387-9.423; p = 0.008) was an independent factor associated with Poor Adherence. In conclusion, we found a discrepancy between subjective and objective measurements for the evaluation of medication adherence. Furthermore, obesity was an independent factor associated with poor medication adherence assessed by the pill counting method; thus, patients with CVD and obesity require a careful follow-up.

Burden of virologic failure, and its determinants among HIV positive children in East Africa: a systematic review and meta-analysis

Background: There are many studies regarding the prevalence of Virologic failure and its associated factors in East Africa, but they are inconclusive. In this study, the prevalence of Virologic failure and its associated factors in east Africa were determined. Methods: Published articles that were conducted in English language were prepared based on preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Web of Science, PubMed, and Google Scholar were explored to find out the articles. STATA Version 14 software was used for computing the pooled estimates of both the prevalence of virologic failure and associated factors. The pooled estimates were computed using both random and fixed effect models. Results were presented by using the randomand fixed effect models. . The pooled estimates were presented with 95% CI. Publication bias was assessed by looking the symmetry in the funnel plot. Result: The pooled prevalence of virologic failure was, 25.90 (19.49, 32.32, p ≤ 0:001) in the random effect model. Four factors, poor adherence (2.91 (Pooled odds ratio(POR): 2.91, 95%CI: 1.93, 4.40), being male (1.17 (POR: 1.17, 95%CI: 1.08, 1.27)), wasting as an under nutrition (3.1 (POR:3.1, 95%CI: 1.63, 5.95), and Nevirapine(NVP) based regimen (2.76 (POR: 2.76 (1.65,95%CI: 4.62)) were found to be independent predictors of virologic failure. Conclusion: The prevalence of virologic failure in East Africa is remarkably high. Four factors were found to be the determining factors Different strategies must be designed to address (poor adherence, being male, wasting as an under nutrition, and NVP based regimen). Keywords: HIV; virologic failure; adherence; viral load suppression.

Combined Diabetes Education/Skills Training and Social Needs Resolution Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (DM Social Needs): Study Protocol for a Randomized Controlled Trial.

Approximately 11.3% of the US population has diabetes. The burden of diabetes is higher in older adults and African Americans (AAs), such that 40% of adults aged 50 years and older have diabetes; African Americans are 60% more likely to be diagnosed with diabetes compared to non-Hispanic Whites (NHWs). Structural racism has resulted in fewer economic and educational opportunities for AAs, higher social risks, and unmet basic needs, which result in financial instability, housing instability, food insecurity, and a lack of transportation compared to NHWs. The presence of these unmet basic needs is a driver of poor adherence to diabetes self-management in older AAs. To test the preliminary efficacy of a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, while also addressing and resolving the unmet social needs of older AAs with poorly controlled type 2 diabetes mellitus (T2DM). The primary hypothesis is that older AAs with T2DM randomized to the DM Social Needs intervention will have significantly lower hemoglobin A1C (HbA1C), blood pressure, and LDL levels compared to the usual care arm at 6 months post randomization. This is a three-year prospective, randomized clinical trial that will enroll 100 AAs aged 50 and older with type 2 diabetes (T2DM) and HbA1C ≥ 8% into one of the following two groups: (1) a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, but also addresses and resolves unmet social needs; or (2) an enhanced usual care group that will receive mailed diabetes education materials. Participants will be followed for 6 months to determine the effect of the intervention on HbA1C, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. Baseline characteristics will be presented by study group, and within- and between-group changes in primary outcomes from baseline to 6 months will be reported. The results from this study will provide insights into the efficacy of a combined diabetes education and skills training and social needs resolution intervention for older African Americans with poorly controlled type 2 diabetes and will inform strategies to improve diabetes outcomes for this vulnerable population.

ABORDAGENS ODONTOLÓGICAS INTEGRADAS NO CUIDADO E INCLUSÃO DE PESSOAS COM TRANSTORNO DO ESPECTRO AUTISTA (TEA)

Autism Spectrum Disorder (ASD) is characterized by difficulties in communication, social interaction, repetitive behaviors, and restricted interests, with these disorders manifesting in early childhood. These patients may also present motor coordination difficulties, poor adherence to oral hygiene, frequent use of medications, and habits such as bruxism. The behavioral development conditions of these patients require targeted approaches for dental care, which poses a challenge for the dentist. According to the literature review, methods such as TEACCH propose visual approaches like panels and schedules that help reduce anxiety and aid in dental treatment. To facilitate communication, the PECS system uses symbols, allowing individuals with autism to express their needs and emotions visually. Knowledge of these dental approaches is crucial for the dentist to gain the patient's trust and better manage the treatment.

12491 Follow Up Of Glycemic Control In Patients Users Of Sensor Augmented Insulin Pump (sap) After Multi Dairy Injection (mdi) Or Change Of Technology

Abstract Disclosure: A. Medina: None. S. Tabares: None. C. Coronado: None. L. Burgos: None. A. Ely: None. Introduction: Sensor augmented insulin pump (SAP) is considered an efective therapy in type 1 diabetes (T1D) that combines continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM). A new metric of glycemic control is the time in range (TIR). More time in the expected range means less severe highs and lows. Objective: To describe glycemic control of a cohort of patients treated with multi-daily injection (MDI) or sensor-augmented insulin pump (SAP) VEO /640G who switched to a new therapy with 640G, 670G and 780G at 3 and 6 months. Methodology: A cohort study was analyzed with patients with T1D receiving SAP therapy in an university hospital. Patients with insulin therapy with MDI or SAP (VEO /640G) prior to SAP (670G /780G) were included and were followed up with glycemic control trough A1c, time in range (TIR), time in hypoglycemia and hyperglycemia, glycemic variability (GV) using continuous glucose monitoring (CGM) for 14 days, at 3 and 6 months after starting a new technology. Results: 40 patients were analyzed from 2022 to 2023, who attended check-ups every 3 months. The median age was 32 y and 65% were male. At baseline data, 40%, 22.5%, 37.5% were on MDI, VEO and 640G respectively, before changing therapy to 670G or 780G. The TIR increased by 97.6% of the patients and 75% reached the TIR (&amp;gt;70% between 70 and 180 mg/dl of glucose).Hypoglycemia decreased in 75% of patients, and of 27 patients in hyperglycemia, only 3, did not decrease glucose levels due to: lack of follow-up, sensor failure and misuse of the pump. In this cohort were included 12 patients in special conditions. The average initial GV was 37,2%, the normal being &amp;lt;36%, with an improvement at 3 and 6 months of 32,8 and 32,9%, respectively.The mean basal A1c was 7,32% . A1c decreased to 6,8 and 6,9% at 3 and 6 months after new therapy. Discusion: Regardless of the basal therapy (MDI, SAP), an improvement in TIR and A1c as measures of glycemic control is observed, as well as a decrease in the time in hypo and hyperglycemia and GV. The few patients who did not experience improvement had poor pump management, inappropriate carbohydrate counting, or poor adherence at checkups. Conclusion: SAP is an effective therapy in patients with (T1D) to reach metabolic goals, without increasing the rate of hypoglycemia. The most recent technologies in insulin pumps demonstrate better glycemic control. Presentation: 6/1/2024

8188 Pituitary hyperplasia resulting from primary hypothyroidism: A case report

Abstract Disclosure: M. Aziz: None. M.I. Manolas: None. V. Tabatabaie: None. L. Rincon: None. Pituitary hyperplasia resulting from primary hypothyroidism: A case report.Background: Primary hypothyroidism is a common endocrine condition seen in 4.6% of USpopulation (1). We describe an uncommon presentation of prolonged severe primaryhypothyroidism leading to significant hyperplasia of the pituitary gland resembling a pituitarymacroadenoma. Clinical Case: A 34-year male with schizophrenia and Hashimoto’s hypothyroidism diagnosedat the age of 17 presented with hallucinations, chest pain, fatigue, and dyspnea. The patient hada 15-year history of uncontrolled hypothyroidism with persistently elevated TSH with values ashigh as 2,299 (n 0.30-4.20 uU/mL) due to poor adherence to levothyroxine. Initial laboratorystudies revealed hyponatremia (Na 130, n135-145 mEq/L), elevated TSH (&amp;gt;100, n0.30-4.20 uU/mL), undetectable FT4 (&amp;lt;0.4, n0.6-1.5 ng/dL) and elevated CK (5671, n&amp;lt;200 U/L).Levothyroxine was restarted at dose of 150 mcg daily. Head CT performed for evaluation ofaltered mental status and hallucinations revealed hyperdensity within the pituitary gland,concerning for underlying hemorrhage and apoplexy. Neurosurgical consultation was requested,and a pituitary MRI was obtained in preparation for potential surgical intervention. MRI showeda prominent anterior pituitary gland measuring up to 14 mm with homogeneous enhancementwithout evidence of hemorrhage. In the absence of any hemorrhage or definitive mass, thepituitary enlargement was considered secondary to the long-standing history of uncontrolledprimary hypothyroidism leading to pituitary hyperplasia, and surgical intervention was deemedunnecessary. Repeat labs 1 week later showed TSH &amp;gt;100uU/mL, FT4 0.6 ng/dL, CK 2799 andrepeat MRI showed slight decrease in size of the pituitary gland, confirming hyperplasiasecondary to severe, prolonged hypothyroidism. Conclusion: Prolonged primary hypothyroidism can lead to pituitary hyperplasia which can bemistaken as pituitary macroadenoma, leading to unnecessary surgical intervention. Carefulreview of history and TSH trends can help elucidate this diagnosis.

Dietary pattern and menstrual disorders among female university students.

Assessment of the relationship between dietary patterns and menstrual disorders among female medical and paramedical students at Beni-Suef University, Egypt. Beni-Suef University conducted a cross-sectional analytical questionnaire-based study. Three hundred fifty two female medical and paramedical students agreed to participate in the study. The collected data about demographics, physical activity, menstrual history, and dietary assessment were transferred to SPSS version 26 for statistical analysis. A p value≤0.05 was considered statistically significant. The prevalence of irregular cycles, heavy blood flow, severe dysmenorrhea, and premenstrual syndrome (PMS) was found to be (21.9 %), (13.1 %), (35.5 %), and (68.9 %), respectively. Poor adherence to the Mediterranean diet (40.1 %) and physical activity (69.9 %) was present. Females with irregular cycles (p=0.472), heavy menstrual blood flow (p=0.007), and severe dysmenorrhea (p=0.029) reported lower adherence to the Mediterranean diet. Mothers' educational level (p=0.034), family income (p=0.005), and family size (p=0.009) were significantly associated with dietary adherence. Poor adherence to regular physical activity and the Mediterranean diet is highly prevalent in our research and is highly associated with menstruation disorders. So, it is critical to support health education programs emphasizing healthy dietary habits and regular physical activity to improve menstrual health and women's quality of life.

Refractory gastroduodenal ulcers: investigating non-peptic etiologies.

This article presents two clinical cases of gastroduodenal peptic ulcers refractory to medical treatment. In both cases, malignancy was excluded following persistent lesions observed in repeated endoscopies, leading to the use of surgery as both a diagnostic and therapeutic approach. These refractory cases require a multidisciplinary approach with a broad differential diagnosis, including etiologies such as toxic substance exposure, persistent Helicobacter pylori infection, or poor adherence to medical treatment, along with less common conditions such as malignancy, acid hypersecretion syndromes, vascular disorders, or immune-mediated diseases.

Impact of sociodemographic factors and depression on medication adherence in schizophrenia: Cross sectional study in Morocco

BackgroundMedication non-adherence in schizophrenia is a major cause of relapse and hospitalization, presenting a significant challenge for clinicians. This study was conducted to estimate the prevalence of medication non-adherence and identify the impact of depression, as well as other factors, on medication adherence in individuals with schizophrenia. MethodsThis was a cross-sectional study conducted among individuals with schizophrenia, both outpatients and inpatients. Data on sociodemographic, clinical, and therapeutic factors were collected using a dedicated questionnaire. Medication adherence and depression were assessed using two validated scales, the Medication Adherence Rating Scale (MARS) and the Calgary Depression Scale for Schizophrenia (CDSS), respectively. ResultsAmong the 305 participants included in this study, 21.3 % had poor medication adherence according to the MARS scores. The logistic regression model showed that only work and depression were significant predictors of poor medication adherence in individuals with schizophrenia. ConclusionThe results of this study highlight a less explored factor that can influence medication adherence in individuals with schizophrenia, namely, depression. This underpins the importance of treating the non-psychotic dimensions of schizophrenia in the recovery process. However, further studies are needed to better characterize the pathways of medication adherence in schizophrenia.

Factors influencing adherence to antiretroviral treatment among people living with HIV aged 15 – 60 years at Cité des Palmiers District Hospital, Cameroon

Antiretroviral therapy (ART), essential for halting the progression of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) infection and restoring immunity, should be taken regularly to be effective. This study aimed to assess the factors that may affect adherence to ART among people living with HIV (PLHIV) aged between 15 and 60 years at the Cit&amp;eacute; des Palmiers District Hospital. Thus, we conducted a descriptive and analytical cross-sectional study using a non-probabilistic, convenience survey. Data were collected using a questionnaire administered to PLHIV aged between 15 and 65 years (n = 309). These factors affecting adherence were established by determining relative and absolute frequencies, and associations were estimated by calculating the odds ratios, confidence intervals, and P-values. Subsequently, 48.5% of participants were found to comply with ART and 51.5% were not. The independent predictors of poor adherence to ART were missed appointments at the HIV unit, occasional use of excitants/cigarettes, fear of disclosing HIV status, perceived limited opening hours of HIV-related services, discomfort with medication, recent initiation of treatment, and use of therapy reminders. Our study results are essential to orient public health policies and measures toward PLHIV non-adherents to ART treatment and mitigate the social, economic, and health impact of HIV threats on developing countries by focusing on good adherence.

Case series of two persons living with HIV with detectable viral loads initiated then suppressed on cabotegravir/rilpivirine with lenacapavir.

Long-acting (LA) cabotegravir/rilpivirine (CAB/RPV) is primarily prescribed for virologically suppressed persons living with HIV (PLWH). Patients experiencing pill dysphagia or profound adherence challenges were excluded from the phase 3 studies, but recent reports demonstrate successful treatment in PWLH with baseline viremia. We describe two PLWH with detectable viral loads (VL) with multidrug resistance mutations. They were unable to sustain virologic suppression on oral therapy with historical poor adherence and dysphagia. Initiation of intramuscular CAB/RPV with subcutaneous lenacapavir (LEN) injections was necessary with baseline resistance. Due to anorexia and a low muscle mass, one patient received CAB/RPV injections in the vastus lateralis rather than the gluteal muscle with a 67-day delay between injections three and four due to health challenges. Both achieved viral suppression on monthly CAB/RPV with LEN. A return to health with a BMI increase from <14kg/m2 to almost 17kg/m2 resulted in the second patient. Injectable LA ART (CAB/RPV + LEN) in PLWH with detectable viremia results in sustained virologic suppression and a return to health and should now be considered a novel option for MDR patients with an inability to adhere to oral regimens.

Psychological distress experienced by pregnant women undergoing antiretroviral treatment: A qualitative study

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;The psychological condition of pregnant women with HIV is often a significant barrier to initiating and adhering to antiretroviral therapy (ART). Psychological distress in these women, if left unaddressed, can lead to poor treatment adherence, increasing the risk of mother-to-child transmission of HIV. Managing psychological distress caused by HIV early is crucial for optimizing maternal health outcomes and reducing transmission risks&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study aims to explore the psychological distress experienced by pregnant women with HIV undergoing ART and to identify ways to improve treatment adherence and reduce the risk of HIV transmission to their children.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods:&lt;/em&gt;&lt;/strong&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;A qualitative research design with a descriptive phenomenological approach was used. Participants were selected through purposive sampling based on specific inclusion and exclusion criteria. Data were collected from five participants through semi-structured, in-depth interviews. Data analysis was performed using ATLAS.ti software.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Four main themes emerged from the data: psychological factors, sociocultural influences, stressors, and life pressures. The study revealed that pregnant women undergoing ART experience significant anxiety, particularly concerning lifelong medication use and the potential transmission of HIV to their babies.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Pregnant women undergoing ART are highly vulnerable to anxiety, driven by concerns about their health and the possibility of transmitting HIV to their children. Family support plays a crucial role in helping mothers manage their anxiety, improve ART adherence, and cope with their psychological distress. Additionally, the legal and religious status of marriage was identified as a key factor contributing to stress, further increasing the risk of anxiety and depression among participants.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

B-302 Therapeutic Drug Monitoring (TDM) of Hydroxychloroquine in Whole Blood: Analysis of Over 10,000 Patient Results

Abstract Background Hydroxychloroquine (HCQ), a mainstay of systemic lupus erythematosus (SLE) therapy, improves survival and reduces flares. Therapeutic drug monitoring (TDM) may be useful in 1) identifying and improving adherence issues, 2) titrating daily dose to achieve therapeutic benefits while 3) minimizing retinopathy due to longterm cumulative exposure. Whole blood (WB) is the correct specimen for HCQ TDM because WB HCQ levels are higher than serum or plasma levels, more stable and reflective of the last month of HCQ ingestion, and are better correlated to efficacy and retinopathy risk. Here, we report WB HCQ concentrations in 10,463 clinical patient samples and their distribution. Methods HCQ concentrations in whole blood are measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) and reported in nanograms per milliliters whole blood. Recommended sample collection is ∼ 3 - 6 months into regular stable dosing to reach pharmacokinetic steady state and correlate with clinical efficacy. Results Here, we report the analysis of 10,463 patient samples for whole blood hydroxychloroquine (WB HCQ) concentrations. More than one-third (3752, 35.9%) were within the target range of &amp;gt; 1000 and &amp;lt; 2000 ng/mL. About one-quarter (2568, 24.5%) were within a tighter therapeutic target window, 1000 to 1500 ng/mL. The vast majority (9852, 94.2%,) of all WB HCQ were &amp;lt; 2000 ng/mL with a small percentage &amp;gt;2000 ng/mL (611, 5.8% between 2000 - 9502 ng/mL). About one-third (31.3%) were higher than 1177 ng/mL which corresponds to higher retinopathy risk. Adherence issues were evident in 10.5% (1102) with undetectable (483, 4.6%) and very low (&amp;lt;200 ng/mL) drug (619, 5.9%) (yellow). Depending upon the target threshold, levels &amp;lt; 500 ng/mL or &amp;lt;1000 ng/mL may be considered subtherapeutic as seen in 2498 (23.9%) and 4263 (40.7%) samples, respectively. Conclusions Due to wide pharmacokinetic variability and adherence issues, a given prescribed dose of HCQ does not correspond to WB HCQ, e.g. following 4, 5 or 6 mg/kg/day, levels are known to vary widely from subtherapeutic &amp;lt;500 to &amp;gt;2000 ng/mL. Here, our clinical database reiterates this wide range in WB HCQ levels from undetectable (&amp;lt;25) to 9502 ng/mL in 10,463 patient samples. One-quarter or one-third were within the therapeutic target range of 1000-1500 or 1000-200 ng/mL where &amp;gt;1000 has been associated with better disease control and survival. At the same time, levels less than 1177 avoid higher retinopathy risk. A small percentage of samples, 5.8%, were higher than 2000 ng/mL, suggesting the usefulness in TDM to fine-tune daily dose. In 10%, there was evidence of poor adherence, with very low or no detectable drug, and one quarter to 40% were subtherapeutic (&amp;lt;500 or &amp;lt;1000). The potential benefits of HCQ are many and include reduced flares and improved lupus nephritis, thrombosis risk, and long-term survival. At the same time, prescribed dose does not predict therapeutic levels. TDM-based counseling and dose adjustment may be instrumental in optimizing HCQ benefits while minimizing retinopathy risk. In conclusion, our analysis demonstrates the growing use of whole blood HCQ TDM to facilitate dose titration to safe and most effective target levels.