Simplified Medication Adherence Questionnaire Research Articles

The relationship between fatigue, pruritus, and thirst distress with quality of life among patients receiving hemodialysis: a mediator model to test concept of treatment adherence.

Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.

The Simplified Medication Adherence Questionnaire: validation of a Brazilian-Portuguese version in hypertensive adults.

Self-reported adherence scales are widely used in research and practice because they are low in cost and easy to apply. A free version in Brazilian-Portuguese of the Simplified Medication Adherence Questionnaire (SMAQ) can be a useful alternative for determining the adherent behavior of hypertensive patients. To translate and evaluate the psychometric properties of the Brazilian-Portuguese version of the SMAQ therapeutic adherence scale for patients with arterial hypertension. A multicenter, cross-sectional study was conducted in five outpatient units in Maceió-AL and Aracaju-SE between January and July 2019. A total of 117 patients aged over 18years using antihypertensive drugs were recruited. The cross-cultural adaptation followed international methodological recommendations. Internal consistency (Cronbach's alpha) was tested as a reliability parameter. Criterion and construct validity were verified by concurrent validation, exploratory factor analysis (EFA), and validation by known groups. The participants had a mean age of 56.6years (SD = 10.7years); most were female (72.6%). The mean number of antihypertensives prescribed per patient was 1.87 (SD = 0.87). There were 79.5% (n = 86) of patients considered non-adherent. Internal consistency was satisfactory (Cronbach's alpha = 0.63). A satisfactory correlation coefficient was verified with the Morisky-Green-Levine test as an external criterion (r = 0.56, p < 0.001). The scale's sensitivity measured through known group validity was 75.3%, specificity 29.5%, positive predictive value 63.9%, and negative predictive value 41.9%. We identified two factors of the instrument's construct from EFA: specific medication-taking behaviors and barriers to adherence. The initial KMO measure of sampling adequacy was 0.691, and Bartlett's test of sphericity was significant (χ2 = 118.342, p < 0.001). The Brazilian-Portuguese version of the SMAQ scale proved valid and reliable for determining adherence to the pharmacotherapy in hypertensive patients. It showed more ability to detect non-adherent patients but with low specificity, possibly influenced by high social desirability.

The value of a mobile educative Application additional to Standard counselling on aspirin Adherence in Pregnancy: the ASAP study, a randomised controlled trial

ObjectiveTo assess the added value of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy versus standard counselling alone. MethodsParticipants were randomly assigned for additional use of a mobile educative application or standard counselling alone. Main outcome measures were adherence to aspirin measured by two validated questionnaires: Simplified Medication Adherence Questionnaire (SMAQ), Believes and Behaviour Questionnaire (BBQ), and patients reported tablet intake >90%. ResultsA total of 174 women with an indication for aspirin during pregnancy were included. The questionnaires were filled in by 126 out of the 174 participants (72.4%). Similar results were found in the app group and the standard counselling groups for both validated questionnaires. Tablet intake >90% was seen in 88.7% and 87.5% (p = 0.834) of the app group and standard counselling group respectively. Subgroup analyses demonstrated a negative effect of BMI and a positive effect of educational level on adherence. ConclusionsOur study revealed no added effect of a novel, mobile educative application to standard counselling on aspirin adherence during pregnancy. Tablet intake was equally high in both groups probably explained by our high educated population. InnovationFuture studies should focus on tailored counselling on medication to pregnant women's needs including medication reminders, addressing concerns, adequate health literacy and side effects, offering rewards to further stimulate aspirin adherence in pregnancy with optimal outcome for mother and their neonate.

Utilization of patient-reported outcomes to assess adherence to relugolix when combined with radiation therapy.

319 Background: Injectable GnRH receptor agonists have been shown to improve cancer control when combined with radiotherapy (RT). Relugolix is an oral GnRH receptor antagonist that achieves rapid testosterone suppression. Non-adherence to oral medications due to poor social support or bothersome side effects may increase the risk of cancer recurrence. This prospective study sought to evaluate early testosterone suppression and relugolix drug adherence when combined with RT. Utilization of patient-reported outcomes (PROs) to evaluate oral medication adherence and guide intervention may improve appropriate utilization of oral medications. This study focuses on the use of the Simplified Medication Adherence Questionnaire (SMAQ) as a tool to assess relugolix adherence. Methods: Relugolix was initiated at least 2 months prior to questionnaire administration. Adherence was assessed using the SMAQ. Total testosterone levels were obtained at the time of SMAQ administration. Castration was defined as serum testosterone ≤ 50 ng/dL. Poor drug adherence was delineated as failure to reach castration or non-adherence per the SMAQ (any non-adherence answer, missed &gt;2 doses in last week or since last visit). To compare the demographic and clinical characteristics of patients who adhered to treatment versus who did not, t-test, Wilcoxon rank sum test, Chi-square test, and Fisher’s exact test were used. A p-value &lt;0.05 determined statistical significance. Results: Between May 2021 and June 2023, 92 men were treated at Georgetown with relugolix and RT per an institutional protocol. The median age was 73 years, and 32% of patients were non-white. Patients initiated relugolix at a median of 5 months prior to the SMAQ (2-24 months). 97% of patients achieved castration (≤ 50 ng/dL) at the time of the SMAQ. 96% of men reported always taking relugolix at the appropriate time. 3% discontinued medication due to bothersome side effects, 18% reported forgetting to take the medication, and 2% reported missing a dose during the weekend. 99% and 97% did not miss a dose more than 2 times in the last week and since the last visit, respectively. Overall patient-reported drug adherence was 73%. Conclusions: Relugolix allows for high rates of castration and drug adherence when combined with RT. Monitoring drug adherence during treatment allows for prompt detection of non-adherence and timely intervention. Future studies should focus on how to optimally incorporate this questionnaire into patient management. [Table: see text]

Medication adherence in kidney transplant recipients: A cross-sectional study from a nursing clinical practice perspective

Medication non-adherence is implicated as one of the major causes of early and late kidney transplant rejection. The present study aimed to evaluate medication adherence in kidney transplant recipients. The study design was cross-sectional and descriptive. The sample was 144 kidney transplant patients, and sampling was by convenience. The researchers collected data using a three-part questionnaire, including demographic characteristics, clinical features, and simplified medication adherence questionnaire (SMAQ). Findings suggest that medication adherence in participants was at the desired level (94.4%; 95% CI: 89.8-97.3; P&lt;0.001) and the number of hospitalizations was a predictor of medication adherence in kidney transplant recipients (95% CI: 0.236-1.009; OR:0.488; P=0.053). The mean serum levels of Tacrolimus, Sirolimus, Cyclosporine, and Everolimus in kidney transplant recipients were 8.22 (SD=4.75), 59.66 (SD=82.71), 138.25 (SD=74.99), and 5.7, respectively. Glomerular filtration rate and serum levels of Tacrolimus and Cyclosporine were higher in patients with appropriate medication adherence than those with poor medication adherence (P&gt;0.05). With the increasing number of hospitalizations, medication adherence in these patients decreased. Overall, the medication adherence in kidney transplant recipients at the Kidney Transplantation Referral Center was at the desired level. Therefore, medicating related training programs are a promising approach to improve the quality of life in kidney transplant recipients and potentially reduce the incidence of transplant rejections among kidney transplant patients.

Prevalence of polypharmacy and pharmacotherapy complexity in elderly people living with HIV in Spain. POINT study

ObjectiveTo determine the prevalence of polypharmacy in persons living with HIV of at least 65 years of age receiving antiretroviral treatment. A characterization of antiretroviral treatment, as well as a determination of the prevalence of comorbidities; of the most common types of concomitant medication; of adherence rates; of the pharmacotherapeutic complexity; and of drug-drug interactions were also among the goals of the study. MethodTh is was a multi-center, cross-sectional observational study that included persons living with HIV aged 65 years or more who were on active antiretroviral treatment. Demographic, clinical (viral load, CD4 count and comorbidities) and pharmacotherapeutic (type of antiretroviral treatment: single tablet regimen, polypharmacy [six active ingredients or more] and major polypharmacy [11 active ingredients or more] variables were considered). Adherence to antiretroviral treatment was measured by dispensation records and the Simplified Medication Adherence Questionnaire, while adherence to concomitant medication was measured using dispensation records and the Morisky-Green questionnaire. The Medication Regimen Complexity Index was calculated. Drug-drug interactions were analyzed using the Liverpool and Lexicomp databases. ResultsSeventy-four patients (86.5% male) were included, with a median age of 69 years (66.7-72.0). The sexual route was the most common route of transmission of the disease (67.6%). The virus was undetectable in 89.2% of patients; the CD4 count was over 200/mL in 94.6% of the sample. The median number of comorbidities was 3.5 (2.0-5.0), 52.7% of them being cardiovascular; 50.0% related to the central nervous system; 176% hepatic; and 8.1% consisting in chronic pulmonary disease. A total of 81.1% of patients received triple therapy and 48.6% single tablet regimen. The median number of concomitant drugs administered was 5.0 (2.0-70), polypharmacy was observed in 71.6% of cases and major polypharmacy in 25.7%. Antihypertensive and cardiovascular drugs were prescribed to 56.8% of patients, lipid-lowering drugs to 50.0%, antiulcer agents to 33.8% and psychoactive drugs to 32.4%. According to dispensation records, adherence to antiretroviral treatment was 85.1% and to concomitant medication 62.8%. The median Medication Regimen Complexity Index for the whole treatment was 13.0 (8.0-176). Potential drug-drug interactions were observed in 55.4% of patients and contraindicated interactions in 12.2%. ConclusionsElderly persons living with HIV exhibit a high prevalence of polypharmacy, pharmacotherapeutic complexity, poor adherence and drug-drug interactions. For that reason, pharmacotherapeutic optimization must be a priority in these patients.

Chronic Hyperkalaemia with Patiromer in Haemodialysis: A Single-Center, Prospective Observational Study in the Clinical Practice

Introduction: Chronic Kidney Disease (CKD) patients on Hemodialysis (HD) experience increased risk of hyperkalemia, a serious potential fatal electrolyte disorder. Although novel effective strategies for managing hyperkalaemia are available, experience in routine clinical practice is still insufficient. Here we report chronic hyperkalemia prevalence and analyze the effects of different treatments on potassium management, adherence ratio and gastrointestinal symptoms in HD population. Methods: 12-week, prospective, single-center study in HD patients with chronic hyperkalaemia (&gt;5.5 mmol/l). Three study phases were established: Phase 1, Dietary Advice (DA); Phase 2, Calcium Polystyrene Sulfonate Resins (CPSRs); and Phase 3, patiromer. Sociodemographic and biochemical data, treatment adherence and compliance (Simplified Medication Adherence Questionnaire), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale, GSRS), HD characteristics and usual medical treatment were analyzed in each phase. Results: Serum potassium values decreased significantly (p&lt;0.05) only in phase 3 (–0.75 mmol/l), with a higher patient percentage reaching optimal K range. Compared with CPSRs, patiromer yielded significantly better overall GSRS scores: abdominal pain (3.7 versus 2.5), constipation (7.1 versus 5.3), indigestion (6.2 versus 5.6); and better treatment compliance. No significant changes were found in other biochemical data, HD characteristics or usual medication over the course of the study. Conclusions: Chronic hyperkalemia is a highly prevalent disorder on our HD unit. Compared to DA and traditional potassium binders; patiromer was effective in managing chronic hyperkalemia, improving gastrointestinal symptoms and treatment adherence with no associated severe adverse effects. Therefore, patiromer can be considered a first-line treatment for chronic hyperkalemia in patients with HD.

Risk factors determining adherence to tyrosine kinase inhibitors in chronic myeloid leukaemia.

Tyrosine kinase inhibitors (TKIs) have successfully changed the natural course of chronic myeloid leukaemia (CML). Although they are highly effective drugs, their clinical benefit is conditioned by adherence. This study aims to analyse the adherence of CML patients treated with TKIs and to identify the main factors influencing their adherence to TKIs treatment. An 8-month prospective, observational, multicentre study which included patients diagnosed with CML on treatment with TKIs attending the outpatient departments (OPD) of the Pharmacy Services of the participating hospitals. Adherence was assessed using two methods: the Simplified Medication Adherence Questionnaire (SMAQ) and the register of treatment dispensations from the OPDs. To analyse the predictors of adherence, a questionnaire was developed to report demographic and socio-economic information on the patients. A total of 130 patients enrolled in this study. Adherence rate was 56.9% (n = 74) among individuals, not conditioned by the type of drug used: imatinib (54.8%), nilotinib (63.6%) or dasatinib (54.3%) (p = 0.67). The patient educational level (p = 0.047) and employment status (p = 0.028) were predictors of non-adherence to treatment. Adherence is one of the most relevant parameters affecting the effectiveness of highly effective chronic treatments. Approximately half of our patients showed inadequate adherence to treatment with TKIs, with employment status and the individual's level of education emerging as the determining factors.

Related factors to non-adherence to antiretroviral therapy in HIV/AIDS patients

ObjectiveTo identify sociodemographic, clinical, and pharmacological factors associated with nonadherence to antiretroviral treatment in patients with human immunodeficiency virus/acquired immunodeficiency syndrome treated between 2017 and 2020 in four cities in Colombia. MethodAn observational, cross-sectional, retrospective study was conducted of a population of patients with human immunodeficiency virus/acquired immunodeficiency syndrome treated between 2017 and 2020. The Morisky-Green scale, the simplified medication adherence questionnaire, and the simplified scale to detect adherence problems to antiretroviral treatment were applied to determine patient adherence. A binomial multiple logistic regression was performed to evaluate the factors that best explain nonadherence. ResultsA total of 9,835 patients were evaluated, of whom 74.4% were men, 71.1% were aged between 18 and 44 years, 76.0% had attended at most secondary school, 78.1% were single, and 97.6% resided in an urban area. After applying three different scales to each patient, 10% of the study population were identified as nonadherent to treatment. The risk of nonadherence was significantly higher in patients who presented any drug-related problem or had an adverse reaction to antiretroviral drugs. ConclusionsThe variables most strongly associated with nonadherence to antiretroviral treatment were drug-related problems, adverse drug reactions, a history of nonadherence to treatment, and psychoactive substance use.

Health-Related Quality of Life in Patients Living with Wilson Disease in Spain: A Cross-Sectional Observational Study.

Wilson disease (WD) is a rare copper metabolism disorder caused by mutations in the ATP7B gene. It usually affects young individuals and can produce hepatic and/or neurological involvement, potentially affecting health-related quality of life (HRQoL). We assessed HRQoL in a cohort of Spanish patients with WD and evaluated disease impact on several domains of patients' lives, treatment adherence, drug preference and satisfaction, and healthcare resource utilisation in a cross-sectional, retrospective, multicentric, observational study. A total of 102 patients were included: 81.4% presented isolated liver involvement (group H) and 18.6% presented neurological or mixed involvement (group EH). Up to 30% of patients reported a deteriorated emotional status with anxiety and depression, which was greater in the EH subgroup; the use of neuropsychiatric drugs was high. Over 70% of the patients were satisfied with their current treatment but complained about taking too many pills, stating they would consider switching to another more patient-friendly treatment if available. The Simplified Medication Adherence Questionnaire revealed only 22.5% of patients were fully adherent to therapy, suggesting that alternative therapies are needed. This real-world study, even though is highly enriched with hepatic patients and mild disease, shows that WD impacts patients' HRQoL, especially in the emotional domain.

Impact of COVID-19 on Adherence to Treatment in Patients with HIV.

In patients with human immunodeficiency virus (HIV), adherence to treatment is affected by the adverse effects of treatment, the presence of additional comorbidities, the complexity of dosage, and family and community support. However, one recent circumstance that was likely to have influenced therapeutic adherence was the COVID-19 pandemic and the applied containment measures. An observational retrospective study of a sample of patients with HIV was conducted to establish the relationship between sociodemographic, clinical, and pharmacological variables and therapeutic adherence before and after the pandemic. Adherence was measured using the validated simplified medication adherence questionnaire (SMAQ) and medication possession rate. A statistical analysis was performed to determine the mean, standard deviation, and median of the quantitative variables and the frequencies of the qualitative variables, and the relationship between the dependent and independent variables was analysed using the chi-squared test and Student's t-test. No statistically significant differences were found between treatment adherence measured before and 22 months after the start of the pandemic. Sex, occupation, treatment regimen, viral load levels, and COVID-19 disease status did not influence adherence during either period. However, the age of patients with HIV had an impact on adherence during both periods (p = 0.008 and p = 0.002, respectively), with the age group under 45 years being less adherent. In addition, experiencing adverse drug reactions (ADRs) was shown to have an impact on adherence before the pandemic (p = 0.006) but not afterwards. The COVID-19 pandemic was not shown to have an impact on the degree of adherence to antiretroviral treatment in patients with HIV. Instead, adherence was influenced by patient age and ADR occurrence; therefore, measures must be taken in this regard. The SMAQ demonstrated sensitivity in assessing adherence.

Physical Activity, Anxiety, Depression, and Adherence to Antiretroviral Therapy in People with HIV.

Physical activity (PA) levels, as well as symptoms of anxiety and depression, can affect adherence to antiretroviral therapy (ART) impacting people's health. This study aimed to evaluate the association between PA levels, clinical symptoms of anxiety and depression, and adherence to ART in people living with HIV (PLHIV). A cross-sectional study, including 125 PLHIV was conducted. Adherence to ART was assessed using the Simplified Medication Adherence Questionnaire (SMAQ). For anxiety and depression, the Hospital Anxiety and Depression Scale was applied. The level of PA was assessed using the short version of the International Physical Activity Questionnaire. SPSS version 22.0 was used for statistical analysis. The prevalence of clinical levels of anxiety and depression symptoms was 53.6% and 37.6%, respectively. Fifty-three percent presented clinical levels of depression and anxiety symptoms. Sixty-one people (48.8%) had vigorous PA levels, 36 people (28.8%) had moderate PA levels, and 28 people (22.4%) had low PA levels. According to the SMAQ, 34.5% of the patients were adherent to ART. People who performed low PA levels had more risk to develop clinical levels of depression symptoms. Clinical level of anxiety, depression, and psychological distress (PD) symptoms was found to increase the risk of nonadherence to ART.

Factors influencing adherence to anti-retroviral therapy in amazonian indigenous people living with HIV/AIDS

BackgroundIndigenous communities in Peru has been historically affected by high mortality rates attributable to HIV-AIDS infection, associated with a low access to health services, and socio-cultural barriers. In this context, the study aimed to describe factors associated with antiretroviral treatment adherence in people from Awajun and Wampis indigenous communities, living with HIV-AIDS in a Peruvian Amazonian region.MethodsA cross-sectional study was completed with a consecutive sample of people from indigenous communities (Awajun or Wampis) living with HIV, who were receiving antiretroviral treatment for at least the last three months. Participants were recruited between October 1 and December 30, 2021, from four districts of Bagua and Condorcanqui provinces in the Amazonian region. An ad-hoc questionnaire was used to collect information about demographic, economic, and socio-cultural factors and access to health services. The Simplified Medication Adherence Questionnaire (SMAQ) was used to evaluate adherence to antiretroviral therapy. Multivariate logistic regression analysis with backward stepwise was performed to explore factors that might influence adherence.ResultsOf the 208 participants, 28.8% reported complete adherence to antiretroviral treatment. The multivariate logistic regression showed that occupation (aPR: 1.86; 95%CI 1.15–3.02), economic income (aPR: 0.64; 95%CI 0.41–0.99), and adverse reactions to antiretroviral therapy (aPR: 0.36; 95%CI 0.18–0.70) were related to complete adherence to medication.ConclusionOnly a third of participants reported complete adherence to antiretroviral therapy. Factors associated with adherence to antiretroviral medication were related to socioeconomic conditions and adverse reactions to the therapeutic scheme. Interventions to improve adherence in indigenous people living with HIV should consider these factors in order to develop effective implementation strategies.

A multi-center, prospective, observational study of patients with prostate cancer being treated with relugolix: OPTYX.

TPS398 Background: Androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) receptor agonists or antagonists are the foundation of advanced prostate cancer (aPC) treatment. Relugolix is an oral non-peptide GnRH receptor antagonist approved in the US for the treatment of aPC. In the phase 3 HERO trial, relugolix maintained suppression of testosterone to castration levels in 96.7% of men from Day 29 to 48 weeks, with superiority to leuprolide acetate. Relugolix was well tolerated and associated with a 54% lower risk of major adverse cardiovascular events relative to leuprolide acetate (Shore N, NEJM 2020;382;23). The goal of this current study (OPTYX) is to generate real-world evidence about the safety and effectiveness of relugolix in patients with prostate cancer during routine clinical care. Methods: This prospective observational cohort study (registry) is enrolling patients who have planned initiation with relugolix within 1 month prior to the time of study enrollment. The study is designed to prospectively understand the actual experience of patients with prostate cancer treated with relugolix through data collection on patients selected for treatment, treatment patterns, adherence, patient reported quality of life (QoL) and safety data. Additionally, a better understanding of the trajectory of patients with prostate cancer following cessation of relugolix therapy will be gained by observing the clinical course of the disease, health outcomes, and health-related quality-of-life (HRQoL) in these patients. Inclusion criteria include patients &gt; 18 years old with prostate cancer and planned total treatment with relugolix of at least 4 months. Estimated enrollment is 1000 patients, and patients will be followed for up to 5 years. In addition to assessing routine clinical care and disease progression, patient reported outcomes will be assessed with the Functional Assessment of Cancer Therapy-Prostate (FACT-P) for HRQoL and Simplified Medication Adherence Questionnaire (SMAQ) for adherence at 3 and 6 months then every 6 months. Clinical trial information: NCT05467176 .

Systematic screening of gender violence and domestic violence among HIV-positive patients: the VIHOLETA study

ABSTRACT We conducted a multicentre observational study in people living with HIV (PLHIV) on antiretroviral therapy in Alicante (Spain) from 2019 to 2020 aiming to analyse the prevalence of abuse and assess treatment adherence according to this variable. We used the Abuse Assessment Screen tool, the simplified medication adherence questionnaire and the medication possession ratio to assess outcomes.. Of the 161 included PLHIV, 53 (32.9%) had suffered abuse (27 emotional abuse, 6 physical abuse, 3 sexual abuse, 13 emotional and physical abuse, 4 unknown type). Seven (4.3%) had suffered abuse in the last year (5 emotional, 2 physical). Abuse had lasted a median of 48 months (interquartile range 12–81). HIV status was considered as a cause of violence by 9.4% of victims. In the multivariable analysis, only abuse was independently associated with non-adherence [adjusted odds ratio (aOR) 3.92; 95% confidence interval (CI) 1.80–8.84; p = 0.0007]. Abuse (aOR 6.14; 95% CI 1.63–27.70; p = 0.001) and previous incarceration (aOR 15.08 95% CI 2.71–104.71; p = 0.003) were associated with detectable viral load. In conclusion, the prevalence of abuse is high in PLHIV, hampering adherence and virological success. Abuse screening tools should be incorporated into routine HIV care.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

BackgroundMedication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.MethodsA cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.ResultsThe magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9–72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03–5.62)], having social support [AOR = 1.11, (95% CI 1.02–1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93–5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04–1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01–3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.ConclusionsA large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

Determinants of Disclosure, Adherence and Viral Suppression in Children and Adolescents Living With HIV in Ecuador: A Cross-Sectional Study.

Studies on HIV disclosure and adherence among children performed in Latin America are anecdotal. We aimed to assess the factors associated with HIV disclosure, adherence and viral suppression among Ecuadorian children and compare the psychologic consequences and the impact on adherence and viral suppression of early against late disclosure age. Cross-sectional study using a questionnaire and collected data on medical records of HIV-infected children between 6 and 21 years of age in Ecuador. In 250 children included, HIV diagnosis was revealed at a median age of 11 years (p25-p75 9-12). Children 12 years old or older (P < 0.0001), 10 or more years since HIV diagnosis (P = 0.001), antiretroviral initiation above 3 years of age (P = 0.018) and decease of the mother (P = 0.048) were significantly associated with total disclosure in multivariate analysis. Profound sadness or anxiety was significantly more common when diagnosis was disclosed after 12 years of age (28.4%) than before (15.4%, P = 0.047). According to the simplified medication adherence questionnaire, 194 children (78.2%) were adherent to antiretroviral therapy and HIV-RNA viral load was undetectable in 168 (67.7%). In multivariate analysis, variables associated with nonadherence were age ≥14 years (P < 0.001), taking ≥3 daily antiretroviral pills (P = 0.013) and the presence of adverse effects (P < 0.001), whereas nonadherence (P = 0.001) was the only variable significantly associated with an unsuppressed HIV-RNA viral load. Although we failed to show that an earlier disclosure age is followed by better adherence outcomes, psychological outcomes did seem to improve, supporting disclosure before 12 years of age.

Adherence to treatment in Parkinson's disease: A multicenter exploratory study with patients from six Latin American countries

BackgroundAdherence to treatment in Parkinson's disease (PD) is compromised due to the need for multiple therapies, comorbidities related to aging, and the complexity of therapeutic schemes. In the present study, we aimed to explore adherence to treatment in groups of PD patients from six Latin-American (LA) countries and identify its associated demographic and clinical parameters. MethodsA multicenter, cross-sectional, exploratory study was conducted from September 2016 to March 2017. Treatment adherence was assessed using the simplified medication adherence questionnaire (SMAQ), applied to patients and caregivers. Sociodemographic and clinical variables (MDS-UPDRS Part III-IV, MMSE, Beck Depression Inventory-II (BDI-II)) were recorded. ResultsEight hundred patients from six LA countries were evaluated. Nonadherence was reported in 58.25% of the population, according to patients. The most frequent issues were forgetfulness and correct timing of doses. A high level of agreement in adherence prevalence and most SMAQ items were observed between patients and their caregivers. The nonadherent population had a significantly higher proportion of unemployment, free access to medication, troublesome dyskinesias and off-periods, lesser years of education, and worse motor, cognitive, and mood scores. In multiple logistic and linear regression analyses, MDS-UPDRS Part III, BDI-II, gender, free access to medication, treatment with dopamine agonists alone, years of education, excessive concerns about adverse effects, and beliefs about being well-treated remained significant contributors to adherence measures. ConclusionEducational strategies, greater involvement of PD patients in decision-making, and consideration of their beliefs and values might be of great need to improve medication adherence in this PD population.

OP-3 LONG-TERM RIFAXIMIN IS SAFE AND ITS RELATED TO LESS FREQUENCY OF COMPLICATIONS LIKE VARICEAL BLEEDING IN CIRRHOTIC PATIENTS

Is well established that rifaximin (RFX) is effective as secondary prophylaxis in patients with a previous episode of hepatic encephalopathy (EH); but recently, some studies have found that RFX is related to a lower frequency of other complications. To evaluate the clinical effect of long-term prescription of RFX (more than 6 months) in cirrhotic patients, and also the possible adverse effects. A case-control study nested in a cohort which included cirrhotic patients taking secondary prophylaxis with RFX because of history of a previous EH episode. From this cohort we abstracted two different groups, cases were those who continue taking RFX for more than 6 months, controls were those who suspended RFX before the first three months because of medical indication or by their own decision and therefore they did not continue the medication for long-term. The two groups were match by age, gender, decompensation of cirrhosis (Child-Pugh B/C), history in the last year of at least an episode of variceal bleeding (VB), infections, EH, ascites, also was considered the previous use of beta-blockers and diuretics in patients with ascites. Adherence to therapy was mandatory, it was evaluated through the simplified medication adherence questionnaire (SMAQ) in all patients. Categorical variables were compared with X2 or Fisher´s exact test, odds ratios and 95% confidence intervals were also calculated. Quantitative variables were compared with Student´s t test. A p<0.05 value was considered significant. Considering the difference in incidence regarding the development of complications between the groups, we also calculate the number needed to treat (NNT) to prevent one event. A total of 139 cirrhotic patients who met the selection criteria were identified, of them, 58 were identified as cases taking long-term RFX (41.7%), and were matched with 81 controls without RFX (58.3%). The median time taking RFX was 8.5 months (range= 6-18). The mean dose identified in the medical prescriptions was 400 mg twice or thrice in day. Basal characteristics were similar in both groups (see Table). Patients taking long-term RFX had significant lower frequency of recurrence of EH (adjusted OR=0.2, 95%CI 0.1-0.4; p=0.003; NNT=3.4); and also regard the development of VB (adjusted OR=0.2, 95%CI= 0.068-0.6; p<0.0001; NNT= 4.8); despite no statistical difference, also there was a tendency to a less frequency of severe bacterial infections: RFX 1.7% vs. without RFX 8.6% (NNT= 14.5). There were no adverse effects related to the RFX prescription, neither multidrug resistant bacterial infections were documented. Long-term use of RFX (more than 6 months) was associated with significant less development of VB, less recurrence of EH, and there was a tendency to a less frequency of severe bacterial infections. Mechanisms that could explain our findings are the modulation of intestinal microbiota, reduction of bacterial translocation, reduction of the inflammatory process and secondary regulation of the portal pressure, all of them possible mediated primarily or secondarily by RFX action.

MO756MANAGEMENT OF CHRONIC HIPERKALAEMIA IN CLINICAL PRACTICE IN HAEMODIALYSIS

Abstract Background and Aims Patients with chronic kidney disease (CKD) on haemodialysis (HD) have an increased risk of hyperkalaemia, a serious and potentially fatal electrolyte disorder. New effective strategies for managing hyperkalaemia have recently become available. However, as yet, there is insufficient experience in routine clinical practice in HD. The aim of our study was to report the prevalence of chronic hyperkalaemia and analyse the effects of different treatment strategies on potassium management, ratio of adherence and gastrointestinal symptoms in our HD population. Method A 12-week, prospective, single-centre study in HD patients with chronic hyperkalaemia (&amp;gt;5.5 mmol/l). Three study phases were established: Phase 1 — dietary advice (DA); Phase 2 — calcium polystyrene sulfonate resins (CPSRs); and Phase 3 — patiromer. In each phase, we analysed sociodemographic data, related biochemical data, treatment adherence and compliance (Simplified Medication Adherence Questionnaire [SMAQ]), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale [GSRS]), HD characteristics and usual medical treatment. Results 29.2% hyperkalaemia (46% mild); 13 patients (61.5% female); mean age 63.8 ± 14.1 years and 46.4 ± 41.6 months on HD. Serum K values decreased significantly (*p &amp;lt;0.05) only in phase 3 (–0.75 mmol/l), with a higher percentage of patients reaching optimal K range. Compared with CPSRs, patiromer yielded significantly better overall GSRS scores: abdominal pain (3.7 versus 2.5), constipation (7.1 versus 5.3), indigestion (6.2 versus 5.6); and also better treatment compliance. No significant changes were found in any other biocbhemical data, HD characteristics or usual medication over the course of the study. Conclusion Chronic hyperkalaemia is a highly prevalent disorder on our HD unit. Compared to dietary advice and traditional potassium binders; patiromer was effective in managing chronic hyperkalaemia, leading to improvement in gastrointestinal symptoms and treatment adherence with no associated severe adverse effects. Thus, considering our results, we shall consider patiromer a first-line treatment for chronic hyperkalaemia in our patients with HD.