Treatment Adherence In People Research Articles

Medication Adherence Among Patients With Kidney Disease: An Umbrella Review.

Chronic kidney disease (CKD) imposes a significant medication burden on patients due to the necessity of multiple treatments to slow disease progression, manage coexisting conditions, and address complications. The complex medication regimen, in turn, has implications for clinical and patient-centered outcomes. This umbrella review provides comprehensive evidence on extent of medication nonadherence among adults with CKD, as well as associated risk factors, outcomes, and the effectiveness of interventions by synthesizing evidence from published systematic reviews and/or meta-analyses. We identified 37 works that met our inclusion criteria. These reviews covered various aspects of treatment adherence in people with CKD, which can be categorized into four main themes: (i) prevalence of treatment nonadherence; (ii) factors associated with (non)adherent behaviors; (iii) outcomes associated with treatment (non)adherence; and (iv) interventions to improve treatment adherence or overall self-management practices. Approximately half of the included studies (15/34) focused on interventions aimed at improving medication adherence or overall CKD management, while outcomes associated with medication (non)adherence were relatively underexplored in the literature. The reported prevalence rates of medication nonadherence varied widely among reviews and stages of CKD. The determinants of adherence identified included socioeconomic variables, disease or clinical conditions, and psychosocial factors. Common interventions to improve adherence included nurse-led interventions, pharmaceutical services, and eHealth technologies, which had varying effects on medication adherence or dialysis sessions.

Improving treatment adherence in patients with cancer in low and middle-income countries, through digital health self-care interventions.

114 Background: The WHO notes that adherence to treatment for people living with chronic conditions, including cancer is of global concern. This poor adherence is brought about in low- and middle-income countries like Nigeria, by patient factors such as poor health literacy, overshadowing religious beliefs, and forgetfulness, as well as systemic factors like fragmented patient care due to physician burnout. The aim of this study was to evaluate the effectiveness of digital self-care interventions via CompleteHealth in improving treatment adherence in people living with cancer. Methods: This was a retrospective study done on 63 patients on treatment for metastatic castrate-resistant prostate cancer, enrolled on mDoc’s digital CompleteHealth platform between January to December 2022. Each patient was assigned a virtual health coach who provided self-care support, monitored their health metrics, encouraged regular physical activity, and maintained normal body weight. Synchronous and asynchronous digital nudges were provided via the multiple channels of the digital CompleteHealth platform such as the web app, SMS, and phone calls. The patients also had access to virtual fitness, nutrition, and emotional wellness coaches as required. Results: 56/63 patients (88%) completed their full course of 6 months of treatment. The adherence was at 78.4%, which represents the average percentage of members who refilled medication as at when due, allowing for 30 days or less between fillings. Allowing for 90 days in between fillings, adherence was at 90.5%. Conclusions: The use of digital health interventions via virtual health coaching for self-care support has been demonstrated through CompleteHealth to improve treatment adherence in patients living with cancer significantly. There is therefore a place to scale up the use of digital health coaching to further improve this statistic, as it is likely to impact treatment outcomes positively.

Comparative effectiveness of sodium-glucose co-transporter 2 inhibitors and dipeptidyl peptidase-4 inhibitors on cardiorenal function and treatment adherence: A Prevalent New-User Design Study in tertiary hospitals

Abstract Objectives Data on the long-term effects comparing sodium-glucose co-transporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) are scarce, especially from middle-income countries. To examine the effects of SGLT2i and DPP4i on the cardiorenal function and treatment adherence for people with type 2 diabetes (T2D) using prevalent new-user design in real-world setting. Methods We conducted a retrospective cohort study in two tertiary hospitals in Malaysia and matched T2D patients initiated on SGLT2i or DPP4i from 2010 to 2021 using time-conditional propensity score. Outcomes of interest included cardiovascular and renal outcomes, as well as clinical lab outcomes, adherence and non-persistence. The hazard ratios for cardiorenal outcomes was inferred using Cox proportional hazards model. Key findings The cohort included 1528 patients, with 406 SGLT2i users matched with 406 DPP4i users. Over a median follow-up of 1.52 years, no differences in cardiorenal outcomes were observed. Patients initiated with SGLT2i had lower HbA1c at 12-month (-0.79%,p<0.001) compared to DPP4i (-0.49%,p<0.05; difference:-0.30%,p<0.05). No differences in the renal, lipid, weight and blood pressure parameters were observed between both groups. Higher medication persistence was noted among SGLT2i users compared to DPP4i users (92% vs 87%,P=0.03). Conclusions Both medications were comparable in exerting distinct effects on cardiorenal risk factors, with better HbA1c control and medication persistence among SGLT2i users. The long-term cardiorenal outcomes remains undetermined.

Guaranteed Income and Financial Treatment Trial (GIFT Trial or GIFTT): a 12-month, randomized controlled trial to compare the effectiveness of monthly unconditional cash transfers to treatment as usual in reducing financial toxicity in people with cancer who have low incomes.

Cancer-related financial hardship (i.e., financial toxicity) has been associated with anxiety and depression, greater pain and symptom burden, treatment nonadherence, and mortality. Out-of-pocket healthcare costs and lost income are primary drivers of financial toxicity, however, income loss is a pronounced risk factor for cancer patients with low incomes. There has been little progress in developing an income intervention to alleviate financial toxicity cancer patients with low incomes. Unconditional cash transfers (UCT), or guaranteed income, have produced positive health effects in experiments with general low-income populations, but have not yet been evaluated in people with cancer. The Guaranteed Income and Financial Treatment (GIFT) Trial will use a two-arm randomized controlled trial to compare the efficacy of a 12-month UCT intervention providing $1000/month to treatment as usual on financial toxicity, health-related quality of life and treatment adherence in people with cancer who have low-incomes. The study will recruit 250 Medicaid beneficiaries with advanced cancer from two comprehensive cancer centers in Philadelphia, obtain informed consent, and randomize patients to one of two conditions: (1) $1,000/month UCT or (2) treatment as usual. Both arms will receive information on financial toxicity and the contact information for their hospital social worker or financial advocate upon enrollment. Participants will complete online surveys at baseline, 3, 6, 9, and 12 months from enrollment to collect patient-reported data on primary (i.e., financial toxicity, health-related quality of life, and treatment adherence) and secondary outcomes (i.e., anxiety, depression, food insecurity, housing stability). Social security records will be used to explore the effect on mortality at 2, 3, and 5 years post-enrollment. Linear mixed-models will be used to analyze all primary and secondary continuous outcomes over time and general estimating equations with a logit link and binary distribution for all binary outcomes over time. Differences between treatment and control groups and treatment effects will be determined using models that control for age, gender, race, baseline food security, baseline housing stability, and baseline ECOG. Findings from this study will have significant implications for the development and implementation of programs and policies that address the financial burden of cancer and other serious illnesses.

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.

Hubungan efikasi diri dengan tingkat kepatuhan pengobatan antiretroviral terapi pada laki-laki seropositif HIV

Background: Compliance with ART treatment is an important indication to improve the quality of life of people dliving with HIV / AIDS (PLWHA), prevent drug resistance, and reduce mortality. One factor that can influence the level of adherence to ART treatment is the self-efficacy of ARV treatment levels.Objectives: To determine the relationship of self-efficacy with adherence to taking medication in men with HIV / AIDS at Victoria Plus Foundation Yogyakarta. Methods: This research is a quantitative correlation with cross sectional approach. The research sample of 35 respondents was determined by probability sampling technique. The research instrument was in the form of a self-efficacy questionnaire and medication adherence. Data analysis techniques using the Kendall Tau test. Results: Self-efficacy in people with HIV / AIDS was in the confident category of 97.1%. Treatment adherence in people with HIV / AIDS is in the category of non-compliance by 80.0%. There is a relationship between self-efficacy and medication adherence in male patients with HIV / AIDS based on pvalue = 0.023. Conclusion: There is a relationship between self-efficacy and medication adherence in male patients with HIV / AIDS at the Victori Plus Foundation in Yogyakarta.

A scoping review: Treatment attitudes and adherence for adults with schizophrenia.

This scoping review presents an exploration of literature on the relationship between treatment attitudes and adherence in adults experiencing schizophrenia. Strategies to address adherence and improve treatment outcomes are described in literature. However, adherence remains a challenge for people experiencing mental illness in practice. Transformational frameworks, evidence-based practice and patient-centred approaches have been established and implemented but non-adherence incidence rates continue to rise among people with schizophrenia. Moreover, the relationship between treatment attitudes and adherence in adults diagnosed with schizophrenia remains unclear. A scoping review using the framework offered by Implementation Science, 5, 2010, 1. The PRISMA-ScR checklist was used to ensure integrity of the review. Four databases PsychINFO, Medline, Cochrane and CINAHL databases were searched for literature along with the reference lists of eligible sources. Original research, peer-reviewed articles published between 2010 and 2020 in English language were included. Articles were included if study participants were adults with a diagnosis of schizophrenia or related psychosis. Methodological quality was evaluated using a quality assessment checklist, the Critical Appraisal Skills Programme tool. Ten articles were included in the study. Five main themes about treatment adherence emerged from the literature: (i) severity of symptoms, (ii) side effects, (iii) beliefs and attitudes, (iv) insight and (v) support and relationships. This scoping review concluded that attitude influenced adherence to medication in people with schizophrenia. The five main themes reported directly influenced attitude, impacting on treatment adherence in people experiencing schizophrenia. This review makes recommendations for a person-centred and recovery framework that aims to improve adherence. Nurses in all healthcare settings could use evidence-based strategies to enhance treatment adherence in people with a range of physical and mental health conditions.

Effectiveness of Acceptance and Commitment Therapy on Treatment Adherence in People with Non-Alcoholic Fatty Liver Disease

Introduction: The present study was conducted with the aim of acceptance and commitment therapy (ACT) on treatment adherence in people with non-alcoholic fatty liver disease (NAFLD).
 Methods: This study was a quasi-experimental design with an experimental group and a control group with pre-test, post-test and two-month follow-up. This study was conducted in 2019 in Tehran in the statistical population of people with NAFLD diagnosis. In this study, 30 individuals with NAFLD were purposefully selected and they were randomly assigned to two groups and received a pre-test. Then, the experimental group underwent group intervention of acceptance and commitment therapy during two months of ten sessions while the control group had received the typical routine interventions from medical centers. The Morisky Medication Adherence Scale (Moriski et al., 2008) was conducted in the all of three stages of measurement. In order to analyze the data, repeated measures analysis of variance test with SPSS-16 software was used.
 Results: The trend of changes in the intervention group compared to the control group in the measurement stages in the treatment adherence to the treatment (F= 4.243, P=0.03) was significantly different (P <0.05) and about 15% of the differences observed in this variable is due to group membership (intervention). To compare these changes over time, Benfron's subtest was used. The difference between pre-test with post-test and follow-up were only significant in the intervention group (P <0.05).
 Conclusion: Acceptance and commitment-based therapy increases treatment adherence. Therefore, it is suggested that this method be used to increase treatment adherence in people with non-alcoholic fatty liver.

The feasibility of the\xa0PAM intervention to support treatment-adherence in people with hypertension in primary care: a randomised clinical controlled trial

The PAM intervention is a behavioural intervention to support adherence to anti-hypertensive medications and therefore to lower blood pressure. This feasibility trial recruited 101 nonadherent patients (54% male, mean age 65.8 years) with hypertension and high blood pressure from nine general practices in the UK. The trial had 15.5% uptake and 7.9% attrition rate. Patients were randomly allocated to two groups: the intervention group (n = 61) received the PAM intervention as an adjunct to usual care; the control group (n = 40) received usual care only. At 3 months, biochemically validated medication adherence was improved by 20% (95% CI 3–36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95% CI 5.69–12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness. For a subsample of patients, improvements in medication adherence and reductions in full lipid profile (cholesterol 1.39 mmol/mol 95% CI 0.64–1.40) and in glycated haemoglobin (3.08 mmol/mol, 95% CI 0.42–5.73) favoured the intervention. A larger trial will obtain rigorous evidence about the potential clinical effectiveness and cost-effectiveness of the intervention.Trial registration Trial date of first registration 28/01/2019. ISRCTN74504989. https://doi.org/10.1186/ISRCTN74504989.

IMPACT study on intervening with a manualised package to achieve treatment adherence in people with tuberculosis: protocol paper for a mixed-methods study, including a pilot randomised controlled trial

IntroductionCompared with the rest of the UK and Western Europe, England has high rates of the infectious disease tuberculosis (TB). TB is curable, although treatment is for at least 6...

Effectiveness of behavioral family therapy in people with schizophrenia: a randomized, controlled clinical trial

Objective. To evaluate the effectiveness of FBT in comparison with usual care in people with schizophrenia treated at an outpatient psychiatric department of a public hospital in Chile. Method. Quantitative study, with a randomized, controlled clinical trial design (CTCT) and pre-post measurements, with two arms. Fifty-four people with schizophrenia and their primary caregivers, randomly assigned to experimental and control groups, were studied. The main outcome variable was social functioning. As secondary outcomes, clinical symptoms and treatment adherence in people with schizophrenia were evaluated. Expressed emotion was evaluated in the primary caregiver. Results. FBT was effective in improving the social functioning of people with schizophrenia and decreasing expressed emotion in the primary caregiver, with a large effect size (d > 0.80). Conclusions. The implementation of FBT as a protocolized intervention, complementing usual care, helps to improve psychosocial outcomes in people with schizophrenia and their caregivers.

Effectiveness of Educational Technology in Promoting Quality of Life and Treatment Adherence in Hypertensive People.

The objective of this study was to test the effectiveness of an educational intervention with use of educational technology (flipchart) to promote quality of life (QOL) and treatment adherence in people with hypertension. It was an intervention study of before-and-after type conducted with 116 hypertensive people registered in Primary Health Care Units. The educational interventions were conducted using the flipchart educational technology. Quality of life was assessed through the MINICHAL (lowest score = better QOL) and the QATSH (higher score = better adherence) was used to assess the adherence to hypertension treatment. Both were measured before and after applying the intervention. In the analysis, we used the Student’s t-test for paired data. The average baseline quality of life was 11.66 ± 7.55, and 7.71 ± 5.72 two months after the intervention, showing a statistically significant reduction (p <0.001) and mean of differences of 3.95. The average baseline adherence to treatment was 98.03 ± 7.08 and 100.71 ± 6.88 two months after the intervention, which is statistically significant (p < 0.001), and mean of differences of 2.68. The conclusion was that the educational intervention using the flipchart improved the total score of quality of life in the scores of physical and mental domains, and increased adherence to hypertension treatment in people with the disease.

Medication adherence in people dually treated for HIV infection and mental health conditions: test of the medications beliefs framework.

Beliefs about medication necessity and concerns predict treatment adherence in people with a wide-array of medical conditions, including HIV infection. However, medication beliefs have not been examined in people dually treated with psychotropic medications and antiretroviral therapy. In the current study, we used a prospective design to investigate the factors associated with adherence to psychotropic medications and antiretrovirals among 123 dually treated persons living with HIV. We used unannounced phone-based pill counts to monitor adherence to psychiatric and antiretroviral medications over a 6-week period. Hierarchical regression models included demographic, health and psychosocial characteristics as predictors of adherence followed by medication necessity and concerns beliefs. Results showed that medication necessity beliefs predicted both antiretroviral and psychiatric medication adherence over and above established predictors of adherence. Medication concerns also predicted psychotropic adherence, but not antiretroviral adherence. These models accounted for 31 and 22 % of the variance in antiretroviral and psychotropic adherence, respectively. Findings suggest that the necessity-concerns medication beliefs framework has utility in understanding adherence to multiple medications and addressing these beliefs should be integrated into adherence interventions.

Psychiatrists' awareness of partial- and non-adherence to antipsychotic medication in schizophrenia: results from the Australian ADHES survey.

The Adherence in Schizophrenia (ADHES) initiative aimed to assess physicians' perspectives about treatment adherence in people with schizophrenia, and assess strategies to improve adherence. Between March and April 2012, a 20-question survey was delivered to Australian psychiatrists (n = 3400). These anonymous surveys were returned by mail. The survey asked about the demographics of participating psychiatrists and the respondents' perceptions of different factors that affect the adherence of people with schizophrenia to their treatment with antipsychotic medications. Adherence was defined by the proportion of prescribed doses taken: non-adherence, if < 30%; partial-adherence, 30%-90%; and adherent, > 90%. Data were reported descriptively and were not weighted. Respondent psychiatrists (n = 406; response rate 12%) reported that one-half (51%) of people with schizophrenia were either non-adherent (20%) or only partially adherent (31%). This was despite most (72%) psychiatrists' reporting that they assessed adherence to medication at every visit. The main reported reasons for medication discontinuation were: lack of insight (45%), drug or alcohol abuse (3%), or side effects (29%). The preferred strategies for improving adherence were switching to or adding a long-acting antipsychotic (40%), or simplifying the medication regimen (30%). Lack of adherence to antipsychotic medication remains a problem. More proactive management is required, to improve adherence and long-term outcomes.

The rational patient and beyond: implications for treatment adherence in people with psychiatric disabilities.

Many people with psychiatric disabilities do not benefit from evidence-based practices because they often do not seek out or fully adhere to them. One way psychologists have made sense of this rehabilitation and health decision process and subsequent behaviors (of which adherence might be viewed as one) is by proposing a "rational patient"; namely, that decisions are made deliberatively by weighing perceived costs and benefits of intervention options. Social psychological research, however, suggests limitations to a rational patient theory that impact models of health decision making. The research literature was reviewed for studies of rational patient models and alternative theories with empirical support. Special focus was on models specifically related to decisions about rehabilitation strategies for psychiatric disability. Notions of the rational patient evolved out of several psychological models including the health belief model, protection motivation theory, and theory of planned behavior. A variety of practice strategies evolved to promote rational decision making. However, research also suggests limitations to rational deliberations of health. (1) Rather than carefully and consciously considered, many health decisions are implicit, potentially occurring outside awareness. (2) Decisions are not always planful; often it is the immediate exigencies of a context rather than an earlier balance of costs and benefits that has the greatest effects. (3) Cool cognitions often do not dictate the process; emotional factors have an important role in health decisions. Each of these limitations suggests additional practice strategies that facilitate a person's health decisions. Old models of rational decision making need to be supplanted by multiprocess models that explain supradeliberative factors in health decisions and behaviors.

A narrative approach to explore grief experiences and treatment adherence in people with chronic pain after participation in a pain-management program: a 6-year follow-up study.

ObjectiveThe aim of this study was to explore grief caused by chronic pain and treatment adherence, and how these experiences are integrated into ongoing life stories.MethodsA 6-year follow-up using a qualitative mixed-methods design based on written narratives and image narratives was performed. Five women suffering from chronic pain comprised the purposive sample. They had completed an 8-week group pain-management program with two follow-ups, and thereafter continued as a self-help group. A narrative approach was used to analyze the written and image narratives guided by three analytic steps.ResultsFindings showed that experiences of grief over time were commonly associated with chronic pain. The participants’ past experiences reflected their grief at having to abandon jobs and social networks, and revealed loneliness and despair. The present life situation seemed to reflect adaptation, and hope for the future had been established. Overall, forward progression means an ongoing struggle towards a reintegrated body and a meaningful life.ConclusionThrough such narratives, health-care workers can identify treatment adherence related to grief and pain, and learn how people might regain their lives beyond using traditional interviews.

Six‐month outcomes of customized adherence enhancement (CAE) therapy in bipolar disorder

There are few psychosocial interventions specifically focused on improved treatment adherence in people with bipolar disorder (BD). Customized adherence enhancement (CAE) is a needs-based, manualized approach intended to improve medication adherence in individuals with BD. This was a six-month prospective trial of a CAE among 43 medication non-adherent individuals with BD who were receiving treatment in a community mental health clinic (CMHC). CAE was flexibly administered in modules applied as indicated by an initial adherence vulnerabilities screening. Screening identified reasons for non-adherence and modules were then administered using pre-set criteria. CAE effects were evaluated at six-week, three-month, and six-month follow-up. The six-month follow-up was our primary time point of interest. The primary outcome was change from baseline in adherence using the Tablets Routine Questionnaire (TRQ) and pill counts. Secondary outcomes included change from baseline in BD symptoms [Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS)]. Subjects completed 86% of scheduled sessions, with only two individuals (5%) not participating in any sessions. The number of dropouts at six months was 12 (28%). Mean baseline non-adherence by TRQ was 48% [standard error (SE) 4.8%] missed tablets within the previous week and 51% (4.1%) missed tablets within the previous month. At six-month follow-up, mean TRQ non-adherence improved to 25% (6.8%) missed tablets for the previous week (p = 0.002) and 21% (5.5%) for the previous month (p < 0.001). Symptoms improved, with a change in the baseline mean (SE) BPRS of 43.6 (1.8) versus an endpoint of 36.1 (2.3) (p = 0.001), and baseline mean (SE) HAM-D of 17.8 (1.1) versus an endpoint of 15.3 (1.6) (p = 0.044). CAE was associated with improvements in adherence, symptoms, and functional status. Controlled trials are needed to confirm these preliminary findings.

Non adherence factors to treatment of people with type 2 Diabetes Mellitus at home. Family caregiver’s view

Objective. To understand the non adherence factors to treatment of people with type 2 Diabetes Mellitus (DM2) from the family caregiver’s view. &#x0D; Methodology. Ethnographic study performed in 2008. 18 interviews to type 2 DM patient’s caregivers who be­longed to diabetes control programs from healthcare institutions of the city of Medellin (Colombia) were conducted. Six observa­tions of significant moments of care were also made. &#x0D; Results. Treatment adherence in people with type 2 DM is mediated by multiple factors that difficult it, as: Cultural beliefs of the disea­se, disagreement between healthcare professionals and popular knowledge, tiredness of taking that many medicines, fear of multiple punctures for insulin application, dis­satisfaction with healthcare services and the long term cost of the disease. &#x0D; Conclusion. From the family caregiver’s view, treatment adherence of people with type 2 DM is low as a consequence of multiple factors which influence it.

Do financial incentives increase treatment adherence in people with severe mental illness? A systematic review

To identify whether financial or material incentives improve treatment adherence in people with severe mental illness. A systematic review of studies published between 1950 and 2008 was conducted. EMBASE, MEDLINE, EBM, AMED and PsycINFO were searched. Studies were included if a financial or material incentive was offered and if the sample had a severe mental illness. Fourteen articles were identified; three studies on adherence to psychiatric treatment and one on physical exercise. Ten articles used incentives for adherence to substance misuse treatment programmes. In all studies, financial incentives were associated with an increase in adherence; however the effect was not always maintained once the incentive was withdrawn. While existing research suggests that financial incentives may improve treatment adherence in severely mentally ill populations, very few studies focus on psychiatric treatment. Further research may address the long term effectiveness of incentives on adherence in this population.

Unit-dose packaged drugs for treating malaria

Unit-dose packaging of antimalarial drugs may improve malaria cure by making it easier for patients to take their treatment correctly. To summarize the effects of unit-dose packaged treatment on cure and treatment adherence in people with uncomplicated malaria. We searched the Cochrane Infectious Diseases Group Specialized Register (November 2004), CENTRAL (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to November 2004), EMBASE (1980 to November 2004), LILACS (November 2004), conference proceedings, and reference lists of articles. We also contacted pharmaceutical companies, organizations, and researchers in the field. Randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs, and controlled before-and-after studies of unit-dose packaged drugs for treating uncomplicated malaria. We independently assessed study eligibility and methodological quality, and extracted data for an intention to treat analysis, where possible. We combined binary data using relative risk (RR) and the fixed-effect model, and presented them with 95% confidence intervals (CI). We attempted to contact study authors for additional information. Three quasi-RCTs (895 participants) and one cluster-RCT (6 health facilities) met the inclusion criteria. Trials were of poor methodological quality, and none adequately assessed treatment failure. Unit-dose packaged drugs (in conjunction with prescriber training and patient information) appeared to be associated with higher participant-reported treatment adherence in all trials.A meta-analysis of two trials (596 participants) showed that participant-reported treatment adherence was higher with blister-packed tablets compared with tablets in paper envelopes (RR 1.18, 1.12 to 1.25). Two trials using tablets in sectioned polythene bags as the intervention also noted an increase in participant-reported treatment adherence: the cluster-RCT (6 clusters) compared it with tablets in paper envelopes, and the other trial compared it with syrup in bottles (RR 2.15, 1.76 to 2.61; 299 participants). There is insufficient evidence to determine the effect of unit-dose packaged antimalarial drugs on treatment failure. Unit-dose packaging supported by prescriber training and patient information appears to improve participant-reported treatment adherence, but these data come from trials with methodological limitations.