Adherence and perceived barriers to oral antiviral therapy for chronic hepatitis B

Abstract

Background: Globally, of the 248 million people chronically infected with the hepatitis B virus (HBV), 74 million reside in China. Five oral nucleot(s)ide analogs (NUCs) have been approved for the treatment of chronic hepatitis B (CHB) in China. Objectives: The aims of this study were to determine rates of adherence to NUC therapy in patients with CHB, to identify the self-perceived barriers to adherence, and to examine the factors associated with adherence. Methods: Questionnaire-based interviews were administered among Chinese patients with CHB at hepatology clinics of a tertiary hospital in the city of Wuhan, China. Adults aged 18 years or older prescribed with NUCs were recruited and interviewed to complete a 27-item questionnaire in a private setting, and adherence was measured using the Morisky Medication Adherence Scale (MMAS-8). Results: Among 369 participants, only 16.5% had high adherence (score of 8), 32.2% had medium adherence (score of 6 to <8), and 51.2% were measured with low adherence (score of <6). A logistic regression model was used to determine the factors associated with medication adherence. Significant predictors of high adherence consisted of urban residency, non-cirrhotic status, not using prescribed pills other than HBV medications, and reminders from family members. The five most common reasons for skipping NUCs were that medication(s) are expensive (48.7%), forgetfulness (45.1%), have experienced or worry about potential side effects (19.8%), do not want others to know about my medication(s) usage (18.5%), and ran out of pills and do not have time to refill (15.9%). Conclusions: This study revealed that adherence rates to oral antiviral therapy were far from optimal. This finding should generate public attention, and it would be beneficial for interventional programs to target Chinese patients from rural regions, as well as patients with low socioeconomic status, cirrhosis, and taking multiple medications.

Factors for self‐management activities among rural patients with chronic hepatitis B: A cross‐sectional study

“…Patients with chronic diseases living in rural areas may have limited access to healthcare services. Previous studies found that knowledge about CHB was low in rural Chinese populations (Yang et al, 2017), and rural patients with CHB had lower medication adherence than urban ones (Xu & Liu, 2018). Self-management of CHB includes complicated tasks, which represents a difficult endeavour for rural patients.…”

“…Effective self‐management mostly depends on the patient's willingness and ability to undertake daily self‐management activities (Wu et al, ). Despite the importance of self‐management, patients with CHB in China were found to be less adherent to self‐management activities, such as low adherence of antiviral drugs, follow‐up visits, abstaining from alcohol and moderate exercise (Lin et al, ; Xu & Liu, ). Exploring factors that influence self‐management activities is important to promote their engagement in self‐management for patients with CHB.…”

S afety and adherence to the long-term treatment with nucleoside and nucleotide analogues in patients with chronic hepatitis B

“…Показано также, что приверженность к лечению, как правило, снижается при увеличении длительности терапии [36,37]. Среди других факторов, ассоциирующихся с приверженностью к терапии, выделяют уровень материального благополучия и образования пациента, количество других принимаемых лекарственных средств, степень взаимодействия врача и пациента [32,35,38,39]. В исследовании Peng и соавт.…”

“…В исследовании Xu и соавт. также показана высокая частота прекращения лечения (в 48,7% случаев) вследствие высокой стоимости препаратов [35]. Таким образом, можно предполагать, что повышение доступности лечения и применение более эффективных и безопасных препаратов будет сопровождаться увеличением показателя "сохранения на терапии" при длительном лечении АН у больных ХГВ.…”

Hepatitis B virus resistance to tenofovir: fact or fiction? A synthesis of the evidence to date

“…Two studies included in our review assessed treatment compliance by measuring drug concentration in plasma (16,41). Studies assessing treatment adherence in chronic HBV have also used questionnaire-based approaches (66)(67)(68), but these are subject to bias as self-. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”