Clinical Utility of Pharmacy-Based Adherence Measurement in Predicting Virologic Outcomes in an Adult HIV-Infected Cohort in Jos, North Central Nigeria

Abah, Isaac Okoh; Ojeh, Victor B; Musa, Jonah; Ugoagwu, Placid; Agaba, Patricia A; Agbaji, Oche; Okonkwo, Prosper

doi:10.1177/2325957414539197

Cited by 17 publications

(12 citation statements)

References 31 publications

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“…The methods used to assess adherence in our studies were previously validated and shown to reliably measure ART adherence in other studies [ 7 , 21 – 23 ]. In fact, it has been shown that regular attendance to pharmacy refills and clinic visit appointments is associated with retention in care and better adherence to ART [ 36 ], predicts viral suppression, and that sub-optimal attendance predicts virologic failure [ 9 , 10 , 21 , 23 , 37 ] and drug resistance [ 15 ]. In our study, a subject was considered non-adherent for a refill if he/she had missed pharmacy refill for over 48 hours.…”

Section: Discussionmentioning

confidence: 99%

“…The adult AIDS Clinical Trial Group (ACTG) adherence questionnaire [ 16 ] was translated into French and validated through back-translation [ 17 ]. This ART adherence questionnaire has been validated in population studies in both developed [ 18 – 20 ] and resources limited countries [ 20 – 23 ], and we previously adapted and validated this French version of the ACTG questionnaire in Cameroon [ 17 ]. This questionnaire was administered to each subject by a physician (JYF) in a face-to-face interview, and the same physician recorded all interview results.…”

Section: Methodsmentioning

confidence: 99%

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Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects

et al. 2017

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Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (p<0.05). Univariate logistic regression analysis demonstrated that subjects with opportunistic infections (on antibiotics) had 2.42-times higher odds of having been non-adherent (p<0.001). Multivariable analysis controlling for ART regimen, age, gender, and education showed that subjects with opportunistic infections had 3.1-times higher odds of having been non-adherent (p<0.0003), with significantly longer periods of non-adherence, compared to subjects without opportunistic infections (p = 0.02). We further showed that compared to younger subjects (≤40 years), older subjects (>40 years) were less likely to be non-adherent (p<0.01) and had shorter non-adherent periods (p<0.0001). The presence of depression symptoms correlated with non-adherence to ART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p = 0.04) and longer non-adherent periods (p = 0.04). Change in ART regimen was significantly associated with increased likelihood of non-adherence and increased duration of the non-adherence period. Addressing these underlying risk factors could improve ART adherence, retention in care and treatment outcomes for HIV/AIDS patients in Cameroon.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects

et al. 2017

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“…Patients who were less than 95% consistent in their drug refill were considered non adherent to therapy, while those who were 95% and above consistent in drug refill were classified as adherent. 14 A research specific pharmacy intervention documentation form adapted from literature 15 was used for documentation of intervention carried out at each patient pharmacy visit. The form also captured information on patient demographics, actions taken, recommendations made, acceptance rate of recommendations, time taken for intervention and perceived patient benefits.…”

Section: Methodsmentioning

confidence: 99%

Pattern of drug therapy problems and interventions in ambulatory patients receiving antiretroviral therapy in Nigeria

Ojeh

Nasir

Abah

et al. 2015

Pharm Pract (Granada)

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*Objectives: We describe the frequency and types of drug therapy problems (DTPs), and interventions carried out to resolve them, among a cohort of HIV-infected patients on ART in Jos, Nigeria. Methods: A prospective pharmacists' intervention study was conducted between January and August 2012 at the outpatient HIV clinic of the Jos University Teaching Hospital (JUTH). Pharmacists identified DTPs and made recommendations to resolve them. The main outcome measures were number of DTPs encountered, interventions proposed and acceptance rate of recommendations. Results: A total of 42,416 prescriptions were dispensed to 9339 patients during the eight months study. A total of 420 interventions (Intervention rate of 1 per 100 prescriptions) were made to resolve DTPs in 401 (4.3%) patients with a mean age of 41 (SD=10) years, and made up of 73% females. DTPs encountered were drug omission (n=89, 21.2%), unnecessary drug (n=55, 13.1%) and wrong drug indication (n=55, 13.1%). Recommendations offered included; Addition of another drug to the therapy (n=87, 20.7%), rectification of incomplete prescriptions (n=85, 20.2%), change of drug or dosage (n=67, 16.0%), and discontinuation of the offending drug (n=59, 14.0%). A total of 389 (93%) out of 420 of the recommendations were accepted. In all, 50.4% (212) of the problematic prescriptions were changed and dispensed, 22.2% (89) were clarified and dispensed, while wrong identities were corrected in 11.7% (49). However, 7.5% (30) (21) were not dispensed, and 3% (12) were unresolved. Conclusion: Our findings suggest that pharmacistsinitiated interventions can ameliorate DTPs in patients receiving ART given the high intervention acceptance rate recorded. The implication of this finding is that pharmacists with requisite training in HIV pharmacotherapy are an excellent resource in detecting and minimizing the effect of antiretroviral drug-related errors.

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“…[19] Although, our analysis did not adjust for the biological variables like CD4+ cell count or HIV viral load, we know that most of the HIV infected women in our sample have been on successful antiretroviral therapy supported by the Presidential Emergency Plan For AIDS Relieve (PEPFAR) adult HIV treatment program in Jos. [20][21][22][23] This assumption is supported by follow-up data in a US population that did not nd a signi cant difference in incident cervical dysplasia and cancer in HIV population on successful HAART. [24,25] Also, recent data from the United Nations on AIDS (UNAIDS) showed that over 80% of HIV infected adults on antiretroviral treatment in Nigeria had HIV viral loads that were suppressed.…”

Section: Discussionmentioning

confidence: 93%

HIV and Development of Epithelial Cell Abnormalities in women with prior normal cervical cytology in Nigeria

Musa

Mehta

Achenbach³

et al. 2020

Preprint

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Background HIV-associated cellular immune dysfunction has been linked to higher risk of cervical dysplasia and cancer in HIV infected women. We sought to understand the relationship between HIV and development of epithelial cell abnormalities (ECA) at follow-up in women with prior normal cervical cytology (NCC).Methods Retrospective cohort analysis of women who received a Pap test at the Operation Stop Cervical Cancer Unit in Jos, Nigeria over a 10-year period (2006-2016). We analyzed the data of women with NCC at first Pap who had at least one follow-up cytology result for time-to-detection of ECA. We determined follow-up time in years from date of first NCC to date of first ECA report or date of last NCC follow up report with censoring at last follow-up date or December 31st, 2016 whichever came first. The primary outcome was development of any ECA as defined by the Bethesda 2001 reporting system. We identified demographic and clinical factors associated with incident ECA using multivariable Cox regression. Results A total of 1,599 women were eligible for this analysis. Overall, 3.7% (57/1,556) of women reported being HIV infected. The median age at first Pap was 39 years (IQR; 33-45). The HIV infected women were younger (36.3 ± 8.1) compared to those uninfected (39.3 ± 6.6), p=0.005. After an accrued follow-up time of 3,809 person-years (PYs), 243 women (15%) had an ECA with an event rate of 6.38 per 100 PYs. Women ≥35 years at first Pap were more likely to have an ECA compared to those <35 years (7.5 per 100 PYs vs 3.8 per 100 PYs, HR=1.96; 95% CI: 1.4, 2.8). HIV status was not significantly associated with developing ECA in either unadjusted (7.4 per 100 PYs vs 6.4 per 100 PYs, HR=1.17; 95% CI: 0.53, 2.3) or adjusted analyses (aHR=1.78; 95% CI: 0.87, 3.65).Conclusion Women living with HIV and on successful antiretroviral treatment may not have a differential hazard in the development of ECA during follow up after a prior normal Pap. Offering a repeat CCS to women who are 35 years or older irrespective of HIV status is likely an effective strategy in resource limited settings.

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Clinical Utility of Pharmacy-Based Adherence Measurement in Predicting Virologic Outcomes in an Adult HIV-Infected Cohort in Jos, North Central Nigeria

Abstract: Adherence to drug refill is a useful predictor of successful virologic control and could be utilized for routine monitoring of adherence to cART in our clinical setting.

Cited by 17 publications

References 31 publications

Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects

Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects

Pattern of drug therapy problems and interventions in ambulatory patients receiving antiretroviral therapy in Nigeria

HIV and Development of Epithelial Cell Abnormalities in women with prior normal cervical cytology in Nigeria

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