Pharmacist-Involved Antiretroviral Stewardship Programs in People Living with HIV/AIDS: A Systematic Review

Ahmed, Aziza; Tanveer, Maria; Dujaili, Juman Abdulelah; Chuah, Lay Hong; Hashmi, Furqan Khurshid; Awaisu, Ahmed

doi:10.1089/apc.2022.0192

Cited by 6 publications

(3 citation statements)

References 83 publications

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Section: Discussionmentioning

confidence: 99%

“…Pharmacists are critical in examining complex multiple treatment regimens for inpatients, such as treatments for HIV and comorbidities and advising clinical teams on revising regimens to reduce drug-interactions and ADR-related admissions. 29 This study has important limitations. We assessed ADRs based on clinical judgment and were not able to do laboratory investigations, which could underreport the ADR-related hospital admissions.…”

Section: Therapeutic Advances In Drug Safetymentioning

confidence: 92%

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Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors

Asio,

Nasasira,

Kiguba

2023

Therapeutic Advances in Drug Safety

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Background: Adverse drug reactions (ADRs) contribute to the burden of disease globally and of particular concern are ADR-related hospital admissions. Objectives: This study sought to determine the burden, characteristics, contributing factors and patient outcomes of ADRs that were the primary diagnosis linked to hospital admission among inpatients in Uganda. Design: We conducted a cross-sectional secondary analysis of data from a prospective cohort study of adult inpatients aged 18 years and older at Uganda’s Mulago National Referral Hospital from November 2013 to April 2014. Methods: We reviewed clinical charts to identify inpatients with an ADR as one of the admitting diagnoses and, if so, whether or not the hospital admission was primarily attributed to the ADR. Logistic regression was used to determine factors associated with hospital admissions primarily attributed to ADRs. Results: Among 762 inpatients, 14% had ADRs at hospital admission and 7% were primarily hospitalized due to ADRs. A total of 235 ADRs occurred among all inpatients and 57% of the ADRs were the primary diagnosis linked to hospital admission. The majority of ADRs occurred in people living with HIV and were attributed to antiretroviral drugs. HIV infection [aOR (adjusted odds ratio) = 2.97, 95% confidence interval (CI): 1.30–6.77], use of antiretroviral therapy (aOR = 5.46, 95% CI: 2.56–11.68), self-medication (aOR = 2.27, 95% CI: 1.14–4.55) and higher number of drugs used (aOR = 1.13, 95% CI: 1.01–1.26) were independently associated with hospital admissions attributed to ADRs. Conclusion: Antiretroviral drugs were often implicated in ADR-related hospital admissions. HIV infection (whether managed by antiretroviral therapy or not), self-medication and high pill burden were associated with hospital admissions attributable to ADRs. The high HIV burden in Sub-Saharan Africa increases the risk of ADR-related hospitalization implying the need for emphasis on early detection, monitoring and appropriate management of ADRs associated with hospital admission in people living with HIV.

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Section: Discussionmentioning

confidence: 99%

Section: Therapeutic Advances In Drug Safetymentioning

confidence: 92%

Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors

Asio,

Nasasira,

Kiguba

2023

Therapeutic Advances in Drug Safety

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“…To improve medication adherence, a variety of interventions, including educational, behavioural, pharmaceutical care, smartphone-based reminders and psychosocial, as well as combinations of these, are used [ 16 – 21 ]. Furthermore, simplifying the complexity of the treatment regimen is likely to improve adherence [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models

Ahmed

Dujaili

Chuah

et al. 2023

Appl Health Econ Health Policy

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Background Although safe and effective anti-retrovirals (ARVs) are readily available, non-adherence to ARVs is highly prevalent among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA). Different adherence-improving interventions have been developed and examined through decision analytic model-based health technology assessments. This systematic review aimed to review and appraise the decision analytical economic models developed to assess ARV adherence-improvement interventions. Methods The review protocol was registered on PROSPERO (CRD42022270039), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant studies were identified through searches in six generic and specialized bibliographic databases, i.e. PubMed, Embase, NHS Economic Evaluation Database, PsycINFO, Health Economic Evaluations Database, tufts CEA registry and EconLit, from their inception to 23 October 2022. The cost-effectiveness of adherence interventions is represented by the incremental cost-effectiveness ratio (ICER). The quality of studies was assessed using the quality of the health economics studies (QHES) instrument. Data were narratively synthesized in the form of tables and texts. Due to the heterogeneity of the data, a permutation matrix was used for quantitative data synthesis rather than a meta-analysis. Results Fifteen studies, mostly conducted in North America (8/15 studies), were included in the review. The time horizon ranged from a year to a lifetime. Ten out of 15 studies used a micro-simulation, 4/15 studies employed Markov and 1/15 employed a dynamic model. The most commonly used interventions reported include technology based (5/15), nurse involved (2/15), directly observed therapy (2/15), case manager involved (1/15) and others that involved multi-component interventions (5/15). In 1/15 studies, interventions gained higher quality-adjusted life years (QALYs) with cost savings. The interventions in 14/15 studies were more effective but at a higher cost, and the overall ICER was well below the acceptable threshold mentioned in each study, indicating the interventions could potentially be implemented after careful interpretation. The studies were graded as high quality (13/15) or fair quality (2/15), with some methodological inconsistencies reported. Conclusion Counselling and smartphone-based interventions are cost-effective, and they have the potential to reduce the chronic adherence problem significantly. The quality of decision models can be improved by addressing inconsistencies in model selection, data inputs incorporated into models and uncertainty assessment methods. Supplementary Information The online version contains supplementary material available at 10.1007/s40258-023-00818-4.

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Antiretroviral Stewardship: Top 10 Questions Encountered by Stewardship Teams and Solutions to Optimize Therapy

Chang,

Guo,

Acbo

et al. 2024

Clinical Therapeutics

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Pharmacist-Involved Antiretroviral Stewardship Programs in People Living with HIV/AIDS: A Systematic Review

Cited by 6 publications

References 83 publications

Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors

Hospital admissions attributed to adverse drug reactions in tertiary care in Uganda: burden and contributing factors

Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models

Antiretroviral Stewardship: Top 10 Questions Encountered by Stewardship Teams and Solutions to Optimize Therapy

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