The Use of Pill Counts as a Facilitator of Adherence with Antiretroviral Therapy in Resource Limited Settings

Achieng, Loice; Musangi, Helen; Billingsley, Katherine; Onguit, Sharon; Ombegoh, Edwin; Bryant, LeeAnn; Mwiindi, Jonathan; Smith, Nathaniel J.; Keiser, Philip

doi:10.1371/journal.pone.0067259

Cited by 20 publications

(21 citation statements)

References 15 publications

(19 reference statements)

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“…Thirteen studies described 12 interventions implemented in participants’ communities or homes [ 40 , 41 , 76 – 86 ]. These interventions included adherence support provided by lay health workers or volunteers, community- and facility-based adherence activities, home-based directly observed therapy (DOT) or adherence support by lay treatment supporters, and community-based social support.…”

Section: Resultsmentioning

confidence: 99%

Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature

et al. 2018

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IntroductionGlobally, an estimated 30% of new HIV infections occur among adolescents (15–24 years), most of whom reside in sub-Saharan Africa. Moreover, HIV-related mortality increased by 50% between 2005 and 2012 for adolescents 10–19 years while it decreased by 30% for all other age groups. Efforts to achieve and maintain optimal adherence to antiretroviral therapy are essential to ensuring viral suppression, good long-term health outcomes, and survival for young people. Evidence-based strategies to improve adherence among adolescents living with HIV are therefore a critical part of the response to the epidemic.MethodsWe conducted a systematic review of the peer-reviewed and grey literature published between 2010 and 2015 to identify interventions designed to improve antiretroviral adherence among adults and adolescents in low- and middle-income countries. We systematically searched PubMed, Web of Science, Popline, the AIDSFree Resource Library, and the USAID Development Experience Clearinghouse to identify relevant publications and used the NIH NHLBI Quality Assessment Tools to assess the quality and risk of bias of each study.Results and discussionWe identified 52 peer-reviewed journal articles describing 51 distinct interventions out of a total of 13,429 potentially relevant publications. Forty-three interventions were conducted among adults, six included adults and adolescents, and two were conducted among adolescents only. All studies were conducted in low- and middle-income countries, most of these (n = 32) in sub-Saharan Africa. Individual or group adherence counseling (n = 12), mobile health (mHealth) interventions (n = 13), and community- and home-based care (n = 12) were the most common types of interventions reported. Methodological challenges plagued many studies, limiting the strength of the available evidence. However, task shifting, community-based adherence support, mHealth platforms, and group adherence counseling emerged as strategies used in adult populations that show promise for adaptation and testing among adolescents.ConclusionsDespite the sizeable body of evidence for adults, few studies were high quality and no single intervention strategy stood out as definitively warranting adaptation for adolescents. Among adolescents, current evidence is both sparse and lacking in its quality. These findings highlight a pressing need to develop and test targeted intervention strategies to improve adherence among this high-priority population.

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Section: Resultsmentioning

confidence: 99%

Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature

et al. 2018

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“…At the same time, we must note that the medication adherence was assessed by pill counts in the current study population. It was possible that the repletion of the survey itself would become an intervention and affect medication adherence [ 17 ], although the influence was so far controversial [ 18 ]. Future prospective studies with a control arm will be needed to conclude that the readjustment would be a cause of the improvement of medication adherence.…”

Section: Discussionmentioning

confidence: 99%

Improved treatment satisfaction and medication adherence after readjusting oral medication regimens with the cooperation of health insurance pharmacy in type 2 diabetic patients in Japan

Ogawa¹,

Takahara²,

Shiraiwa³

et al. 2017

J Pharm Health Care Sci

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BackgroundTreatment satisfaction and medication adherence can be improved if physicians carefully monitor the situations, check the level of difficulties patients experience when taking medications at specific times, and readjust medication regimens based on this information. However, physicians in Japan encounter difficulties in taking enough time to collect this information in clinical practice. The aim of the current study was to investigate improvements in satisfaction and adherence with the cooperation of a health insurance pharmacy in clinical practice.MethodsWe retrospectively analyzed 29 type 2 diabetic outpatients who were receiving their prescriptions at a medical clinic and filling prescriptions at a nearby pharmacy. The pharmacy collected information regarding satisfaction, adherence, and preferred time of taking medications, and provided these data to the clinic. The oral medication regimens for these 29 patients were readjusted based on the information obtained.ResultsAfter readjustments, the dosing frequency was decreased from 3.4 ± 1.2 to 1.8 ± 0.5 times/day, and the number of pills was reduced from 5.7 ± 2.0 to 4.5 ± 1.7 (both p < 0.001). Increases in treatment satisfaction from 33 ± 12 to 44 ± 10 points (n = 29, p < 0.001) were observed when assessed using a questionnaire (60-point maximum). Medication adherence based on pill counts increased from 75% ± 22% to 91% ± 14% (n = 24, p < 0.001) (5 patients were excluded due to missing data).ConclusionsTreatment satisfaction and medication adherence were improved after readjustments of oral medication regimens with the cooperation of a health insurance pharmacy in clinical practice in Japan.

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“…As a self‐report study, there may be differences between patients’ actual behaviour or, for example, the information they had received, and those that they have reported in this study. Available objective adherence measures, for example electronic monitoring, pharmacy refill records, and pill count, could not be used to validate reported adherence because of the online survey nature of this study.…”

Section: Discussionmentioning

confidence: 99%

Glucocorticoid therapy for adrenal insufficiency: nonadherence, concerns and dissatisfaction with information

Chapman¹,

Llahana

Carroll

et al. 2016

Clinical Endocrinology

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Summary Objective Appropriate self‐management of glucocorticoid therapy (GC) is crucial for patients with adrenal insufficiency (AI). We aimed to describe patients’ self‐reported nonadherence to GC, evaluate perceived doubts about need for GC, concerns about adverse effects, and dissatisfaction with information received about GC. Design Cross‐sectional survey. Patients Patients prescribed GC for AI (n = 81) from five European countries. Measurements Online survey including the Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire© (BMQ Specific, adapted for AI) and Satisfaction with Information about Medicines Scale© (Prof Rob Horne; SIMS). Results Most patients (85·2%) reported a degree of nonadherence to GC. The most frequent types of nonadherence concerned changing the timing of GC doses, for example taking a dose later in the day than advised (37·0%). Few patients doubted their personal need for daily GC, but most reported high concerns about GC including potential weight gain (50·6%), osteoporosis (53·6%) and the continuing risk of adrenal crisis (50·6%). Dissatisfaction with information about GC was frequent, with participants particularly dissatisfied with the amount of information they had received about potential problems with GC. People who expressed dissatisfaction with information about GC, and concerns about its adverse effects were also more likely to report nonadherence (P < 0·05). Conclusions Nonadherence to treatment, concerns about potential adverse effects and dissatisfaction with the information provided about treatment were frequently reported by this European sample of AI patients. Many AI patients may need additional information about their GC and support to address concerns about GC and facilitate adherence.

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The Use of Pill Counts as a Facilitator of Adherence with Antiretroviral Therapy in Resource Limited Settings

Cited by 20 publications

References 15 publications

Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature

Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature

Improved treatment satisfaction and medication adherence after readjusting oral medication regimens with the cooperation of health insurance pharmacy in type 2 diabetic patients in Japan

Glucocorticoid therapy for adrenal insufficiency: nonadherence, concerns and dissatisfaction with information

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