Study on covert administration of medications practices among persons with severe mental illness: A cross-sectional study

Background: Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a commonly observed medication delivery practice in India. Aims: This study aims to examine different medication delivery practices adopted by caregivers to provide care to SMI at times of medication refusal. Method: This study was conducted at the outpatient department between April 2019 and November 2019. A semi-structured questionnaire was used to interview the caregivers of persons with SMI to assess medication delivery practices. Results: A total of 300 caregivers were interviewed. CoAdM was practiced in 96 (32.0%) persons with SMI at least once during their lifetime, and other strategies used were pleading ( n = 105, 35.0%), lying ( n = 10, 3.3%), and threatening ( n = 154, 51.4%). Logistic regression showed that male gender (OR 4.75; CI 1.37–16.46), absent insight (OR 10.0; CI 2.01–47.56), and poor adherence to medication (OR 4.75; CI 1.31–16.92) were significantly associated with CoAdM in the last 1 year. Caregivers perceived significant improvement in self-care ( Z = −4.37, p < .01), interpersonal ( Z = −7.61, p < .01), work ( Z = −5.9, p < .01), family functioning ( Z = −7.82, p < .01) difficult behavior ( Z = −8.27, p < .01), and dependency ( Z = −6.34, p < .01) in persons with SMI with use of CoAdM. Conclusions: CoAdM was given to one in three persons with SMI at some point in their lives. Male gender, absent insight and poor adherence were predictive of CoAdM in the last 1 year. Caregiver perceived improvements in self-care, work, interpersonal, family functioning, problem behaviors, and dependency after CoAdM. Policies need to be evolved to serve all stakeholders while keeping these practices in mind.

Factors Associated with Adherence to Antiretroviral Drugs among HIV Positive Patients Attending Selected Comprehensive Care Centers in Semi-Urban, Kenya

Management of Human Immunodeficiency Virus (HIV) is multipronged but its nerve centre is lifelong adequate and consistent use of antiretroviral drugs (ARVs). The overall objective of this study was to determine the factors associated with adherence to antiretroviral drugs among HIV positive patients attending selected Comprehensive Care Centres (CCC) in Kibwezi West Sub-county, Makueni County, Kenya. 385 respondents were recruited by systematic random sampling and interviewed. Three Focused Group Discussions (FGD) and two Key Informant Interviews (KII) were also conducted. Majority 364(94.5%) of the respondents were adherent to ARVs. There was a significant association between adherence to ARVs and gender {χ 2 (1) =4.636, p<0.05} with males likely to have poor adherence {OR 0.174 (95%CI 0.130, 0.233)}. Age was significantly associated with adherence {Likelihood Ratio G2 (4) =10.693, p<0.05} with older ages (above 65 years) likely to adhere. Living in the same house with someone on ARVs was significantly associated with adherence to ARVs {χ 2 (1) =3.997 p=<0.05} with respondents living in the same house with someone on ARVs likely to adhere {OR 0.144 (95%CI 0.103, 0.200)}. Majority of the respondents had adequate knowledge and positive attitude towards adherence to ARVs. FGDs and KIIs identified fear, stigma, not believing in oneself, participating in activities that hamper adherence such as drinking alcohol, ignorance, denial, lack of social support, busy work schedule poor attitude by health service providers, drug stock outs, distance and long waiting time as contributing to poor adherence to ARVs. In conclusion, constant education and awareness creation on importance of adherence to ARVs should be strengthened particularly during clinic appointments to maintain knowledge and enhance positive attitude towards adherence. Measures to improve adherence among the male and younger population should be strengthened. Key words: adherence, antiretrovirals age, gender, knowledge, attitude.

A model to predict adherence to antiretroviral therapy among people living with HIV

ObjectivesSuboptimal adherence to antiretroviral therapy (ART) dramatically hampers the achievement of the UNAIDS HIV treatment targets. This study aimed to develop a theory-informed predictive model for ART adherence based on data from Chinese.MethodsA cross-sectional study was conducted in Shenzhen, China, in December 2020. Participants were recruited through snowball sampling, completing a survey that included sociodemographic characteristics, HIV clinical information, Information-Motivation-Behavioural Skills (IMB) constructs and adherence to ART. CD4 counts and HIV viral load were extracted from medical records. A model to predict ART adherence was developed from a multivariable logistic regression with significant predictors selected by Least Absolute Shrinkage and Selection Operator (LASSO) regression. To evaluate the performance of the model, we tested the discriminatory capacity using the concordance index (C-index) and calibration accuracy using the Hosmer and Lemeshow test.ResultsThe average age of the 651 people living with HIV (PLHIV) in the training group was 34.1±8.4 years, with 20.1% reporting suboptimal adherence. The mean age of the 276 PLHIV in the validation group was 33.9±8.2 years, and the prevalence of poor adherence was 22.1%. The suboptimal adherence model incorporates five predictors: education level, alcohol use, side effects, objective abilities and self-efficacy. Constructed by those predictors, the model showed a C-index of 0.739 (95% CI 0.703 to 0.772) in internal validation, which was confirmed be 0.717 via bootstrapping validation and remained modest in temporal validation (C-index 0.676). The calibration capacity was acceptable both in the training and in the validation groups (p>0.05).ConclusionsOur model accurately estimates ART adherence behaviours. The prediction tool can help identify individuals at greater risk for poor adherence and guide tailored interventions to optimise adherence.

ASSOCIATION OF DIETARY AND LIFESTYLE FACTORS ON BLOOD PRESSURE CONTROL AMONG ADULT HYPERTENSIVE PATIENTS ATTENDING A UGANDAN TERTIARY HOSPITAL

Hypertension is an important worldwide public-health challenge due to its high prevalence and being a risk factor for cerebrovascular, cardiovascular, and chronic renal diseases. Despite these risk factors, blood pressure control among hypertensive patients is still poor. The main objective was to assess dietary and lifestyle factors associated with uncontrolled blood pressure control among Ugandan hypertensive patients at Kiruddu hospital. Materials and methods: A cross-sectional study involving 271 adult hypertensive patients attending the outpatient hypertensive clinic was enrolled. Data were obtained on dietary, lifestyle factors (alcohol intake, smoking status, and level of physical activity), social demographics, Body Mass Index (BMI), comorbidities, and adherence to hypertensive medication. An average of the current and previous two Blood pressure readings was recorded. Factors associated with uncontrolled blood pressure were assessed using a multivariate logistic regression model. Results: The mean age of study participants was 57 ± 0.76 years, with female dominance (77.9%). Among the study participants, 121 (44.7%) had uncontrolled BP. Dietary factors that were associated with uncontrolled blood pressure with adjusted OR (95%CI) included consumption of raw salt: 4.18 (1.32-13.24) and inadequate fruit consumption: 2.18 (1.26-3.75) while clinical factors included being overweight: 2.51 (1.27-4.95) and poor adherence to antihypertensive medications prescribed: 1.82 (1.03-3.21). Conclusion: The proportion of hypertensive patients with uncontrolled Blood Pressure was high (44.7%). Consumption of raw salt, inadequate fruit consumption, being overweight and poor adherence to antihypertensive medication were significantly associated with uncontrolled BP. From these findings, factors that were associated with the control of blood pressure are modifiable.

Antibiotic overuse in obstetric and gynecologic procedures at Zagazig university hospitals: A prospective observational study

Surgical site infection (SSI) constitutes a major problem in healthcare in terms of healthcare cost, morbidity and mortality. Surgical antibiotic prophylaxis (SAP) is one of the effective strategies for SSI prevention. Poor adherence to SAP guidelines across different countries has been observed. Misuse of prophylactic antibiotics threatens patient safety and leads to an increase in the acquisition of antibiotic resistance. The aim of this study was to assess the utilization of SAP in obstetric and gynecologic procedures in terms of indication for prophylaxis, antibiotic selection, timing of administration and prophylaxis duration. A prospective observational study was conducted at the obstetrics and gynecology department of Zagazig University Hospital during the period from January 2020 to June 2020. Medical records of 264 women were recorded and evaluated. The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines, World Health Organization (WHO) recommendations and The American College of Obstetricians and Gynecologists (ACOG) practice bulletin were used for data evaluation and hence women were stratified into two groups. For women who underwent procedures in which guidelines recommended the use of SAP (200 patients; 75.75%), 198 women (99%) received preoperative prophylaxis. None of women (0%) received the recommended first line antibiotic by guidelines while the most commonly used prophylactic antibiotics were Cefotaxime (86 patients; 43.43%) and Ampicillin-sulbactam (62 patients; 31.31%). Preoperative antibiotic prophylaxis timing was 0-60 minutes before skin incision. All women received postoperative prophylaxis that extended to an average of 7 days. Regarding the other group who underwent procedures in which prophylactic antibiotics weren’t recommended by guidelines (64 patients; 24.24%), 37 women (57.81%) followed the guidelines and didn’t receive SAP while 27 women (42.18%) received SAP. Poor adherence to guidelines recommendations regarding prophylactic antibiotic selection and prophylaxis duration was observed. High utilization rate of prophylactic antibiotics in procedures that didn’t require their use was reported..

Factors associated with antiretroviral therapy adherence among people living with HIV in Haiti: a cross-sectional study

Background Socioeconomic, demographic and clinical factors can affect adherence to treatment among people living with HIV (PLH) and potentially have an impact on their prognosis and survival. The main objective of this study was to assess these factors as potential barriers to adherence among patients receiving care in central Haiti. Methods A cross-sectional study was conducted among PLH receiving antiretroviral therapy (ART) at the TB/HIV clinic at St. Therese Hospital in Hinche, Haiti. A total of 426 potential participants were approached during their follow-up visits from June to August 2019, of whom 411 participated in the study. After giving informed consent, study participants completed a structured interview that included the Self-Report Item Scale (SRIS), a standard measure, to assess adherence. Socio-demographic, economic and clinical factors were assessed for their association with adherence. Results The 411 participating patients represented 39% of the patient population at the TB/HIV clinic during the timeframe of the study. The mean age was 43.7 years (range: 19–80), 65.5% were female and 78.1% had only achieved a primary level of schooling. Nearly 78% had received ART for less than 10 years, 3.41% reported having poor adherence and 28% less than excellent adherence. Factors related to poor adherence in bivariate analysis were age less than 40 years (OR: 6.32, 95% CI 2.04–10.58, p < 0.01) and inability to meet basic needs (OR: 2.70, 95% CI 1.04–7.0, p = 0.03). Conclusions To improve medication adherence, the hospital should strengthen patient counselling of younger recipients of ART and provide financial assistance and other social service interventions. Studies should be implemented in other HIV management centers in Haiti and similar contexts to examine barriers to ART adherence with the goal of improving prognosis and survival in the long-term among PLH in resource-limited setting.

902. Unreturned Pill Bottles in the 1489 and 1490 Clinical Trials: An Important Measure of Poor Adherence that Is Often Ignored in Pill Count Calculations

Background Adherence to antiretroviral therapy is important for HIV suppression. In clinical trials, adherence is commonly measured by pill count; limitations are that unreturned pills may not have been taken and unreturned pill bottle data are omitted. This analysis focuses on the relationship between unreturned pill bottles as a measure of poor adherence and the overall effect on virologic success rates across all treatment groups. Methods Pill bottle return category (all bottles returned or ≥1 bottle unreturned) and return rates for participants across all treatment groups from two treatment-naïve INSTI clinical trials (Studies 1489 and 1490) were calculated. Association of bottle return category or rates with virologic events through week 144, including last on-treatment observation carried forward (LOCF) outcome, was determined; comparisons used Fisher’s exact or Wilcoxon rank sum test. Results Virologic suppression with ≥95% adherence by pill count can differ for those with unreturned pill bottles (Figure). In these studies, 60% of participants returned all their pill bottles through week 144; if one visit with ≥1 unreturned bottle was allowed, this percentage increased to 81%. The mean bottle return rate was 94% and did not differ by study, treatment arm, or sex. Failure to return pill bottles was significantly associated with lower suppression rates. Additionally, significant differences in pill bottle return rate (p &lt; 0.01) were observed by week 144 LOCF outcome (95% vs 77% mean return rate for those with HIV RNA &lt; 50 c/mL vs ≥50 c/mL), need for resistance testing (95% vs 77% return rate for those not tested vs tested), confirmed virologic failure (VF) (94% vs 90% return rate for those without VF vs with VF) and blip status (95% vs 92% return rate for those without blips vs with blips). HIV-1 Viral Loads of Two Participants with ≥95% Adherence by Pill Count through Week 144 Conclusion In these treatment-naïve INSTI clinical trials, failure to return pill bottles was associated with lower suppression rates. Although the calculated adherence rates in these studies was relatively high (median ≥95%), these calculations did not account for unreturned pill bottles. We believe that assessing adherence by both pill count and pill bottle return rate may provide a more complete picture of adherence in clinical trials. Disclosures Rima K. Acosta, BS, Gilead Sciences, Inc. (Employee, Shareholder) Grace Q. Chen, BS, Gilead Sciences, Inc. (Employee) Hailin Huang, PhD, Gilead Sciences, Inc. (Employee, Shareholder) Hui Liu, PhD, Gilead Sciences, Inc. (Employee, Shareholder) Kirsten L. White, PhD, Gilead Sciences, Inc (Employee, Shareholder)