Comparative incidence of adverse drug reaction during the first and subsequent year of antiretroviral therapy in a Nigerian HIV infected Cohort.

BACKGROUND: Despite close to two decades of antiretroviral therapy (ART) in Nigeria, data on late on-onset ART-associated adverse drug reactions (ADRs) are sparse. OBJECTIVES: To describe early and late-onset ADRs and compare their incidence in an outpatient HIV positive Cohort on ART. METHOD: We described the incidence of clinical ADRs identified and documented in an outpatient clinic cohort of HIV-positive patients treated between June 2004 and December 2015 at a tertiary health facility in Nigeria. Incidence rates of ADRs during the first and subsequent years of ART were compared. RESULTS: of the 13,983 patients' data analyzed, 9317 were females (66%), and those in the age bracket of 25 to 45 years made up 78% of the studied population. During 52,411 person-years (py) of ART, 1485 incident ADRs were recorded; Incidence rate (IR) 28.3 (95% confidence interval [CI] 26.9:29.8) ADRs per 1000 person-years (py) of ART. The IR of ADRs was about two times higher in the first year of ART compared to subsequent years of treatment; crude incidence rate ratio (IRR) 1.77 (95% CI 1.59:1.97). Anemia, hypersensitivity reactions, and nervous system disorders had 7, 23, and 5 times higher incidence, respectively, in the first year of therapy, compared to subsequent years. CONCLUSION: The first year of ART is the period of highest risk of ADRs. Individual and programmatic treatment success in resource-limited settings requires strategies for early identification and management of ADR during the period of greatest risk of ADRs.

Pharmaceutical care and medication adherence in management of psychosis in a Nigerian tertiary hospital.

OBJECTIVE: The primary objective of this study is to examine the medication adherence levels (as a function of pharmaceutical care) and its contributing factors in schizophrenic patients receiving antipsychotic drugs. METHODS: This was a cross-sectional study administering a structured questionnaire to 231 patients. Adherence was measured through patient self-reporting. Association between independent variables and adherence to antipsychotics were measured through odds ratios (OR) in the univariate analysis while the best predictors of adherence were determined through the multiple logistic regressions. FINDINGS: Adherence level was found to be 65.8% (95% confidence interval [CI]: 59.3-71.9%). The following factors were identified to be associated with adherence in the univariate analysis: age (OR 1.088), sex (OR 1.231), employment (OR 0.366), marital status (singles, OR 0.022), drug adherence counseling (OR 11.641), twice a day frequency (OR 8.434), alcohol non-intake (OR 1.469), educational level (primary OR 1.9312, secondary OR 11.022, tertiary OR 4.771), occupation (public servant 6.273). In the multivariate analysis, age, three times a day frequency of drug intake, singles and educational levels such as primary, secondary or tertiary school, strongly affected adherence (P < 0.05). CONCLUSION: Although patients adherence level was high (65.8%), there is a need to emphasize that pharmacists spend more time in counseling and educating patients, especially younger ones on drug adherence before any antipsychotic medications are dispensed. Furthermore, patients should be taught the use of adherence devices such as reminders so that adherence to antipsychotic medications can be optimized.