Factors influencing adherence to antiretroviral therapy from the experience of people living with HIV and their healthcare providers in Sierra Leone: a qualitative study.

BACKGROUND: Antiretroviral therapy (ART) is the primary mode of treatment for Human Immunodeficiency Virus (HIV). It slows disease progression and reduces the spread of infection. HIV treatment is also known to require a high level of adherence of over 90% to achieve good treatment outcomes and viral load suppression. In Sierra Leone, about 70% of People Living with HIV (PLHIV) are non-adherent in their first year of treatment. Understanding the reasons behind this high rate of non-adherence from the perspectives of both PLHIV and health workers is critical for developing strategies to improve adherence. This qualitative study is rooted in the field of public health services. It identifies the barriers and facilitators influencing adherence to antiretroviral treatment in Sierra Leone.  METHODS: A qualitative study design using in-depth interviews of four healthcare workers and 16 PLHIV in two districts in Sierra Leone- Freetown and Bo. The interviews were analyzed using a grounded theory approach to identify emerging themes from the data. RESULTS: The study identified several facilitators and barriers to ART adherence at the personal, community, and health system levels. The facilitators included perceived benefits of ART, family support, having an informal caregiver, receiving free ART medicines, and belonging to peer support groups. The identified barriers were stigma and discrimination, frequency of medication, use of traditional medicine, lack of money for food and transport, work barriers, inadequate medicines and test kits, limited health workers, and long distances to clinics. CONCLUSIONS: Our study emphasized the need for implementing behavioural change communication programmes and activities to reduce stigma and discrimination in the community. Knowledge of the facilitators and barriers to antiretroviral therapy could provide relevant information for more responsive and equitable programmes supporting adherence implementation in low- and middle-income countries. This study also identifies the vital need for community integration of HIV treatment services.

Community Pharmacists' Knowledge and Attitudes Towards Pediatric Pain Management in Nigeria.

PURPOSE: Community pharmacists (CPs) frequently attend to pediatric patients with pain but limited data exist regarding their knowledge of and attitude to effective management of pediatric pain in Nigeria. Thus, this study aimed to evaluate the knowledge of and attitude to pediatric pain management among CPs in Nigeria. PATIENTS AND METHODS: A validated and pilot-tested questionnaire, the Community Pharmacists Survey on Pediatric Pain, was administered to 517 eligible participants at the 38th Annual National Conference of the Association of Community Pharmacists of Nigeria. Independent samples t-test and one-way analysis of variance were used for inferential statistical analyses. RESULTS: CPs with additional higher academic qualifications and clinically related additional academic degrees had significantly higher mean knowledge scores relative to first degree only holder counterpart (t= 4.33, p< 0.05, Eta2=0.05) and those without clinically related second degrees (t= 6.34, p< 0.05, Eta2=0.27). Pain knowledge among the study cohort also varied significantly by age group, years of practicing community pharmacy, ownership structure of premises, geographical location of practice and previous exposure to pain management training (F(4370)=2.858, p=0.025, Eta2=0.03; F(3371)=3.985, p=0.008, Eta2=0.03; F(2372)=3.643, p=0.027, Eta2=0.02; F(5369)=4.497, p=0.01, Eta2=0.06; F(2372)=3.587, p=0.029, Eta2=0.02), respectively. CONCLUSION: Community pharmacists' knowledge of and attitude to pediatric pain management in Nigeria appeared sub-optimal, and requires regular targeted educational intervention to fill the identified gaps, improve service delivery and patient outcomes.

Antibiotics prescription pattern and determinants of utilization in the national health insurance scheme at a Tertiary Hospital in Nigeria.

BACKGROUND: Subsidizing the cost of medicines through insurance schemes increases consumption of medicines and may contribute to irrational use of antibiotics. OBJECTIVES: To describe the systemic antibiotics prescriptions patterns and analyze the determinants of their utilization in the National Health insurance Scheme (NHIS). METHODS: Established WHO guideline was followed to conduct this cross-sectional retrospective study at University of Nigeria Teaching Hospital, Nigeria. Data were collected from randomly sampled prescription sheets of one year duration. Logistic regression analysis was performed to determine the predictors of antibiotics prescriptions. RESULTS: The results are based on 802 sampled out-patients NHIS prescriptions. Average number of medicines per encounter was 4.0 ± 1.8, whereas 46.9% of antibiotics were prescribed by generic name. Penicillins (most frequently amoxicillin/clavulanate), and nitroimidazole (most frequently metronidazole) were the most commonly prescribed antibiotics with percentage share of 43.3% and 22.2%. Being <5 years old, and taking more than 4 medicines (OR 2.20, 95% CI 1.37-3.55) were the factors associated with the highest risk of antibiotics exposure. CONCLUSION: There were poly-pharmacy, and non-adherence to generic antibiotic prescriptions. Penicillins (amoxicillin/clavulanate) were the most commonly prescribed antibiotic class. Being < 5 years old, and taking more than 4 medicines were significant predictors of antibiotics exposure.

Prescribing of antidiabetic medicines to older diabetes type 2 patients in Lagos, Nigeria.

BACKGROUND: The incidence of diabetes mellitus in older adults is increasing in Lagos and other parts of Nigeria but there is paucity of information on the use of medicines in this group of patients. OBJECTIVE: A survey was therefore carried out to determine the prevalence of potentially inappropriate prescribing of antidiabetic medications to older diabetes adults in Lagos, Nigeria. METHODS: A convenient sample of physicians working in seven health care facilities in Lagos were surveyed using a self-administered pre-tested questionnaire to determine the medications they often prescribed for diabetes patients older than 50 years, whether they consider dosage reduction in these patients, and the counselling information they provide to the patients. AGS 2012 Beer's criteria were used to determine potentially inappropriate medication (PIM) for the patients. Factors associated with the tendency to prescribe inappropriately were then evaluated using logistic regression analyses. RESULTS: Glibenclamide, metformin, and metformin/glimepiride combination were regularly prescribed by 45.64-87.25% of the physicians but gliclazide, pioglitazone, pioglitazone/metformin and pioglitazone/glimepiride combinations were prescribed occasionally by 41.61-61.74% of them. Majority of the physicians (87.25%) prescribe glibenclamide to the older patients and do not also always consider dosage reduction on account of older age. Some of these (30.2%) of these physicians equally prescribed chlorpropamide to the patients. Postgraduate qualification was the only significant factor associated with prescription of chlorpropamide (p < 0.05). CONCLUSION: Inappropriate use of chlorpropamide and glibenclamide, and failure to consider dosage reduction on account of older age have been reported by physicians treating older diabetes patients in Lagos. This calls for continuous education of physicians in Lagos as well as in other parts of Nigeria to promote rational use of antidiabetic medications in the country.

Pharmacist's intervention in the control of blood sugar levels in randomised diabetes patients at a primary health care setting in Benin City.

BACKGROUND: The extended roles of pharmacists in Nigeria in the improvement of quality of health care at the primary health care (PHC) level is currently poorly executed even though pharmacists have been proven to be involved in interventional activities in health care delivery. OBJECTIVE: To evaluate pharmacists' intervention in the control of blood sugar levels of diabetes patients in a PHC setting in Benin City, Nigeria. METHODS: At baseline, the fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), body mass index (BMI) and blood pressure (BP) of randomly selected 170 diabetic patients in a primary health care centre were evaluated. This was followed-up with intervention by the pharmacists through counselling on lifestyle modification, self-medication and drug adherence on monthly basis for three consecutive months after which the FBS, HbA1c, BMI and BP were re-evaluated. RESULTS: indicated significant reduction in BMI, HbA1c and FBS from 27.1 +/- 4.2 kg/m2, 8.1 +/- 3.0% and 10.0 +/- 4.2 mmol/l to 23.5 +/- 3.5 kg/m2, 7.1 +/- 1.8% and 8.5 +/- 2.1 mmol/l, respectively (p < 0.001) was observed following the intervention by the pharmacists. CONCLUSION: Direct involvement of pharmacists in the care of diabetic patients in PHC settings can significantly improve the quality of life provided to these patients and hence reduce mortality resulting from the disease. Recruitment of reasonable number of pharmacists should always be considered in health policies for PHC settings in developing countries.

Irrational prescribing of calcium channel blockers for the elderly in health facilities: a qualitative study in four hospitals in Benin City, Nigeria.

BACKGROUND: Calcium channel blockers (CCBs) can further depress a failing heart and are not recommended for elderly patients with systolic heart failure (HF). OBJECTIVE: This study conducted in four hospitals in Benin City was undertaken to evaluate rational prescribing of CCBs in hypertensive elderly outpatients. METHODS: Self-administered questionnaire was administered to 161 medical doctors to detect the proportion of physicians who prescribe CCBs to elderly outpatients with systolic HF with or without evaluating the heart status and/or counseling them on the possibility of recognizing the dangerous effect on heart while taking the CCBs. The association between inappropriate prescription of CCBs and sociodemographic variables was determined using logistic regression analysis. RESULTS: Majority (98.7%) of the 150 respondents reported ever treating hypertension in 48.5 +/- 42.3 (range: 2-250) elderly outpatients per month with most evaluating the patients' heart status. CCBs (nifedipine and amlodipine) were often prescribed for systolic HF for the elderly by 34.3% of participants but only 4.7% of them properly counseled the patients. Area of specialization (odds ratio = 1.076), hospital where the doctors worked (OD = 1.080) and status of the doctors were good predictors of CCBs prescription in systolic HF. CONCLUSION: It is concluded that irrational prescribing of CCBs for elderly outpatients is common in the four hospitals studied. This calls for appropriate educational intervention that will improve the knowledge of physicians in Benin City in rational prescribing of drugs for the elderly.