Barriers and facilitators of adherence to antiretroviral treatment at a public health facility in Ghana: a mixed method study.

BACKGROUND: HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness toward viral suppression leading to disease progression, greater risk of death, and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups. METHOD: A mixed method approach was used comprising a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analyzed using bivariate and multivariate methods while qualitative data were analyzed using thematic framework approach. RESULTS: Adherence levels were found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR = 0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times, and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. Conclusion: Adherence to ART among patients living with HIV was suboptimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.

Socio-demographic factors modify awareness, knowledge, and perceived risk of glaucoma in rural and urban residents in Ghana: a population-based survey.

PURPOSE: To evaluate the awareness, knowledge and the perception of risks of glaucoma among rural and urban dwellers in Ghana, a high prevalent country, in order to provide information for health promotion planning. METHOD: In a population-based descriptive cross-sectional survey, 1200 adults were selected from household settings, using a two-stage cluster and simple systematic random sampling. Quantitative data collection, using interviewer-administered questionnaire, was employed. Descriptive statistics were performed using chi-square, ordinal univariate, multinomial and multivariate logistic regression models used to calculate odds ratio with 95% confidence interval (CI) to identify predictive factors. RESULTS: Overall, only 326 (27.2%, 95% CI = 24.6-29.7) indicated they were aware of glaucoma, whereas 331 (27.6%, 95% CI = 24.6-29.7) had ever undergone an eye screening. Low knowledge was demonstrated in 152 (46.6%, 95% CI = 41.2-52.0) and high knowledge in 99 (30.4%, 95% CI = 25.4-35.4) glaucoma-aware participants. Only 238 (19.8%, 95% CI = 17.6-22.1) of respondents presumed themselves to be at risk of developing glaucoma. Having eye examination (within the last 6 months) was positively associated with knowledge (adjusted odds ratio (AOR) = 1.413; 95% CI = 0.9-1.896) and awareness (AOR = 1.13; 95% CI = 0.938-2.449). Three levels of education (no education (AOR = 0.041; 95% CI = 0.016-0.11), primary (AOR = 0.057; 95% CI = 0.018-0.179), and middle school (AOR = 0.254; 95% CI = 0.127-0.51)) were associated with low knowledge while all levels of education were inversely associated with awareness. Perceived risk of glaucoma was also influenced by area of residence (rural (AOR = 0.344; 95% CI = 0.21-0.57)), being young (18-24 years (AOR = 4.308; 95% CI = 2.36-7.88)) and having previously undergone screening for glaucoma (AOR = 13.200; 95% CI = 5.318-32.764). CONCLUSION: The main modifiers of glaucoma awareness and knowledge were education and previous eye examination, but awareness had additional factor of area of residence. Perceived risk of glaucoma was influenced by being young and living in urban areas.

Impact of Cost on the Safety of Cancer Pharmaceuticals.

Cancer care drug costs are rising due to a variety of factors, and safety concerns account for some of the cost. At the same time, clinical and economic concerns drive drug safety improvements. This chapter examines pressures on drug costs due to the complexity of care and drug therapies, marked structure in which care is provided, and regulatory requirements driving safety.

Safety of Cancer Therapies: At What Cost?

The cost of cancer drugs has increased concurrently with drug safety resulting in both increased survivorship and increased out-of-pocket costs and co-payments for patients. This article evaluates the interplay between patient safety and cancer drug costs to determine how cancer drug costs affect patient safety and well-being. A literature review was performed that identified the main drivers of drug safety costs: drug-drug interactions, adverse drug events, medication errors, and nonadherence. Three main types of costs were identified: out-of-pocket spending, drug cost growth, and safety-related costs. Insured patients receiving chemotherapy pay an average of $10,000/month on out-of-pocket expenses. Annual drug cost growth has been as much as 21% in recent years. Over a span of 13 years, 1999-2013, insurance premiums and out-of-pocket payments have increased by 182% and 200%, respectively. Safety-related concerns include the high cost of developing a new drug, estimated at $5 billion. The cost of development is reflected in the cost of the 12 new cancer drugs that received Food and Drug Administration approval in 2012; 11 were priced at 6 figures. Although advances in pharmaceutical technology and research have yielded effective cancer therapies that reduce physical or treatment-related toxicity, patients have had to face worsening financial uncertainty both during and after treatment. Actions are needed to achieve financial safety, as well as therapeutic and clinical safety, for cancer patients.