Clinical Utility of Pharmacy-Based Adherence Measurement in Predicting Virologic Outcomes in an Adult HIV-Infected Cohort in Jos, North Central Nigeria.

OBJECTIVES: We examined the association between adherence to drug-refill visits and virologic outcomes in a cohort of HIV-infected adults on combination antiretroviral therapy (cART) in North Central Nigeria. METHODS: Retrospectively, 588 HIV-infected, cART-naive adults (aged ≥15 years), initiated on first-line ART between 2009 and 2010 at the Jos University Teaching Hospital, were evaluated. Association between adherence to drug-refill visits, virologic (viral load>1000 copies/mL), and immunologic failure was assessed using multivariable logistic regression. RESULTS: After a median of 12 months on cART, 16% (n=94) and 10% (n=59) of patients had virologic and immunologic failures, respectively. In the final multivariable model, suboptimal adherence to drug-refill visits was a significant predictor of both virologic (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI]:1.2-2.3) and immunologic (AOR 1.92; 95% CI:1.06-3.49) failures. CONCLUSION: Adherence to drug refill is a useful predictor of successful virologic control and could be utilized for routine monitoring of adherence to cART in our clinical setting.

Pattern of drug therapy problems and interventions in ambulatory patients receiving antiretroviral therapy in Nigeria / / Patrón de problemas relacionados con medicamentos en intervenciones en pacientes ambulatorios que reciben tratamiento antirretroviral en Nigeria

Objectives: We describe the frequency and types of drug therapy problems (DTPs), and interventions carried out to resolve them, among a cohort of HIV- infected patients on ART in Jos, Nigeria. Methods: A prospective pharmacists’ intervention study was conducted between January and August 2012 at the outpatient HIV clinic of the Jos University Teaching Hospital (JUTH). Pharmacists identified DTPs and made recommendations to resolve them. The main outcome measures were number of DTPs encountered, interventions proposed and acceptance rate of recommendations. Results: A total of 42,416 prescriptions were dispensed to 9339 patients during the eight months study. A total of 420 interventions (Intervention rate of 1 per 100 prescriptions) were made to resolve DTPs in 401 (4.3%) patients with a mean age of 41 (SD=10) years, and made up of 73% females. DTPs encountered were drug omission (n=89, 21.2%), unnecessary drug (n=55, 13.1%) and wrong drug indication (n=55, 13.1%). Recommendations offered included; Addition of another drug to the therapy (n=87, 20.7%), rectification of incomplete prescriptions (n=85, 20.2%), change of drug or dosage (n=67, 16.0%), and discontinuation of the offending drug (n=59, 14.0%). A total of 389 (93%) out of 420 of the recommendations were accepted. In all, 50.4% (212) of the problematic prescriptions were changed and dispensed, 22.2% (89) were clarified and dispensed, while wrong identities were corrected in 11.7% (49). However, 7.5% (30) prescriptions were dispensed as prescribed, 5.2% (21) were not dispensed, and 3% (12) were unresolved. Conclusion: Our findings suggest that pharmacistsinitiated interventions can ameliorate DTPs in patients receiving ART given the high intervention acceptance rate recorded. The implication of this finding is that pharmacists with requisite training in HIV pharmacotherapy are an excellent resource in detecting and minimizing the effect of antiretroviral drug-related errors (AU)

Objetivos: Describimos la frecuencia y los tipos de problemas relacionados con medicamentos (DTP) y las intervenciones realizadas para resolverlos en una cohorte de pacientes infectados con HIV a tratamiento con antirretrovirales (ART). Métodos: Se realizó un estudio prospectivo de intervención farmacéutica entre enero y agosto de 2012 en la consulta ambulatoria de HIV del Hospital Universitario de Jos (JUTH). Los farmacéuticos identificaban DTP e hicieron las recomendaciones para resolverlos. Los outcomes principales fueron el número de DTP encontrados, las intervenciones propuestas y la tasa de aceptación de las recomendaciones. Resultados: Se dispensó un total de 42.416 recetas a 9.339 pacientes durante los 8 meses del estudio. Se realizaron un total de 420 intervenciones (tasa de intervención de 1 por 100 recetas) para resolver los DTP de 401 (4,3%) pacientes con una media de edad de 41 (DE=10) años, de los que el 73% eran mujeres. Los DTP encontrados fueron omisión de medicamento (n=89; 21,2%), seguido de medicamento innecesario (n=55; 13,1%) e indicación terapéutica errónea (n=55; 13,1%). Las recomendaciones ofrecidas incluyeron: Adición de otro medicamento al tratamiento (n=87; 20,7%), rectificación de receta incompleta (n=85; 20,2%), cambio de medicamento o dosis (n=67; 16,0%), y discontinuación de medicamento problemático (n=59; 14,0%). Un total e 389 (93%) de las 420 recomendacioens fueron aceptadas. En total, el 50,4% (212) de los medicamentos problemáticos fueron cambiados y dispensados, el 22,2% (89) fueron aclarados y dispensados, mientras que se corrigieron identidades erróneas en el 11,7% (49). Sin embargo, el 7,5% de las recetas fueron dispensadas como fueron prescritas, el 5,2% (21) no fue dispensada, y el 3% (12) quedó sin resolver. Conclusión: Nuestro resultados sugieren que las intervenciones farmacéuticas pueden mejorar los DTP en pacientes que reciben ART, dada la alta aceptación registrada. La implicación de este hallazgo es que los farmacéuticos con entrenamiento en terapéutica para HIV son un recurso excelente para detectar y minimizar el efecto de los errores de los antirretrovirales (AU)

Patterns and Predictors of First-Line Antiretroviral Therapy Modification in HIV-1-Infected Adults in a Large Urban Outpatient Cohort in Nigeria.

OBJECTIVE: We described the magnitude, type, and factors associated with first-line antiretroviral therapy (ART) modification in HIV-1-infected adults on ART in Jos, Nigeria. METHOD: Data on 6309 patients initiated on first-line ART between January 2004 and December 2006 were analyzed retrospectively. Factors predictive of modification to initial ART were assessed by chi-square and multivariable logistic regression analysis. RESULTS: Overall, 5212 (83%) included patients incurred a modification (73.3% drug substitution and 9.7% drug switch) to their initial first-line ARV regimen during a median (interquartile range) follow-up period of 7 (3-8) years. Drug substitutions of zidovudine (ZDV) were less likely than of tenofovir (TDF; adjusted odd ratio [AOR] 0.6; 95% confidence interval [CI]: 0.51-0.71), and Drug substitutions of efavirenz (EFV) were more likely than of nevirapine (NVP)-containing (AOR 1.82; 95% CI: 1.42-2.33) regimens. Predictors of switch to second-line regimen include older age (AOR 2.05; 95% CI: 1.68-2.51), CD4 count≤100 cells/mm3 (AOR 1.89; 95% CI: 1.49-2.37), EFV compared to NVP (AOR 1.38; 95% CI: 1.02-1.88), and drug toxicity (AOR 1.90; 95% CI: 1.48-2.43). CONCLUSION: Modification to initial ART was common in this study. Further evaluation of the contribution of guideline changes on regimen modification and treatment outcomes is recommended.