Adherence to antiretroviral therapy and associated factors among HIV-positive adolescents in Sub-Saharan Africa: a systematic review

Gebre Gelana Gudisa,전상은 한국기초간호학회 2023 Journal of korean biological nursing science Vol.25 No.4

Purpose: Although long-term viral suppression and antiretroviral therapy (ART) success depend on sustained adherence, adolescents’ adherence rates are suboptimal. Optimal adherence is influenced by various factors. Since Sub-Saharan Africa is home to over 80% of adolescents living with human immunodeficiency virus (HIV) and considering their unique characteristics and susceptibility to poor adherence, it is crucial to provide updated knowledge on adherence rates and their determinants among this population. This review aims to present up-to-date data on adherence rates and associated factors among HIV-positive adolescents in Sub-Saharan Africa. Methods: A systematic review was conducted following the PRISMA guidelines. The PubMed and Scopus databases were used to identify documents corresponding to the study’s objectives. Eleven studies were included in this review after being selected from among all studies that were found online from 2017 to 2023. Results: The reported adherence rates ranged from 55% to 86%. In total, 32 factors were found to be related to adherence among HIV-positive adolescents in Sub-Saharan Africa. These included 12 adherence-facilitating factors and 20 adherence-inhibiting factors. The most often mentioned factors affecting adherence were advanced World Health Organization clinical stage (i.e., stage IV), ART dose and regimens, a lack of support, and violence victimization. Conclusion: Our findings can help healthcare providers collaborate with HIV-positive adolescents to improve ART adherence and ensure the best possible health outcomes.

Medication-Related Knowledge and Medication Adherence in Pediatric and Adolescent Patients with Inflammatory Bowel Disease

Jong Keon Lim,이연주,박재홍 대한의학회 2020 Journal of Korean medical science Vol.35 No.14

Background: Non-adherence to oral maintenance therapy in adolescents with inflammatory bowel disease (IBD) is a significant healthcare problem. Knowledge of the prescribed medication can increase medication adherence. We aimed to investigate the relationship between medication adherence and disease-related knowledge of pediatric and adolescent patients with IBD. Methods: We conducted a “pop quiz” to investigate the disease-related knowledge of pediatric patients with IBD who were followed-up at our institution and reviewed their medical records, including data on sex, diagnosis, age at diagnosis, and disease duration. Medication adherence was evaluated by the doctor in charge, and ≥ 80% of patients constituted the “good adherence group.” Results: Of 93 patients, 59 (63.4%) were males, and 78 (83.9%) had Crohn's disease. The mean age at diagnosis was 13.8 ± 2.8 years; mean follow-up duration, 4.8 ± 3.4 years; and mean patient age, 18.6 ± 3.7 years. Only 65 patients (69.9%) knew the exact name of the medication they were currently taking, and 34 (36.6%) knew the correct dose. Only 15 patients (16.1%) knew the name of the medications they were previously taking. A total of 64 patients (66.8%) showed an adherence rate of 80% for the weekly prescribed oral medication. The patients in the poor adherence group were significantly older than those in the good adherence group (P = 0.035). The number of hospitalizations per year was statistically higher in the good adherence group (P = 0.024). The proportion of patients who knew the names of the medications they were previously taking and were aware of the side effects of the medications was significantly higher in the good adherence group (P = 0.008 and P = 0.020, respectively). Conclusion: Adolescent IBD patients have lower oral medication adherence. Knowledge of the prescribed medications taken previously, and the adverse effects of these medications are associated with good adherence. IBD specialists should educate the patients regarding the disease and about their medication.

Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications

Kim, Soyeun,Shin, Dong Wook,Yun, Jae Moon,Hwang, Yunji,Park, Sue K.,Ko, Young-Jin,Cho, BeLong American Heart Association, Inc. 2016 Hypertension Vol.67 No.3

<P>The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction). Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged 20 years, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003 to 2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence. Subjects were divided into good (cumulative medication adherence, 80%), intermediate (cumulative medication adherence, 50%-80%), and poor (cumulative medication adherence, <50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. Among 33728 eligible subjects, 670 (1.99%) died of coronary heart disease or stroke during follow-up. Patients with poor medication adherence had worse mortality from IHD (hazard ratio, 1.64; 95% confidence interval, 1.16-2.31; P for trend=0.005), cerebral hemorrhage (hazard ratio, 2.19; 95% confidence interval, 1.28-3.77; P for trend=0.004), and cerebral infarction (hazard ratio, 1.92; 95% confidence interval, 1.25-2.96; P for trend=0.003) than those with good adherence. The estimated hazard ratios of hospitalization for cardiovascular disease were consistent with the mortality end point. Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific cardiovascular diseases, emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice.</P>

Survival impact of adherence to tyrosine kinase inhibitor in chronic myeloid leukemia

( Yundeok Kim ),( Tae-Hwa Go ),( Jaeyeon Jang ),( Jii Bum Lee ),( Seung Taek Lim ),( Kwang Yong Shim ),( Jong In Lee ),( Jee Hyun Kong ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.6

Background/Aims: Adherence to tyrosine kinase inhibitors (TKIs) has become a critical aspect of care in chronic myeloid leukemia (CML). We aimed to examine the association of TKI adherence with overall survival (OS) outcomes in Korean patients diagnosed with CML and treated with TKIs using data from the National Health Information Database. Methods: This study included 2,870 CML patients diagnosed between 2005 and 2013. Drug adherence was evaluated according to the medication possession ratio (MPR) and classified as high adherence (i.e., MPR ≥ 0.95 [upper 50%]), moderate adherence (i.e., MPR ≥ 0.68 and < 0.95 [middle 25%]), and low adherence (i.e., MPR < 0.68 [lower 25%]). Results: The median MPR was 0.95 (range, 0 to 4.67). Male sex (p = 0.003), age < 70 years (p < 0.001), high income (≥ 30%, p < 0.001), and maintaining frontline TKI (< 0.001) were associated with better adherence. Adherence to dasatinib was the lowest (vs. imatinib or nilotinib, p < 0.001). Compared with high MPR patients, those with moderate MPR (hazard ratio [HR], 4.90; 95% confidence interval [CI], 3.87 to 6.19; p < 0.001) and low MPR (HR, 11.6; 95% CI, 9.35 to 14.42; p < 0.001) had poorer OS. Conclusions: Adherence to TKI treatment is an important factor predicting survival outcomes in Korean CML patients. Male sex, age < 70 years, high income, and maintaining frontline TKI are associated with high adherence to TKI. Thus, those without these characteristics should be closely monitored for treatment adherence.

Characteristics of Patients With More Than 90% Adherence to Automatic Positive Airway Pressure

Kim Min Su,Kang Jae-yoon,Park Soo-Kyoung,Kim Yong Min 대한수면학회 2022 sleep medicine research Vol.13 No.3

Background and Objective Among patients suffering from obstructive sleep apnea, there is a group with surprisingly high adherence (≥ 90%) to automatic positive airway pressure (APAP) treatment. This study aims to evaluate the characteristics of these patients.Methods Medical records of 4757 patients, who received APAP prescriptions between July 2018 and December 2019, were reviewed retrospectively. After the exclusion of patients not meeting the study criteria, a total of 103 patients were included in the study, and patients were divided into a very good adherence (VGA; adherence ≥ 90%) group and a poor adherence (PA; adherence < 70%) group, based on nine months of APAP adherence. Patient demographics, medical history, body mass index, and pretreatment polysomnography (PSG) results, as well as APAP therapy adherence-related variables (percentage of total days of APAP usage, and the mean time of APAP usage), the 90th percentile pressure (P90), residual apnea-hypopnea index (AHI), and the type of devices or company managers were compared between the two groups.Results Median age was significantly higher in the VGA group than in the PA group (p = 0.032). The Beck Depression Inventory (BDI) also differed significantly (p = 0.017) between the two groups. There were significant differences in the total sleep time (p = 0.003): 309.04 ± 64.96 min in the VGA group and 345.47 ± 53.06 min in the PA group. Patient sleep efficiency was observed and differed significantly (p = 0.003) 74.46 ± 13.73% in the VGA group and 82.09 ± 10.82% in the PA group. Other parameters, such as a pretreatment PSG and sleep-related questionnaires, did not show significant differences between the two groups. The device-related data at 1, 3, and 9 months were similar, and there were significant differences in the mean usage time (p < 0.001) and the number of days on which the device was used for more than 4 hours a day (p < 0.001) between the two groups. However, the two groups had no significant differences in mean pressure, residual AHI, and the P90.Conclusions The total sleep time, sleep efficiency, and BDI were the main determinants of adherence in patients in the VGA group. To find additional fac Background and Objective Among patients suffering from obstructive sleep apnea, there is a group with surprisingly high adherence (≥ 90%) to automatic positive airway pressure (APAP) treatment. This study aims to evaluate the characteristics of these patients.Methods Medical records of 4757 patients, who received APAP prescriptions between July 2018 and December 2019, were reviewed retrospectively. After the exclusion of patients not meeting the study criteria, a total of 103 patients were included in the study, and patients were divided into a very good adherence (VGA; adherence ≥ 90%) group and a poor adherence (PA; adherence < 70%) group, based on nine months of APAP adherence. Patient demographics, medical history, body mass index, and pretreatment polysomnography (PSG) results, as well as APAP therapy adherence-related variables (percentage of total days of APAP usage, and the mean time of APAP usage), the 90th percentile pressure (P90), residual apnea-hypopnea index (AHI), and the type of devices or company managers were compared between the two groups.Results Median age was significantly higher in the VGA group than in the PA group (p = 0.032). The Beck Depression Inventory (BDI) also differed significantly (p = 0.017) between the two groups. There were significant differences in the total sleep time (p = 0.003): 309.04 ± 64.96 min in the VGA group and 345.47 ± 53.06 min in the PA group. Patient sleep efficiency was observed and differed significantly (p = 0.003) 74.46 ± 13.73% in the VGA group and 82.09 ± 10.82% in the PA group. Other parameters, such as a pretreatment PSG and sleep-related questionnaires, did not show significant differences between the two groups. The device-related data at 1, 3, and 9 months were similar, and there were significant differences in the mean usage time (p < 0.001) and the number of days on which the device was used for more than 4 hours a day (p < 0.001) between the two groups. However, the two groups had no significant differences in mean pressure, residual AHI, and the P90.Conclusions The total sleep time, sleep efficiency, and BDI were the main determinants of adherence in patients in the VGA group. To find additional factors which affect adherence, further studies will be needed.

조현병을 처음 진단받은 환자들의 초기 투약 순응도에 따른 발병 1년 후 임상 결과: 국민건강보험공단 자료에 기반한 후향적 코호트 연구

최우혁,주성우,안수진,최영재,김선민,이중선 대한조현병학회 2023 대한조현병학회지 Vol.26 No.1

Objectives: Early pharmacologic intervention is considered necessary for improving the prognosis in patients with first-episode schizophrenia (FES). However, few nationwide population-based studies have focused on early medication adherence. We in- vestigated the status of early adherence to antipsychotics and the effect of early adherence on later clinical outcomes in FES. Methods: We used data from the South Korean Health Insurance Review Agency database (2009-2021). We selected 28,931 pa- tients with FES who had a prescription record of at least one antipsychotic medication within 180 days after their diagnosis. We measured early medication adherence using the medication possession ratio (MPR) and compared demographic characteristics and results of psychiatric hospitalization between the adherence group (0.6≤MPR<1.1) and the non-adherence group (MPR<0.6). Results: The average early medication adherence was 0.82 by MPR, and the non-adherence group accounted for 15.6% of all subjects. From 1 to 2 years after diagnosis, the adherence group showed a higher number of psychiatric hospitalizations per hos- pitalized patient but a shorter duration than the non-adherence group. Additionally, the proportion of patients who experienced psychiatric hospitalizations was smaller in the adherence group. Conclusion: In patients with FES, early medication adherence is associated with lower rates of psychiatric hospitalization and shorter hospitalization durations.

Identifying psychological predictors of adherence to a community-based lifestyle modification program for weight loss among Chinese overweight and obese adults

Leung, Alice Wai Yi,Chan, Ruth Suk Mei,Sea, Mandy Man Mei,Woo, Jean The Korean Nutrition Society 2019 Nutrition Research and Practice Vol.13 No.5

BACKGROUND/OBJECTIVES: Existing evidence on lifestyle modification programs for weight loss is limited by the high attrition rate of such programs. Identifying predictors of adherence to a lifestyle modification program could result in program improvement. However, little is known about behavior-specific adherence and its psychological predictors. This study aimed to examine the psychological predictors of adherence after one-month participation in a community-based lifestyle modification program among Chinese overweight and obese adults in Hong Kong. SUBJECTS/METHODS: A total of 205 Chinese overweight and obese adults aged $38.9{\pm}10.5years$ completed the study. Data were collected at baseline and after one month using self-reported questionnaires, which assessed knowledge (self-developed scale), motivation (Treatment Self-Regulation Questionnaire), stage of change (Stage of Exercise Scale) and self-efficacy (Self-Rated Abilities for Health Practices Scale). At one month, a 4-day dietary recall and the International Physical Activity Questionnaire-Short Form were used to assess dietary and physical activity (PA) adherence. Food and PA diaries were examined to indicate self-monitoring. Program attendance was tracked between baseline and one-month follow-up. RESULTS: After one month, participants reported high dietary adherence, attendance, and adherence to self-monitoring but low PA adherence. Multiple regression analyses suggested that diet self-efficacy (baseline) and nutrition knowledge (one-month change) were independent predictors of dietary adherence score at one month, whereas autonomous PA motivation (baseline) and PA self-efficacy (both baseline and one-month change) were independent predictors of PA adherence score at one month. No significant psychological predictor was identified for attendance or self-monitoring. CONCLUSIONS: The results suggest that the effect of psychological factors on adherence differs between diet and PA adherence outcomes. To promote adherence, practitioners should assess self-efficacy, knowledge, and motivation at the beginning of a weight-loss program and explore behavior-specific strategies to improve knowledge and self-efficacy. The results of this study have direct implications for program improvements.

Identifying psychological predictors of adherence to a community-based lifestyle modification program for weight loss among Chinese overweight and obese adults

Alice Wai Yi Leung,Ruth Suk Mei Chan,Mandy Man Mei Sea,Jean Woo 한국영양학회 2019 Nutrition Research and Practice Vol.13 No.5

BACKGROUND/OBJECTIVES: Existing evidence on lifestyle modification programs for weight loss is limited by the high attrition rate of such programs. Identifying predictors of adherence to a lifestyle modification program could result in program improvement. However, little is known about behavior-specific adherence and its psychological predictors. This study aimed to examine the psychological predictors of adherence after one-month participation in a community-based lifestyle modification program among Chinese overweight and obese adults in Hong Kong. SUBJECTS/METHODS: A total of 205 Chinese overweight and obese adults aged 38.9 ± 10.5 years completed the study. Data were collected at baseline and after one month using self-reported questionnaires, which assessed knowledge (self-developed scale), motivation (Treatment Self-Regulation Questionnaire), stage of change (Stage of Exercise Scale) and self-efficacy (Self-Rated Abilities for Health Practices Scale). At one month, a 4-day dietary recall and the International Physical Activity Questionnaire-Short Form were used to assess dietary and physical activity (PA) adherence. Food and PA diaries were examined to indicate self-monitoring. Program attendance was tracked between baseline and one-month follow-up. RESULTS: After one month, participants reported high dietary adherence, attendance, and adherence to self-monitoring but low PA adherence. Multiple regression analyses suggested that diet self-efficacy (baseline) and nutrition knowledge (one-month change) were independent predictors of dietary adherence score at one month, whereas autonomous PA motivation (baseline) and PA self-efficacy (both baseline and one-month change) were independent predictors of PA adherence score at one month. No significant psychological predictor was identified for attendance or self-monitoring. CONCLUSIONS: The results suggest that the effect of psychological factors on adherence differs between diet and PA adherence outcomes. To promote adherence, practitioners should assess self-efficacy, knowledge, and motivation at the beginning of a weight-loss program and explore behavior-specific strategies to improve knowledge and self-efficacy. The results of this study have direct implications for program improvements.

Relationships between health literacy, self-efficacy, and medication adherence in older people with polypharmacy: A cross-sectional study

조지영,장선주 한국노인간호학회 2023 노인간호학회지 Vol.25 No.4

Purpose: This study identified the relationships between health literacy, self-efficacy, and medication adherence among older people with polypharmacy and analyzed the factors affecting medication adherence. Methods: This was a cross-sectional study using a survey of 95 participants who were on five or more drugs, 65 years or older, and visited one community center in Seoul between August 5, 2019 and August 7, 2019. Data were collected using a questionnaire and analyzed with descriptive statistics, t-test, ANOVA, Tukey test, Pearson’s correlation coefficient, and multiple regression via the IBM SPSS 23.0 program. Results: The participants took on average 8.32±3.90 drugs daily. Their health literacy was very low at 3.53±2.07. Self-efficacy and medication adherence were high at 33.63±5.36 and 15.03±3.27, respectively. Health literacy differed based on age and education levels, whereas self-efficacy differed depending on the frequency of medication. No demographic or medication-related factors caused a difference in medication adherence. Health literacy did not correlate with self-efficacy and medication adherence. Self-efficacy showed a negative correlation with medication adherence (r=-.52, p<.001). However, as a lower medication adherence score indicates greater adherence, a negative correlation means higher self-efficacy is linked with better adherence. Self-efficacy influenced medication adherence (β=-0.52, p<.001) with an explanatory power of 27.0% (F=17.01, p<.001) in this group. Also, the negative regression coefficient means higher self-efficacy was associated with better adherence. Conclusion: Medication adherence was generally high, with self-efficacy being the main influencing factor. Hence, intervention programs that promote self-efficacy should be implemented for older people with polypharmacy.

성인여성의 생활무용참가와 몰입경험 및 무용지속의도의 관계

오진숙(Jin Sook Oh) 한국무용과학회 2010 한국무용과학회지 Vol.22 No.-

이 연구는 생활무용참가와 몰입경험 및 무용지속의도의 관계를 규명하고자 하였다. 연구목적을 위해 충청북도 청주시에서 생활무용을 지속적으로 참가하는 성인여성을 대상으로 총 397명을 표집 하였다. 그리고 설문지를 이용하여 조사 하였다. 수집된 자료는 일원분산분석, 중다회귀분석, 경로분석을 통해 분석하였으며, 분석한 결과는 다음과 같다. 첫째, 개인적 특성(교육수준, 월수입, 주관적 건강)에 따른 무용지속의도는 유의한 차이가 있었다. 둘째, 생활무용참가에 따른 몰입경험에서 참가빈도와 참가기간은 인지몰입에 유의한 영향을 미쳤으며, 참가기간과 참가시간은 행위몰입에 유의한 영향을 미쳤다. 셋째, 생활무용참가에 따른 무용지속의도에서 참가 빈도는 무용지속의도의 하위변인인 지속적참가의도와 참가경향의도에 유의한 영향을 미쳤다. 참가기간은 무용지속의도의 하위변인인 모든 변인 즉, 지속적참가의도와 참가경향의도 그리고 타인추천의도에 정적인 영향을 미쳤으며, 참가시간은 지속적참가의도와 타인추천의도에 부적(-)인 영향을 미쳤다. 넷째, 몰입경험과 무용지속의도의 관계에서 인지몰입은 무용지속의도의 하위변인 모두에 유의한 영향을 미쳤으며, 행위몰입은 참가경향의도에 유의한 영향을 미쳤다. 다섯째, 생활무용참가와 몰입경험 및 무용지속의도는 인과관계가 있는 것으로 나타났다. The purpose of this study was to explore the relationship among dance for participation of women, flow experience and dance adherence. The subjects of this study were sampled 397 women who live in Cheongju. Data were collected through the questionnaire, were analyzed to test hypotheses with statistical methods such as ANOVA, multiple regression analysis, and path analysis. On the basis of the results analysed, the conclusions were drawn as following. First, Personal characteristics of participants such as educational background, income, subjective health had a significant difference on dance adherence. Second, Dance for all participation of women had significantly influence on flow experience. That is, frequence, period influenced cognition flow and period, time influenced behavior flow. Third, Dance for participation of women had significantly influence on dance adherence. That is, frequence influenced continuous dance adherence, inclination of dance adherence, period influenced all of dance adherence and time influenced continuous dance adherence(-), recommendation of dance adherence(-). Fourth, Flow experience had significantly influence on dance adherence. That is, cognition flow influenced all of dance adherence and behavior flow influenced inclination of dance adherence. Fifth, Dance for participation of women, flow experience and dance adherence had a causal relationship.