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Pediatric Antiretroviral Treatment Uptake, Treatment Adherence, Regimen Switches, and Retention in Care in Namibia

In Namibia, a preliminary review of EDT records suggests that children form a small proportion of the patients accessing ART in any given setting, nationally composing 8% of the patients on ART in the MoHSS facilities. Over the years, managing children has been complicated with formulations that have not been friendly for children, complicated regimens, and occasional stock-outs of pediatric ARVs. These challenges may increase the number of children that might receive suboptimal care, including delayed or no interventions in face of poor adherence, ultimately leading to suboptimal response to treatment. This can then increase the risk of HIV drug resistance and leads to short survival of HIV-infected children. Findings from this assessment will provide much needed evidence on trends in pediatric HIV treatment uptake, levels of adherence, and retention among those on treatment. Ultimately, the evidence generated will support MoHSS policy makers and leaders in modifying and strengthening interventions aimed at enhancing treatment uptake, adherence, retention, and viral load suppression among HIV-infected children in Namibia.

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Every Breath Counts: Strengthening Pharmaceutical Systems for Better Health Outcomes with Pneumonia

By Jane Briggs, Principal Technical Advisor More than 900,000 children die of pneumonia each year (more than malaria, measles, and HIV/AIDS combined), according to the World Health Organization. Many of these cases go undiagnosed and untreated. How can this be when we know what works? A five-day, twice-daily amoxicillin regimen—in either dispersible tablet (DT) or oral […]

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Systems-based Approaches to Improving Medication Adherence

With the shift from a disease landscape that focuses on the treatment of acute and short-term illnesses to one that faces an increasing burden of chronic diseases that may require life-long medicine use, the role of medicines in ensuring a healthy population is more important than ever.

However,even when medicines are available, patients may not take them as directed. In other words, they may not adhere to the treatment prescribed to them. This problem is surprisingly widespread. Several studies have estimated that in developed countries, only approximately 50% of patients who suffer from chronic diseases take their medicines as directed.

This document suggests a health systems strengthening (HSS) approach to addressing
medication adherence issues, with a particular emphasis on its application in low- and middle-income settings. Chapter 2 reviews the importance of considering health systems in improving medication adherence and introduces a system-based framework, while Chapters 3–5 discuss approaches, interventions, and activities that span the health system as described at the
macro, meso, and micro levels and provide implementation examples.

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Baseline Study Report: Prescription Practices for Antiretroviral Therapy in Comprehensive Care Services of the Dominican Republic

The purpose of this study is to determine if the current prescription practices adhere to the national therapeutic guidelines. Finding notable discrepancies between the prescription practices and the guidelines would explain unjustified expenses in ARV therapy and the stockout problems and overstocks that occasionally occur.

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Join SIAPS at #WCLH2015

This week, SIAPS joins delegates from all over the globe for the 46th Union World Conference on Lung Health (#WCLH2015), in Cape Town, South Africa. At this year’s conference, SIAPS staff will present at several sessions focusing on how strong pharmaceutical systems support efforts to end TB including increasing access to TB medicines, expanding pharmacovigilance systems, […]

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Defeating pneumonia: Considering both providers and caregivers in achieving medication adherence

More than 900,000 children die of pneumonia each year. Many of these cases go undiagnosed and untreated. The countdown to 2015 report notes that only 54% of children with pneumonia symptoms are taken to a health care provider, while the Global Action Plan for Pneumonia and Diarrhea reports that only 31% of children with suspected […]

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New Global Health eLearning Course published on antimicrobial resistance

The second in the series, the newly published, SIAPS-authored course on Antimicrobial Resistance expands upon the concepts presented in Part 1 and explains the major factors that contribute to the development and spread of antimicrobial resistance. The course also explores some of the proven interventions and global strategies currently being used to combat AMR, reviews […]

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Taking medicine as directed, also known as medication adherence, is critical to achieve good health outcomes for patients. However, staying on medication and adhering to treatment regimens can be a challenge, especially for patients with chronic or long-term health conditions. The World Health Organization estimates that as many as 50% of all patients do not […]

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Preventing and Minimizing Risks Associated with Antituberculosis Medicines to Improve Patient Safety

All medicines carry some risk of adverse events; although certain risks are identified when medicines are tested during clinical trials, others aren’t recognized until after the medicine is on the market and has been used in “real world” settings. Adverse events not only endanger the health of patients, but if not well managed, they may also result in patients stopping their treatment early. For tuberculosis (TB), premature discontinuation of medicines has serious consequences for both the individual and their community. Patients who stop their treatment early remain sick, develop resistance to the medicines, and risk spreading TB to others in their community.

To help patients complete their full course of TB treatment, the United States Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program created a guide for national TB programs (NTP) on minimizing medicine risks. The guide Preventing and Minimizing Risks Associated with Antituberculosis Medicines to Improve Patient Safety offers insights into planning and implementing risk-reduction strategies in the treatment of TB.

The first step toward medicine-risk reduction is for the NTP to work with key stakeholders to identify factors that can prevent individuals from successfully completing their treatment. The guide notes that this stage involves answering questions such as, “What can happen to a patient on this medicine?” and “At what point will this happen?” Once risks have been identified, the guide provides instructions for how to categorize them according to severity, on the basis of considerations such as the likelihood of each risk and the estimated number of people that will be affected. From this ranking, NTPs can then develop solutions to mitigate the identified risks. Solutions can include interventions, such as SMS messaging to remind patients about how to safely take their medicines or creating information guides for health care providers on topics like medicine safety for individuals with both TB and HIV.

Preventing and Minimizing Risks Associated with Antituberculosis Medicines to Improve Patient Safety provides the tools and resources needed to ensure that appropriate measures are in place  to keep patients safe.

Download the Guide in English

Download the Patient Risk Awareness Posters
(If you would like to adapt and print these posters please contact us for the original files at

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