Tag Archives | Adherence

Community-based Group ARV Dispensing Improves ART Services in Namibia

The US Ambassador to Namibia, H.E. Thomas F. Daughton, launched CBART group ARV refills on June 1, 2017. These groups are implemented widely in Onandjokwe and other districts in northern Namibia, where the HIV burden is high. During the CBART group ARV refill initiative launch, the ambassador remarked “simple solutions = best solutions; bring the pharmacy to the people rather than sending people to the pharmacy”. Since then, SIAPS has been supporting Namibia’s Ministry of Health and Social Services (MoHSS) and partners to implement this initiative. The MoHSS, with support of partners, has decentralized ART services to achieve the ambitious UNAIDS 90-90-90 targets for ending the AIDS epidemic by 2020. Although Namibia faces a high HIV burden, with approximately 220,000 living with HIV, the MoHSS has successfully expanded its ART patient coverage to more than 80%. With more than 150,000 people receiving ART from public health facilities countrywide, the MoHSS is making efforts to ensure retention of ART clients on treatment to minimize the development of HIV drug resistance.

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Lucky Specials Brings Focus to TB Awareness Week in Namibia

Theresia Cloete was diagnosed with tuberculosis (TB) in 2002. She was put on treatment but after four months stopped taking her TB medication. Last year, she was diagnosed with drug-resistant TB. Like Cloete, many TB patients stop taking their life-saving medication before they are cured. She is now one of eight in-patients waiting for stabilization […]

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The Antimicrobial Resistance Challenge: No Room for Complacency

A presentation by Mohan P. Joshi, Principal Technical Advisor and Lead for Pharmaceutical Services, SIAPS, at USAID in Arlington, VA on November 9 2017.

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HIV/TB Pharmaceutical Management Training in Swaziland to Improve Medicine Availability and Rational Use

An off-site training was held for 104 pharmacy personnel (32 males, 72 females) responsible for managing HIV and TB medicines in 88 health facilities in the 4 regions around the country. SIAPS supported the training, which included pharmacists, pharmacy technicians, and nurses. The trainings took place over August 7–17, 2017, and each region was trained […]

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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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The Economic Cost of Non-Adherence to TB Medicines Resulting from Stock-Outs and Loss to Follow-Up in the Philippines

A key element of successful tuberculosis (TB) control programs is adherence to treatment. Non-adherence results in increased length and severity of illness, death, disease transmission, and drug resistance. The purpose of this study was to estimate the morbidity and mortality impact and economic costs of non-adherence to TB medicines resulting from treatment interruption due to stock-outs or loss to follow-up (LTFU).

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The Economic Cost of Non-adherence to TB Medicines Resulting from Stock-outs and Loss to Follow-up in Kenya – Research Summary

One of the key elements of successful tuberculosis (TB) control programs is adherence to treatment, which is a cornerstone of most international and national policies and guidelines. Non-adherence results in increased length and severity of illness, death, disease transmission, and drug resistance. Treatment interruption is often due to patient-related factors—classed as loss to follow-up (LTFU)—but can also be a result of provider issues, such as stock-outs of medicines. The purpose of this study was to estimate the morbidity, mortality, and economic impact of TB treatment interruption due to stock-outs and LTFU. The results are expected to help promote the benefits of ensuring the availability of good quality medicines and of undertaking interventions to reduce LTFU.

For the full report, please follow this link.

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The Economic Cost of Non-adherence to TB Medicines Resulting from Stock-outs and Loss to Follow-up in Kenya

One of the key elements of successful tuberculosis (TB) control programs is adherence to treatment, which is a cornerstone of most international and national policies and guidelines. Non-adherence results in increased length and severity of illness, death, disease transmission, and drug resistance. Treatment interruption is often due to patient-related factors—classed as loss to follow-up (LTFU)—but can also be a result of provider issues, such as stock-outs of medicines. The purpose of this study was to estimate the morbidity, mortality, and economic impact of TB treatment interruption due to stock-outs and LTFU. The results are expected to help promote the benefits of ensuring the availability of good quality medicines and of undertaking interventions to reduce LTFU.

For the research summary, please follow this link.

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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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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 siaps@msh.org)

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