Posts Tagged ‘HIV’

The Role of Cognitive Functioning in Medication Adherence of Children and Adolescents with HIV Infection.

07/29/2008 , 10:45 AM by Alex Sicre

Here is today’s medication adherence abstract from Medline:

OBJECTIVE: To evaluate the relationship between cognitive functioning and medication adherence in children and adolescents with perinatally acquired HIV infection.

METHODS: Children and adolescents, ages 3-18 (N = 1,429), received a cognitive evaluation and adherence assessment. Multiple logistic regression models were used to identify associations between adherence and cognitive status, adjusting for potential confounding factors.

RESULTS: Children’s average cognitive performance was within the low-average range; 16% of children were cognitively impaired (MDI/FSIQ <70). Cognitive status was not associated with adherence to full medication regimens; however, children with borderline/low average cognitive functioning (IQ 70-84) had increased odds of nonadherence to the protease inhibitor class of antiretroviral therapy. Recent stressful life events and child health characteristics, such as HIV RNA detectability, were significantly associated with nonadherence.

CONCLUSION: Cognitive status plays a limited role in medication adherence. Child and caregiver psychosocial and health characteristics should inform interventions to support adherence.

Med-eMonitor Improves HIV Medication Adherence, BUT Look at The Test Group

03/28/2008 , 9:43 AM by Alex Sicre

I picked this up from lifesciencesworld.com, but it was on the PRWire as well. SEE my comments at the end.

ROCKVILLE, Md., March 26 /PRNewswire-FirstCall/ — InforMedix Holdings, Inc. (OTC Bulletin Board: IFMX), announced that results presented by Dr. David Bangsberg, an internationally renowned expert on medical adherence, at the Third International Conference on HIV Adherence, showed that HIV+ patients using its Med-eMonitor™ “smart pillbox” that monitors medication and care plan adherence, achieved an average 89.5% medication adherence rate.

The Med- eMonitor “smart pillbox” is linked to the Med-eXpert™ software system that analyzes patient information and provides Web-enabled reports and urgent outbound alerts to caregivers when patients miss medication or suffer declining health.

Approximately 1.2 million people in the US are living with HIV, with an additional 40,000 becoming infected each year, costing the US health care system approximately $50,000-$75,000 per year per patient, or $50 to $75 billion in total annual costs.

Average adherence to HIV antiretroviral therapy is under 70%, and 20-33% of HIV-positive patients will miss at least one of their doses over any given 3-day period. Given that a 10% difference in adherence by individuals is associated with a doubling of viral load, and a 21% increase in the risk of progression to full-blown AIDS; based upon the statistics above Med-eMonitor/Med-eXpert offers the potential for a 40% decrease in the risk of an HIV patient developing full blown AIDS.

The challenging population of 76 patients that were enrolled in the program not only suffered from HIV infection, but frequently were also suffering from drug abuse and severe mental illness, and were near-homeless.

COMMENTS
As I always say, I applaud anything that encourages and enhances medication adherence. It am impressed by these raised adherence rates for HIV patients, but I think regular adherence rates are even lower. Here is my one question though, the sample group of 76 patients were near -homeless, and suffered from drug abuse and severe mental illness. This, to me, does not seem like an accurate test of the efficacy of Med-eMonitor™ – since it is in a controlled environment. I am not knocking the Med-eMonitor, but certain factors have to be in place to use it: #1 being a house to put it in, a fast internet connection, and a patient who waits for the machine to tell them when to take their pills.

With such a structured regimen as HIV medications, sometimes 10 – 20 medications a day, at certain times, one would have to be in front of the Med-eMonitor all day, waiting for the cue to take their meds. So how did the study go? Did the drug addicted, mental unstable near homeless stay in a shelter, rehab facility or mental institution and have their own Med-eMonitor programmed for them? Instead of the nurse coming around with their pills, it was the machine?

I will have to look further into this study to get a real understanding of it all. It just struck me as bizarre. If you are going to announce these results, maybe not mention that the patients were mentally ill, homeless drug addicts.

I still applaud the work and the use of Med-eMonitor and InforMedix for the software they have developed to increase medication adherence. I will have to look at AlignMap to see if Showalter has any comments.

XDR-TB in South Africa due to Noncompliance

07/16/2007 , 10:00 AM by Alex Sicre

Here is more news about the deadly new strain of TB – now in South Africa as well. This feels like something out of a doomsday movie. The increased strength of viral strains due to medication noncompliance.

From The Chronicle Newspaper (Lilongwe) by Moses Kaufa.

In Malawi, Tuberculosis (TB) is closely linked to the HIV epidemic. Of the 28,000 cases of TB reported in the year 2005, approximately 70% of the patients tested HIV positive.

Although TB can be cured, the recent surfacing of an Extensively Drug Resistant-TB (XDR-TB) in South Africa is cause for concern.

With the current official rate of 14% HIV infection in Malawi and the link between HIV and TB, the need to put TB firmly on the political agenda of the country has become more necessary and urgent.

The government, through the Ministry of Health and the National TB Control Programme has committed to making sure that there a plan in place to respond effectively should any cases of XDR-TB surface in Malawi.

Advocacy, Communication and Social Mobilization (ACSM) an initiated component of the Malawi National TB Control Programme, seeks to create awareness, facilitate community involvement and participation and promote activities that will inform the public on the importance of adhering to treatment and medical advice for Tuberculosis in an effort to avoid the possible development of the fatal, Extremely Drug Resistant TB (XDR-TB).

Henry Chimbali, the Communications Officer of the National TB Control Program, ACSM has embarked on an advocacy campaign involving activities designed to place TB high on the political and development agenda.

The campaign also aims to increase financial and other resources on a sustainable basis as well as hold authorities to account. Additionally, the campaign seeks to ensure that pledges are fulfilled at the local level.

A major and very important part of the campaign is to prevent the possible development of the deadly XDR-TB in Malawi.

Reports indicate that XDR-TB probably developed because cases of normal TB are not treated properly. TB that is not effectively treated will resurface with resistance to the drugs used in the treatment and become Multi Drug Resistant – TB (MDR-TB). Concerns are high that XDR-TB could develop if patients are not aware of the importance of following the strict medical regime necessary to treat MDR- TB.

Records indicate that no one knows yet exactly how many cases of XDR-TB exist but surveillance shows that countries most affected by TB are those that are poor.

Chimbali told Health Check that XDR-TB mostly develops in patients who at one time used the drugs for other ailments or if they had defaulted in the treatment of TB.

However, the infection of XDR-TB is transmitted in the same way as the standard TB.

He says the intervention embarked on by ACSM seeks to prevent any possible occurrence of XDR-TB in this country and the further spread of infections should it occur.

“The program will be looking at adherence and compliance of treatment. This will be achieved by ensuring that all TB patients are under closely supervised treatment and all health workers have adequate knowledge on TB treatment guidelines. There will be a need to engage more health care providers in TB treatment monitoring, strengthening treatment monitoring systems at all levels and intensifying proper diagnosis of all TB suspect cases,” Chimbali said.

He said the program is also focusing on prevention and control of the transmission of XDR-TB to health workers and the public.

“This will be achieved through early diagnosis of all TB treatment failures, relapses and tracing of all treatment defaulters and the establishment of special treatment centers for XDR-TB,” said the Communications Officer.

XDR-TB is said to be very difficult to treat as it involves a regime that lasts for a long period of time. Drugs to treat the infection are extremely expensive making access to treatment of XDR-TB impossible for many under-privileged people