The information sources on new drugs most frequently used by the physicians include scientific conferences, journals and medical representatives and they yearn for unbiased information regarding safety and efficacy of the promoted drugs before prescribing the new medicines. Thus, there is a window of opportunity for hospital pharmacists to serve the unmet needs of the physicians.

In settings where medications and viral load (VL) monitoring are limited by cost, clinicians need reliable ways to assess patient adherence to therapy. We assessed sensitivity and specificity of two self-reported adherence tools (a visual analogue scale [VAS] and the CASE [Center for Adherence Support Evaluation] adherence index), against a standard of detectable VL, with 288 patients from three sites in Thailand. We also assessed predictors of non-adherence. The sensitivity and specificity of the VAS <95% and CASE adherence index ≤11 against a VL >50 copies/mL were 26% and 90%, 19% and 95%, respectively. Against a VL ≥1000 copies/mL sensitivities increased to 55% and 36%, respectively, and specificities were unchanged. Attending a clinic not staffed by HIV specialists (odds ratio [OR] 3.14; 95% confidence interval [CI] 1.19-8.34) and being educated to primary school level or less (OR 2.24; 95% CI 1.01-4.94) were associated with self-reported adherence <95% on the VAS in multivariate analysis. Adherence assessed by the VAS was a more accurate predictor of detectable VL. Policy-makers in resource-limited settings should ensure that treatment centres are staffed with well-trained personnel aware of the importance of good patient adherence.

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infections, although the incidence of symptomatic infections in the older age classes does increase. The impact of the different assumptions used in the model was in general limited. CONCLUSIONS: We conclude that over a wide range of assumptions, an additional booster dose can reduce the incidence of pertussis in the population. OBJECTIVES:To investigate doctors' perceptions towards factors underlying irrational prescribing practices in treatment of malaria in Pakistan. METHODS: A qualitative study with snowball sampling technique was used to identify nineteen doctors working at hospitals in Islamabad and Rawalpindi. Semi-structured interviews were conducted with the doctors until the point of saturation was obtained. The interviews, which were audio-taped and transcribed verbatim, were evaluated by thematic content analysis and by other authors' analysis. RESULTS: Thematic content analysis identified three major themes and several subthemes: 1) Factors responsible for irrational prescribing practices in treatment of malaria; 2) Lack of implementation of standard malaria treatment guidelines in the country; and 3) Strategies to improve irrational prescribing practices in treatment of malaria. All the doctors agreed on lack of implementation of standard guidelines in treatment of malaria while mixed responses were observed regarding factors influencing rational prescribing. Influence of pharmaceutical industry and unsupervised polytherapy were cited as major determinants for irrational prescribing practices in case of malaria. CONCLUSIONS: The findings suggest that the doctors in Pakistan are aware of irrational prescribing practices and its consequences in treatment of malaria but are facing significant barriers in terms of improving the current prescribing practices. There is an urgent need to design strategies such as implementation of standard malaria treatment guidelines, revision of health policies and up gradation of education and training of health players in order to improve the current prescribing practices for antimalarials.