Factors associated with poor adherence to antiviral treatment for hepatitis B

Abstract

Antiviral therapy for hepatitis B is effective and reduces the risk of progression to cirrhosis and liver cancer but is often required for an indefinite duration. Treatment adherence is important to prevent the development of resistance and optimize outcomes. Pharmacy adherence measures can be used to assess treatment adherence, with the medication possession ratio being less susceptible to bias than physician- or self-reported adherence. The aim of this study was to measure adherence in public hospital outpatients over a 3-year period and to examine factors associated with nonadherence. A retrospective study of pharmacy records of patients dispensed antiviral therapy for hepatitis B from four major hospitals in Melbourne between 2010 and 2013. Hospital record numbers were linked with and de-identified demographic information including age, sex, Indigenous status, country of birth, interpreter requirement, spoken language and postcode of residence. The medication possession ratio was the outcome measure with poor adherence defined <.90. Univariate logistic regression and multivariate logistic regression were performed to examine associations with nonadherence. Records of 1026 patients were included in the analysis. Twenty per cent of all participants met the definition of poor adherence. Significant factors affecting adherence included age <35 years (P=.002), hospital site and treatment by multiple doctors within shorter time periods. This is the largest study examining detailed factors associated with adherence to hepatitis B treatment. Understanding poor adherence in clinical settings, and the factors associated with lower adherence, is important to inform efforts towards promoting treatment adherence for hepatitis B.

Adherence and perceived barriers to oral antiviral therapy for chronic hepatitis B

“…Therefore, healthcare providers should actively inform patients about the importance of adhering to antiviral therapy and the potential consequences for skipping NUCs. One study based on a review of medical records of 69 immigrant patients in Chicago discovered that concerns about the long-term safety of NUCs was cited as one of the main barriers to treatment initiation and one of the main reasons for treatment discontinuation [26]. Likewise in our study, ‘Have experienced or worry about potential side effects’ was identified as the third most common barrier to NUC adherence.…”

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

“…From an initial screen of 878 titles, 30 studies providing data for 23,823 patients met our eligibility criteria and were taken through for review (Fig. ) . The majority (23 studies, 17,057 patients) were from high‐income settings, mainly the United States (seven studies), Australia (four studies), and France (three studies).…”

Adherence in chronic hepatitis B: associations between medication possession ratio and adverse viral outcomes

“…A recent systematic review including 30 studies with different adherence measures estimated overall adherence to treatment in CHB with oral therapy was 75% and was similar in both high and low income settings [11]. Factors that have been shown to be related to poor adherence have included forgetting and change to routine, younger age, higher physician turnover and recent initiation of therapy [11][12][13][14][15]. Adverse reactions to medication can also result in poor adherence however antivirals for CHB have a low side effect profile and rarely adverse outcomes [16].…”