Healthcare providers’ experiences with adverse drug reactions and adherence challenges in antiretroviral therapy of HIV patients in the Eastern Cape Province, South Africa

Ruud, Karine Wabø; Srinivas, S.; Toverud, Else‐Lydia

doi:10.1007/s00228-012-1254-1

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…Inadequate knowledge on the patient’s part and insufficient counseling by the healthcare giver has been cited as reasons for adverse drug reactions contributing towards poor adherence to care [40]. Despite the drop in adherence in the first 6 months in our study, a key observation here is the equalization in adherence measurements in patients grouped by the occurrence and severity of ADRs after the first 6 months.…”

Section: Discussionmentioning

confidence: 53%

Influence of Adverse Drug Reactions on Treatment Success: Prospective Cohort Analysis of HIV-Infected Individuals Initiating First-Line Antiretroviral Therapy in India

Shet

Antony²,

Arumugam³

et al. 2014

PLoS ONE

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IntroductionAdverse drug reactions related to antiretroviral therapy (ART) remain a challenge in resource-limited settings, often causing significant morbidity and impaired adherence leading to treatment failure. This 2-year prospective study aimed to describe patterns and predictors of adverse reactions to first-line ART and assess the impact of these events on treatment success.MethodsBetween 2010–2013, 321 ART-naïve eligible adults were enrolled at two clinics in southern India. ART regimens included zidovudine or stavudine plus lamivudine, plus nevirapine or efavirenz. Pill count adherence, immunological and virological monitoring, and laboratory-based adverse drug reactions were measured prospectively and analyzed.ResultsAmong 321 patients in the study, 289 (90.0%) patients experienced at least 1 adverse reaction, and 85 (26.5%) experienced at least 1 severe reaction. The incidence rate was 52 and 15 per 100 person-years for all reactions and severe reactions respectively. The cumulative incidence of zidovudine-induced anemia was 37.1% over 2 years. At 12 and 24 months, the proportion of patients with optimal adherence, undetectable viral load and CD4 counts >350 cells/mm3 were similar between patients who experienced or did not experience severe adverse drug reactions.ConclusionsOur results highlight the high frequency of ART-related adverse drug reactions among individuals initiating first-line ART in India, underscoring the importance of detailed counseling and monitoring for maintaining ART durability. Severe drug-induced anemia needs to be addressed urgently with alternative first-line agents, and close laboratory surveillance. High treatment efficacy despite decreased drug safety seen here may be because patients have limited treatment options. Our results support the use of currently recommended safer first-line ART regimens that minimize the risk of severe life-threatening toxicities and provide for a better quality of life.Trial registrationISRTCN Registry: ISRCTN79261738.

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Section: Discussionmentioning

confidence: 53%

Influence of Adverse Drug Reactions on Treatment Success: Prospective Cohort Analysis of HIV-Infected Individuals Initiating First-Line Antiretroviral Therapy in India

Shet

Antony²,

Arumugam³

et al. 2014

PLoS ONE

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“…As no causal relation could be formally established between perceived symptoms and drug-related toxicity among HAART-treated patients, there is a clear need to enhance pharmacovigilance activities in a context of HAART scale-up in sub-Saharan Africa. Indeed, previous reports have highlighted the lack of knowledge concerning drug-related adverse events identification and staging in our study environment [28, 32] and elsewhere in Africa [33]. With this respect, appropriate training in the assessment and management of drug-related toxicity is a priority to improve HRQOL.…”

Section: Discussionmentioning

confidence: 95%

Antiretroviral treatment and quality of life in Africans living with HIV: 12‐month follow‐up in Burkina Faso

Jaquet

Garanet

Balestre

et al. 2013

Journal of the International AIDS Society

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IntroductionThe scale-up of highly active antiretroviral therapy (HAART) has led to a significant improvement in survival of the HIV-positive patient but its effects on health-related quality of life (HRQOL) are less known and context-dependent. Our aim was to assess the temporal changes and factors associated with HRQOL among HIV-positive adults initiating HAART in Burkina Faso.MethodsHIV-positive people initiating HAART were prospectively included and followed over a one-year period in three HIV clinics of Ouagadougou. HRQOL was assessed at baseline and at each follow-up visit using physical (PHS) and mental (MHS) summary scores derived from the Medical Outcome Study 36-Item short-form health survey (MOS SF-36) questionnaire. Toxicity related to HAART modification and self-reported symptoms were recorded during follow-up visits. Determinants associated with baseline and changes in both scores over a one-year period were assessed using a mixed linear model.ResultsA total of 344 patients were included. Their median age at baseline was 37 years [interquartile range (IQR) 30–44] and their median CD4 count was 181 cells/mm3 (IQR 97–269). The mean [standard deviation (SD)] PHS score increased from 45.4 (11.1) at baseline to 60.0 (3.1) at 12 months (p<10−4) and the mean (SD) MHS score from 42.2 (8.7) to 43.9 (3.4) (p<10−2). After one year of treatment, patients that experienced on average two symptoms during follow-up presented with significantly lower PHS (63.9) and MHS (43.8) scores compared to patients that presented no symptoms with PHS and MHS of 68.2 (p<10−4) and 45.3 (p<10−3), respectively.DiscussionThe use of HAART was associated with a significant increase in both physical and mental aspects of the HRQOL over a 12-month period in this urban African population. Perceived symptoms experienced during follow-up visits were associated with a significant impairment in HRQOL. The appropriate and timely management of reported symptoms during the follow-up of HAART-treated patients is a key component to restore HRQOL.

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“…This weak knowledge about the importance of ADR reporting in Clinics PA and N may negatively affect health outcomes and the safety of patient populations. 51 Ideally, pharmacovigilance involves both medicine-related information and clinical knowledge, for example, drawing relationships between a medicine and a reported adverse event. Thus, a decentralised or mentorship role of a pharmacist best placed to combine both medicine-related information and clinical knowledge could see better understanding of medicine safety of differing personnel.…”

Section: Discussionmentioning

confidence: 99%

Different models of pharmaceutical services and care in primary healthcare clinics in the Eastern Cape, South Africa: Challenges and opportunities for pharmacy practice

Bobbins

Burton

Fogarty

2020

African Journal of Primary Health Care & Family Medicine

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Background: Primary health care (PHC) re-engineering forms a crucial part of South Africa’s National Health Insurance (NHI), with pharmaceutical services and care being crucial to treatment outcomes. However, owing to a shortage of pharmacists within PHC clinics, task-shifting of the dispensing process to pharmacist’s assistants and nurses is common practice. The implications of this task-shifting process on the provision of pharmaceutical services and care remains largely unstudied.Aim: The study aimed to explore the pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models within the PHC setting.Setting: The Nelson Mandela Bay Health District, South Africa.Methods: A mixed methods approach was utilised comprising of Phase 1: a pharmaceutical services audit to analyse pharmaceutical service provision and Phase 2: semi-structured interviews to describe the pharmaceutical care provision within each dispensing model thematically.Results: Pharmaceutical services partially fulfilled minimum standards within all models, however, challenges exist that limit the quality of these services. Phase 2 showed that the provision of pharmaceutical care within all models was restricted by context-related constraints, thus patient-centred activities to underpin pharmaceutical services were limited.Conclusion: Although pharmaceutical services may have been available for all models, compromised quality of these services impacted overall quality of care. Limited pharmaceutical care provision was evident within each dispensing model. The results raised concerns about the current utilisation of pharmacy personnel, including the pharmacist, within the PHC setting. Further opportunities exist, if constraints allow, for the pharmacist to contribute to better patient-centred care.

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Healthcare providers’ experiences with adverse drug reactions and adherence challenges in antiretroviral therapy of HIV patients in the Eastern Cape Province, South Africa

Cited by 9 publications

References 21 publications

Influence of Adverse Drug Reactions on Treatment Success: Prospective Cohort Analysis of HIV-Infected Individuals Initiating First-Line Antiretroviral Therapy in India

Influence of Adverse Drug Reactions on Treatment Success: Prospective Cohort Analysis of HIV-Infected Individuals Initiating First-Line Antiretroviral Therapy in India

Antiretroviral treatment and quality of life in Africans living with HIV: 12‐month follow‐up in Burkina Faso

Different models of pharmaceutical services and care in primary healthcare clinics in the Eastern Cape, South Africa: Challenges and opportunities for pharmacy practice

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