Factors Associated with Non-Adherence to Treatment in Sickle Cell Patients Monitored at the National Reference Center for Sickle Cell Disease in Niger

Introduction: Sickle cell disease is a real public health problem in the world and particularly in Niger where the prevalence of the S gene is estimated at 25% and that of the homozygous forms at between 1% and 2%. Treatment combines quarterly follow-up of patients and management of complications. The objective of this study was to identify the potential explanatory factors of non-adherence to treatment in sickle cell patients followed at the national reference center for sickle cell disease in Niger. Methods: This is a cross-sectional study of sickle cell cases followed at the CNRD in Niger. The population consisted of all sickle cell patients followed in this center in 2021. The data collection techniques were individual interviews and documentary reviews. Non-adherence was assessed with the Girerd test. Descriptive statistical tests and simple and multiple logistic regression models were performed. Results: A total of 368 patients were enrolled. The median age is 7 years (4;10) and the sex ratio is 1.04. Ninety-eight (98) or 26.6% were compliant and 270 (73.4%) were non-compliant. In multivariate analysis, the factors independently and negatively associated with non-adherence to treatment were schooling (adjusted OR [95% CI], p-value), 0.17 [0.10 - 0.30];p Conclusion: The factors influencing treatment compliance identified in this study are all modifiable. To prevent the complications of sickle cell disease, we must fight against ignorance, make care services accessible and make care free.

Prevalence of Medication Non-Adherence among Psychiatric Patients in a Tertiary Hospital in Nigeria

Background: The consequences of non-adherence to prescribed medications by psychiatric patients for both patients and the health care system are myriad and grave. Aim: The study was designed to ascertain the prevalence of medication non-adherence among psychiatric patients and identify factors that aid this malady. Methods: This prospective, cross-sectional study was carried out within a 4 month period at the out-patient psychiatric clinic of the University of Port Harcourt Teaching Hospital;using the Medication Adherence Rating Scale (MARS) and a self designed questionnaire containing socio-demographic and psychiatric illness variables. Results: A total number of 111 patients who participated in the study were analyzed. The cohort comprises 22 (19.8%) schizophrenics, 38 (34.2%) mood disorder patients, 24 (21.6%) anxiety disorder patients, 10 (9.0%) patients suffering from substance abuse and 17 (15.3%) with other psychiatric diagnoses (somatoform and personality disorders). Most of the patients were male (53;47.7%), aged between 21 - 30 yrs (44;39.6%), unemployed (38;34.2%), as single (58;52.3%). The prevalence of non-adherence to medications among the cohort studied is 39.6%. There was a significant association between consistency in taking one’s medications and MARS scores but none between socio-demographic variables and MARS score. Conclusion: The rate of medication non adherence among the subjects in this study was 39.6%. The three most important reasons reported for this behaviour include: Feeling that they had recovered from their illness and hence have been cured, belief that their illness was of a spiritual origin and hence would not be amenable to orthodox medicine and the side effects of the medications. Non adherence to medication increases the risk of psychiatric morbidity and mortality and efforts at curbing this trend must be eclectic.

Patient Characteristics Associated with Non-Adherence to Tuberculosis Treatment: A Systematic Review

Background: A high level of adherence to treatment is essential for cure and prevention of tuberculosis (TB) treatment resistance. Methods: A Systematic review of 53 studies addressing the patient characteristics associated with TB medication non-adherence was performed. The publications were identified by searching the PubMed, World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) database, EmBase, Scopus database Arts, Humanities, Social Science database and Google scholar. Only English language publications were eligible. Potentially eligible studies were retrieved and the full articles were assessed. The potentially eligible studies were included if they concerned patients treated for tuberculosis, reported non adherence and reported on potential risk factors associated with non-adherence. Results: Factors that were most frequently consistently and statistically significantly related to non-adherence to tuberculosis treatment were: family income, patient movement and changing address or giving wrong address, tuberculosis relapse or multidrug-resistant TB (MDRTB), during intensive phase of treatment, history of default, treatment regimen (long course), response to treatment, homeless, stigma, seeking traditional healers, staff receptiveness, lack of directly observed therapy short course (DOTS), poor knowledge or lack of health education, side effects of drugs, feeling better, alcohol intake and lack of family and social support. Conclusions: Non-adherence to tuberculosis treatment was influenced by several factors.

Patient and Health System Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Background: Non-adherence to hypertensive medication continues to become a contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure. Associated factors to non-adherence are complex, are both internal and external to the patient and are difficult to extrapolate. Reports from Chuka referral hospital records showed that in 2016 there were 140 patients with hypertensive complications from 560 patients who attended the medical clinic that year. Objective: This study sought to explore the patient’s related factors that are associated with non-adherence to hypertension medication. Methods: This is a descriptive study design of (N = 575) people among them doctors, pharmacists, nurses, record officers and hypertension patients. Simple random sampling for patients (n = 81) and census sampling for health care workers was done and data collected using questionnaires and interview schedules between April 4th-May 30th 2019. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. Results: 64% of the patients stated that they had missed medication. A significant negative correlation (rpb = -0.23, p < 0.05) between age and non-adherence, significant positive correlation with monthly income (rpb = 0.24, p < 0.04), non-significant relationship between non-adherence and marital status (rpb = -0.13, p = 0.25) and patients’ level of education (rpb = -0.06, p = 0.57). The overall model of health system related factors were found to be significant (p < 0.05) and this included;quality of health service, physician patient relationship, stock out, health education, and availability of medicine (p = 0.012). Conclusion: Lacks of funds, unavailability of drugs are the leading factors to regimen completion. This could be easily be addressed by the government.

Medication Non-Adherence and Disability among Outpatients with Schizophrenia in North-Central Nigeria

Background: About fifty percent of patients with Schizophrenia do not take their medication as prescribed. This scenario often results in disease progression and increased relapse rates, resulting in poor outcomes, including functional disability. Aim: This study was design to evaluate the relationship between medication non-adherence and disability in patients with Schizophrenia attending the outpatient clinic at the Jos University Teaching Hospital, north-central Nigeria, from June 2017 to November 2017. Methods: We carried out a cross-sectional study that employed a systematic sampling method to select 301 eligible subjects. We used the Medication Adherence Rating Scale (MARS) 10 and World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.00) to assess medication adherence and levels of disability. Results: The results show that 39.9% of the respondents were medication nonadherent. Medication adherence correlated negatively with the total disability score and all the domains of disability. A low level of education and poor social support were significant predictors of non-adherence. Conclusion: Medication non-adherence and its associated factors, if identified early and proper interventions instituted, a disability could be avoided or minimized among people with Schizophrenia. Therefore, we recommend regular screening of patients with mental disorders for early identification and intervention for medication adherence.

Predictors of Non-Adherence to Combined Anti-Retroviral Therapy among Expectant and Breastfeeding Women Receiving Care through Test and Treat Model in Lusaka

Introduction: To achieve viral suppression and reduce vertical transmission of HIV, more than eighty percent of pregnant or breastfeeding women in Zambia have been started on combined ART using the Test and Treat model. However, Chawama First Level Hospital in Lusaka had records which showed that 32 percent of pregnant or breastfeeding women were non-adherent to combined anti-retroviral therapy (cART). Method: A mixed-method study was conducted to establish predictors of non-adherence to cART by women in the Test and Treat model of care. For the quantitative component, 92 consenting Pregnant and breastfeeding women were randomly drawn from ART defaulter register and a semi-structured questionnaire was administered. Multiple logistic regression was conducted to improve predictive power and control for confounders. Quantitative Results: The mean age was 28years. The study established that housewives were 84 percent less likely to be non-adherent [AOR 0.16;95% CI 0.12, 0.36] compared to women who were formally employed with a statistically significant P-value of 0.04. Pregnant or breastfeeding women who were several months away from home were 84.9 percent more likely to be non-adherent [AOR 15.11;95% CI 13.9, 16.4] compared to women who had travelled away from home for several days. The associated P-value was 0.03. The study also established that pregnant and breastfeeding women who were counselled in individually enclosed units were 91 percent less likely to be non-adherent compared to those who were counselled in an open space as a group [AOR 0.09;95% CI 0.02, 0.53] with an associated P-value of 0.01. Conclusion: The study established that predictors of non-adherence to cART among pregnant and breastfeeding women were: being a working-class client;being away from home or usual clinic for several months;being counselled in open spaces, and negative staff attitude. Therefore, researcher can conclusively say that predictors of non-adherence to cART can be solved by training and re-training of health workers in Patient-Centred Care Model for effective patient engagement. Women should be counselled in private rooms. Furthermore, an improvement in patient’s tracking system by the use of smart-care-cards for pregnant and breastfeeding women countrywide can reduce patient’s non-adherence to cART.

Non-adherence to Anti-retroviral Therapy among HIV-Infected Individuals in Kyrgyzstan:Prevalence and Risk Factors,2014-2016

Backgrounds:Currently in Kyrgyzstan,ART(antiretroviral therapy)is freely provided to HIV-infected individuals on clinical grounds.Strict adherence to ART is required,it improves HIV-infected individuals’survival and quality of life,prevents HIV transmission and drug resistance.Our study aims to identify the prevalence of non-adherence to ART therapy and factors associated with it so that strategies can be designed to help maintain adherence.Methods:In a retrospective cohort study,we enrolled randomly selected 432 individuals,≥18 years of age,from among all HIV-infected individuals in Kyrgyzstan(n=950)who started ART during Jan.2014-Sep.2016.All were followed up until Dec.2016.Non-adherents were:(1)individuals lost to follow-up;(2)individuals who missed≥4.5 days of treatment per 30 days during the study period-this was established by comparing the total tablets prescribed,dates of visits for treatment,and number of tablets consumed.We reviewed the country’s HIV surveillance data and medical facilities records.We collected information on the known non-adherent risk factors,HIV clinical presentation,and details of treatment-regimens.We used logistic regression to assess the risk factors and non-adherent associations.Results:The overall non-adherence rate was 50%(214/432).In sub-group analysis,the highest rate was:61%(50/82)among alcohol abusers,60%(65/109)in those who received≥2 tablets/dose,59%(44/75)in those receiving≥2 doses/day,57%(89/155)in drug users,and 53%(144/271)in individuals aged<40 years.In multivariate analysis,≥2 tablets/dose(OR=2.1,95%CI 1.0-4.1),age<40 years(OR=1.7,95%CI 1.1-2.6),and alcohol abuse(OR=1.6,95%CI 1-2.8)were associated with non-adherence.Conclusion:The observed non-adherence rate is unacceptably high.Adherence can be improved by introducing the one tablet/day treatment regimen,establishing regular contact with those under ART,and providing them with appropriate counseling,especially those<40 years of age or with substance abuse.

Evaluation of Therapeutic Adherence in Patients Suffering from Chronic Inflammatory Rheumatism in the Rheumatology Wards of Lomé (Togo)

Objectives: Therapeutic compliance can be defined as the degree of adequacy between a patient’s behaviour and his doctor’s recommendations. Non-adherence to treatment has serious consequences in terms of morbidity and mortality. Our aim was to assess adherence among patients treated for chronic inflammatory rheumatism in Lomé. Patients and Methods: This was a multicentre cross-sectional study conducted from January 2015 to December 2021. Patients aged 18 years or older, treated in the rheumatology departments of the Sylvanus Olympio University Hospital or the Bè Hospital during the study period, were included if they were diagnosed with chronic inflammatory rheumatism and started on disease-modifying therapy. Adherence was assessed using the Compliance Questionnaire Rheumatology 19 questionnaire, with a threshold for good compliance set at 80%. Results: Out of 13,214 patients received, 159 suffered from chronic inflammatory rheumatism (hospital frequency 1.5%), and 60 met the inclusion criteria for our study. There were 55 women (91.7%) and 5 men (8.3%), giving a sex-ratio of 1/11. The mean age was 49.5 ± 13.5 years (extremes: 19 and 78 years). Rheumatoid arthritis (68.3%) was the most common rheumatic disease, followed by undefined rheumatic diseases (16.6%) and spondyloarthritis (8.3%). Average compliance with treatment was 76.9% ± 12.4% (extremes 29.8 and 91.2). There was no statistically significant difference according to the type of rheumatism. Conclusion: Overall compliance was poor, with a Compliance Questionnaire Rheumatology 19 of less than 80%. It was non-significantly influenced by socioeconomic status, disease severity and duration of progression.

Factors Associated with Non-Compliance among Patients with Chronic Kidney Disease at the Departmental University Hospital of Borgou and Alibori in Parakou (Benin)

Introduction: Therapeutic compliance in chronic kidney disease (CKD) represents a major challenge for the prevention of this condition, which is both a non-communicable disease (NCD) and a complication of other NCDs. Non-adherence to treatment (NOT) is a factor in the poor prognosis of CKD in developing countries, particularly in Benin. The aim of this study was to evaluate therapeutic compliance (TC) and determine the factors associated with non-compliance in patients with chronic kidney disease undergoing treatment at the Departmental University Hospital of Borgou and Alibori in Parakou (CHUD/B-A). Patients and Methods: This study was carried out in the Nephrology Department of CHUD/B-A. It was a cross-sectional, descriptive study with analytical aims that ran from December 25, 2022 to March 15, 2023 and covered data from 2017 to 2022. It involved 345 patient records meeting the diagnosis of CKD according to the KDIGO 2012 criteria. NOT was defined by a Girerd score evaluation greater than or equal to 3. Data processing and analysis were performed with R software version 4.3.0. Results: The mean age (SD) of patients was 50 years (±14.9). The prevalence of NOT was 57.1%. Potential predictors of non-adherence were: monthly revenue (p = 0.009), mode of admission (p = 0.001), phytotherapy (p = 0.040), traditional treatment (p = 0.049) and quantity of drugs (p = 0.042). Conclusion: Therapeutic compliance among chronic kidney patients still needs to be improved through awareness-raising sessions.

Medication adherence in schizophrenia

Non-adherence is a major problem in the treatment of schizophrenia. Its high prevalence, potentially severe consequences and associated costs make the study of this phenomenon a priority issue. In this article, basic non-adherence concepts of prevalence, consequences, evaluation methods, methodological restrictions of available studies, risk factors and intervention strategies, are reviewed. Studying non-adherence risk factors is a necessary step toward designing adequately oriented intervention strategies. An operative definition of adherence and good knowledge of its evaluation methods are essential to study this phenomenon. Unfortunately, most available studies contain methodological restrictions, especially concerning the evaluation methods, and an agreed operative definition of adherence has only very recently been reached. Knowing non-adherence risk factors, intervention strategies and available evidence on their effectiveness is essential in making treatment decisions in daily clinical practice.

Treatment-adherence in bipolar disorder: A patient-centred approach

About half of the patients diagnosed with bipolar disorder(BD) become non-adherent during longterm treatment, a rate largely similar to other chronic illnesses and one that has remained unchanged over the years. Non-adherence in BD is a complex phenomenon determined by a multitude of influences. However, thereis considerable uncertainty about the key determinants of non-adherence in BD. Initial research on nonadherence in BD mostly limited itself to examining demographic, clinical and medication-related factors impacting adherence. However, because of inconsistent results and failure of these studies to address the complexities of adherence behaviour, demographic and illness-related factors were alone unable to explain or predict non-adherence in BD. This prompted a shift to a more patient-centred approach of viewing nonadherence. The central element of this approach includes an emphasis on patients' decisions regarding their own treatment based on their personal beliefs, life circumstances and their perceptions of benefits and disadvantages of treatment. Patients' decisionmaking processes are influenced by the nature of their relationship with clinicians and the health-care system and by people in their immediate environment. The primacy of the patient's perspective on non-adherence is in keeping with the current theoretical models and concordance-based approaches to adherence behaviour in BD. Research over the past two decades has further endorsed the critical role of patients' attitudes and beliefs regarding medications, the importance of a collaborative treatment-alliance, the influence of the family, and the significance of other patient-related factors such as knowledge, stigma, patient satisfaction and access to treatment in determining non-adherence in BD. Though simply moving from an illness-centred to a patientcentred approach is unlikely to solve the problem of nonadherence in BD, such an approach is more likely to lead to a better understanding of non-adherence and more likely to yield effective solutions to tackle this common and distressing problem afflicting patients with BD.

Challenges and Recommendations to Recruiting Women Who Do Not Adhere to Follow-Up Gynecological Care

Purpose: Non-adherence to recommended follow-up visits after an abnormal cytological finding is associated with poorer outcomes and higher health care costs. The purpose of this paper is to describe the challenges when examining reasons for non-adherence to cervical cancer screening follow-up and to discuss the recommendations to overcome those challenges. Methods: We conducted a telephone survey with two subgroups of women: 1) those which adhered to recommended follow-up care after an abnormal Pap test, and 2) those which did not adhere. Results: The follow-up accrual among non-adherent women lagged behind that of adherers. We were able to contact and conduct a survey with 51% of the adherers and 26% of the non-adherers. The challenges in studying non-adherent women were related to several distinct factors: 1) the definition of non-adherence, 2) the availability of alternate contact information, 3) the amount and type of financial incentives, and 4) the availability of staffing. We describe strategies employed to increase the accrual of non-adherent women. Discussion: This paper describes four recommendations that may play a role in understanding and reducing non-adherence to follow-up gynecological care.

Patient and Health System Factors Associated with First Line Tuberculosis Treatment Adherence, 2009-2014

Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the strength of association between known patient and health system factors associated with first line tuberculosis treatment adherence. Methods: A quantitative cross sectional study. Retrospective chart reviews were conducted among 570 persons who had primary tuberculosis and received first line treatment at a health facility within the Nkangala district, Mpumalanga province and who had a treatment outcome recorded between 1st January 2009 and 31st December 2014. Adherence to first line tuberculosis treatment was defined as taking ≥80% of tuberculosis prescribed drugs within a period of 6 to 8 months. Stata software (logistic regressions model) was used to analyze results and find the strength of association between known factors and treatment adherence. Results: Out of the 570 study participants, 473 were adherent and 96 were not adherent. There was a statistically significant association between age 18 years and above (OR: 1.02, P-value: 0.027), sex (lower in males OR: 0.44, P-value: 0.001) and support (OR: 3.04, P-value: 0.05) and HIV (OR: 1, P-value: 0.634) and first line TB treatment adherence. Conclusion and Recommendation: >80% adherence to first line tuberculosis outcome is possible. The support given to people with tuberculosis will further enhance adherence to first line tuberculosis treatment.