Ontario HIV Treatment
Network; Canadian Institutes for Health Research; National Institues of Health (AI005535901, K23A106858201, AA015287, MH54907, AI27763); British Columbia Michael Smith Foundation; The Doris Duke Charitable Foundation

https://www.ghdonline.org/uploads/Adherence_to_HAART_A_Systematic_Review_of_Developed_and_Developing_Nation_Patient-Reported_Barriers_and_Facilitators_.pdf

Adherence to HAART: A Systematic Review of Developed and Developing Nation Patient-Reported Barriers and Facilitators

Nonadherence with medication occurs in all chronic medical disorders It is a particular challenge in schizophrenia due to the illness's association with social isolation, stigma, and comorbid substance misuse, plus the effect of symptom domains on adherence, including positive and negative symptoms, lack of insight, depression, and cognitive impairment Nonadherence lies on a spectrum, is often covert, and is underestimated by clinicians, but affects more than one third of patients with schizophrenia per annum It increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life It results from multiple patient, clinician, illness, medication, and service factors, but a useful distinction is between intentional and unintentional nonadherence There is no gold standard approach to the measurement of adherence as all methods have pros and cons Interventions to improve adherence include psychoeducation and other psychosocial interventions, antipsychotic long-acting injections, electronic reminders, service-based interventions, and financial incentives These overlap, all have some evidence of effectiveness, and the intervention adopted should be tailored to the individual Psychosocial interventions that utilize combined approaches seem more effective than unidimensional approaches There is increasing interest in electronic reminders and monitoring systems to enhance adherence, eg, Short Message Service text messaging and real-time medication monitoring linked to smart pill containers or an electronic ingestible event marker Financial incentives to enhance antipsychotic adherence raise ethical issues, and their place in practice remains unclear Simple pragmatic strategies to improve medication adherence include shared decision-making, regular assessment of adherence, simplification of the medication regimen, ensuring that treatment is effective and that side effects are managed, and promoting a positive therapeutic alliance and good communication between the clinician and patient These elements remain essential for all patients, not least for the small minority where vulnerability and risk issue dictate that compulsory treatment is necessary to ensure adherence

/pdf/nonadherence-with-antipsychotic-medication-in-schizophrenia-53lp78qf5y.pdf

Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies

Pharmaceuticals have greatly improved health in developing countries, but many people in developing countries do not obtain even inexpensive pharmaceuticals and little pharmaceutical R&D is oriented toward products needed by developing countries, such as a malaria vaccine. Access to existing products could be improved by facilitating differential pricing, for example by subsidizing donation programs, and reforming health care delivery. R&D incentives could be improved if rich countries or international organization committed to purchase needed products when they are developed and make them available to the poor.

/pdf/pharmaceuticals-and-the-developing-world-2cyxjj3ssw.pdf

Pharmaceuticals and the developing world.

Adherence to HIV treatment among IDUs and the role of opioid substitution treatment (OST)

HIV/AIDS in Europe: Moving from Death Sentence to Chronic Disease Management

The case-notes of 3210 patients with HIV infection were audited. A sexual history was documented within four weeks before or after initial HIV diagnosis in 69% of cases (regional range 45-84%), and in the six months before attendance during the audit interval in 34% (12-53%). An offer of tests for sexually transmitted infections was documented within four weeks before or after HIV diagnosis in 58% (30-83%), and in the prior six months in 28% (14-47%). Syphilis serology was offered in the previous three months to 45% (14-100%) of cases resident in syphilis outbreak areas and to 25% (7-62%) of other cases. Hepatitis B testing was performed for 98% (95-100%) of cases and for hepatitis C, for 91% (79-100%). Cervical cytology results in the past year were documented for 73% (43-94%) of eligible women. Considerable inter-regional variation in performance exists. Interventions are needed to improve the sexual health care of people with HIV infection.

UK national audit of sexual health care for people with HIV infection: case-notes audit.

A national audit of 781 early syphilis cases presenting during 2002-03 in UK genitourinary medicine clinics was conducted in late 2004, organized through the Regional Audit Groups. Data were aggregated by region and National Health Service trust, allowing practice to be compared between regions, between trusts within regions, as well as to national averages and the UK National Guidelines. An enzyme immunoassay was used to diagnose 695 (89%) cases (regional range 18-100%). Use of a non-treponemal test was not recorded for 44 (6%) cases. Dark ground microscopy was used in the diagnosis of only 80 (29%) primary cases. Uptake of HIV testing was 77% (range 69-94%). Nationally, 527 (67%) treatments were parenteral, with almost equal use of benzathine penicillin G for 262 (50%, range 0-97%) cases and procaine penicillin G (PPG) for 260 cases (49%, range 3-100%). There were 14 (5%) treatments with less than the recommended 750 mg dose of PPG. One hundred and five (40%) PPG treatments were with greater than 750 mg and/or for longer than 10 days of which 76 (72%) were for early latent syphilis and/or cases with HIV infection. One hundred and ninety two (86%, range 0-100%) of all oral treatments were with doxycycline. The recommended regimen of 100 mg doxycycline twice daily for 14 days was used for 104 (53%) cases; the other 91 (47%) treatments were with a variety of regimens, mainly treatments with larger doses and/or longer treatment intervals and some combination treatments. Fourteen (2%) cases were not treated; treatment was not reported for seven (0.9%) and not known for 10 (1.3%) cases, who were treated at other centres.

/pdf/uk-national-audit-of-early-syphilis-management-case-notes-1sxscdwyrh.pdf

UK National Audit of Early Syphilis Management. Case notes audit: diagnosis and treatment.

Of clinics responding to the audit, 99 and 97% have policies that are compliant with the British Association for Sexual Health and HIV National Guidelines for testing of asymptomatic men and women for HIV and syphilis, respectively. All clinics offer men, and all but one clinic offer women, screening for chlamydial infection with nucleic acid amplification tests (NAATs), as recommended by the guidelines. However, for gonorrhoea screening one-third of clinics offer men urine or urethral NAATs, and one quarter of clinics offer women endocervical, vulvovaginal or urinary NAATs, and not endocervical culture, and these practices are not compliant with the guidelines. Eight clinics did not specify whether they routinely offer testing for gonorrhoea in women. One-third of clinics routinely perform rectal and oropharyngeal screening for gonorrhoea in men who have sex with men (MSM), but fewer screen for chlamydia, regardless of sexual history which is stated as a determinant of offering screening at these anatomical sites. Finally, one-fifth of clinics offer urethral microscopy to asymptomatic heterosexual men and MSM, and about one half of clinics offer urethral culture for detection of gonorrhoea in asymptomatic women, even though these practices are not compliant with the guidelines.

National audit of asymptomatic screening in UK genitourinary medicine clinics: clinic policies audit

Contact tracing was provided for 683/781 (87%, regional range 57-97%) cases, and identified 997 traceable contacts of whom 511 (51%) were seen, short of the recommended standard of 60%. However, the performance range for this standard was 26-70%, with seven regions achieving 60% or more. Of 511, 215 (42%, range 3-73%) contacts had syphilis. Treatment completion was recorded for 691 (88%, range 71-100%) cases, and resolution of lesions for 348/469 (74%, range 40-96%) cases. Nationally, 419/764 (55%, range 37-70%) cases were recorded as having a two dilution (four-fold) or greater decrease in non-treponemal test titre within 3-6 months after treatment; not achieving this titre decrease was mainly attributable to non-attendance for follow-up and failure of titre levels to fall. Follow-up of infectious syphilis in UK genitourinary medicine clinics is poor and falls far short of that recommended by National Guidelines. Only 16 (2%) cases had follow-up at intervals approximating to 1, 2, 3, 6 and 12 months, and only 312 (40%, range 5-61%) cases attended at least two follow-up visits. Only 17 (7%) of all 236 oral treatments (including switches to oral treatment), and 33 (27%) of 123 cases with HIV infection were recorded as designated annual follow-up. Further work is needed to determine factors that account for the wide variation between regions in contact tracing and follow-up performance.

/pdf/uk-national-audit-of-early-syphilis-management-case-notes-34kqvz5c7z.pdf

UK National Audit of Early Syphilis Management. Case-notes audit: contact tracing, information giving, follow-up and outcomes.

In 1996 the General Medical Council recommended, where possible, offering chaperones to patients during intimate examinations. This advice was incorporated into a report from a Royal College of Obstetricians and Gynaecologists working party.1 Subsequently, Torrance et al performed a postal survey of practice in 175 genitourinary medicine (GUM) clinics in the United Kingdom.2 This study also concluded that chaperones should be offered to patients more widely during genital examinations in genitourinary medicine (GUM) clinics.2 In contrast, other studies have shown that male patients are comfortable with genital examinations being performed by doctors of either sex,3 and …

https://sti.bmj.com/content/sextrans/79/1/74.2.full.pdf

Chaperoning in genitourinary medicine clinics.

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