Frontiers of Retrovirology       2011   3 – 5 October, 2011       Presentation Developed by Doreen Ofosu
The Dose-Adherence Model:A Critical Review of the Computation of Level of   Adherence to Antiretroviral Drug Regimen      ...
Outline• Research Objectives• Research Background• Literature Review• Further Research• Significance of Study• The Study  ...
Outline Contd• Questionnaire• Results o Result of Objective A o Results of Objective B• Conclusion• Recommendation• Biblio...
Research Objectives• Objective A  To develop a model for determining long-term dose-  adherence•    Objective B    To dete...
Research Background                       Adherence Defined• Usually taking 80% or more of the prescribed regimen.(Chesney...
Research Background ContdHIV treatment adherence is essentialSource: YouTube Video Uploaded by Mindset Health             ...
Literature Review1. Bachiller et al., 1998   ... reports of adherence range from 25% - 85%.2. Weiser et al., 2003   ... ad...
Literature Review Contd3. Haubrich et al., 1999   ... labeled patients as adherent if at least 80% of the   prescribed dos...
Further Research• No known model for computing long-term adherence• Sample tweets on next slide confirms this             ...
TweetsPresentation Developed by Doreen Ofosu
Significance of ModelConsiders  • Long-term default frequency  • Short-term recall of missed doses or self-report         ...
The Study• Study Population  o ART clients• Inclusion Criteria   o Must be 18 years and above   o Must be an outpatient   ...
The Study ContdEthical Considerations   • Permission sought from regional, district and facility     administrations befor...
The Study ContdStudy Area   • Eastern Region of GhanaFacts About the Eastern Region of Ghana  • Highest HIV prevalence n t...
The Study ContdStudy Sites   • Social support groups – eleven   • Ten districtsART facilities - three   • Regional hospita...
The Study ContdMethodology  Study Design  • Cross-sectional  Data Collection Tool  • Standardized questionnaires  Data Col...
Questionnaire Administration On        Dose-Adherence     Questions Asked and Responses           Presentation Developed b...
Questionnaire• Q. ART duration (expected doses)  A. One month to three years• Q. Missed doses  A. Yes or no• Q. Reasons fo...
Questionnaire Contd• Q. Ever re-started if defaulted  A. Yes or no• Q. Reasons for re-starting if yes  A. I got my drugs  ...
Questionnaire Contd• Q. Difficulty in adhering to dose regimen  A. Yes or no• Q. Frequency at which doses were missed (Def...
Questionnaire ContdFrame of long-term default frequency question   • Educational level   • OccupationSeasons Used  • Relig...
ResultsPresentation Developed by Doreen Ofosu
Result Of Objective AThe Dose-adherence model developed from  • Expected doses  • Default frequency  • Observed doses     ...
Results of Objective A ContdComputation of Expected Doses (E)   • Number of weeks on ART (ART duration) multiplied by 14Co...
Results of objective A ContdComputation of Observed Doses (O)  • Defaulted continuously for weeks =                E multi...
The Dose-Adherence Model      Presentation Developed by Doreen Ofosu
The Dose-Adherence Model• A Mathematical Model for Determining Long-term Level of  Adherence to Dose Regimen:  "Level of a...
The Dose-Adherence Model ContdMathematically:• Level of Adherence (%) = O / E•    Level of Adherence (%) = Default Frequen...
Results of Objective BRespondents statistically significant at p-value of 0.051• 25%       -   1.1% of respondents• 50%   ...
ConclusionThe Dose-Adherence Model  • Complements other methods of deducing adherence level  • Considers long-term default...
Recommendation• Digitising long-term adherence computation using the Dose-  adherence Model                     Presentati...
Presentation Developed by Doreen Ofosu
Bibliography1. Bachiller, P., Arrando, F.R., Liceago, G., Iribarren, J.A. & Olloquiegui, E. (1998).   Drug Compliance in P...
AcknowledgmentCo-Authors• Mr. P. Agyei-Baffour (Academic Supervisor, KNUST)• Rev. Dr. E. Browne (Fmr Head, Community Healt...
Further Information  • www.bit.ly/gi8Awh  • ww.doseadherencemodel.wordpress.comDo You Have Questions And / Or Comments? Go...
Presentation Developed by Doreen Ofosu
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ARV Adherence Model

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Doreen's quest to determine the adherence levels of ART clients in the Eastern Region of Ghana led to the discovery of a model for computing the adherence levels of respondents - The Dose Adherence Model.

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ARV Adherence Model

  1. 1. Frontiers of Retrovirology 2011 3 – 5 October, 2011 Presentation Developed by Doreen Ofosu
  2. 2. The Dose-Adherence Model:A Critical Review of the Computation of Level of Adherence to Antiretroviral Drug Regimen By: Doreen Ofosu Kwame Nkrumah University of Science & Technology Kumasi, Ghana Presentation Developed by Doreen Ofosu
  3. 3. Outline• Research Objectives• Research Background• Literature Review• Further Research• Significance of Study• The Study Presentation Developed by Doreen Ofosu
  4. 4. Outline Contd• Questionnaire• Results o Result of Objective A o Results of Objective B• Conclusion• Recommendation• Bibliography• Acknowledgment• Further Information Presentation Developed by Doreen Ofosu
  5. 5. Research Objectives• Objective A To develop a model for determining long-term dose- adherence• Objective B To determine the dose-adherence levels of ART clients in the Eastern Region of Ghana Presentation Developed by Doreen Ofosu
  6. 6. Research Background Adherence Defined• Usually taking 80% or more of the prescribed regimen.(Chesney, 1997)• In people with HIV infection, reports of adherence range from 25% to 85%.(Bachiller et al., 1998) Presentation Developed by Doreen Ofosu
  7. 7. Research Background ContdHIV treatment adherence is essentialSource: YouTube Video Uploaded by Mindset Health Presentation Developed by Doreen Ofosu
  8. 8. Literature Review1. Bachiller et al., 1998 ... reports of adherence range from 25% - 85%.2. Weiser et al., 2003 ... adherence for ARV therapy ranges from 40% to 60% with an average of 50% adherence level. Presentation Developed by Doreen Ofosu
  9. 9. Literature Review Contd3. Haubrich et al., 1999 ... labeled patients as adherent if at least 80% of the prescribed doses are taken.4. Paterson et al., 2000 ... it has been estimated that at least 95% of the prescribed dose is needed to maintain HIV viral suppression and to prevent the occurrence of drug resistance. Presentation Developed by Doreen Ofosu
  10. 10. Further Research• No known model for computing long-term adherence• Sample tweets on next slide confirms this Presentation Developed by Doreen Ofosu
  11. 11. TweetsPresentation Developed by Doreen Ofosu
  12. 12. Significance of ModelConsiders • Long-term default frequency • Short-term recall of missed doses or self-report Presentation Developed by Doreen Ofosu
  13. 13. The Study• Study Population o ART clients• Inclusion Criteria o Must be 18 years and above o Must be an outpatient o Must be willing to participate• Exclusion Criteria o Below 18 years o Weak clients Presentation Developed by Doreen Ofosu
  14. 14. The Study ContdEthical Considerations • Permission sought from regional, district and facility administrations before commencement of study • Client consent sought • Consent form explained to client in detail • Willing clients sign consent forms and given a copy Presentation Developed by Doreen Ofosu
  15. 15. The Study ContdStudy Area • Eastern Region of GhanaFacts About the Eastern Region of Ghana • Highest HIV prevalence n the country • 2004 HIV Sentinel Survey puts HIV prevalence of the Region at 6.5% against the national figure of 3.1% • 2008 regional prevalence 4.5% against national rate of 1.7%Study Coverage • Fifteen of the then seventeen districts Presentation Developed by Doreen Ofosu
  16. 16. The Study ContdStudy Sites • Social support groups – eleven • Ten districtsART facilities - three • Regional hospital • District hospital • Mission hospital Presentation Developed by Doreen Ofosu
  17. 17. The Study ContdMethodology Study Design • Cross-sectional Data Collection Tool • Standardized questionnaires Data Collection Technique • Exit interviews Presentation Developed by Doreen Ofosu
  18. 18. Questionnaire Administration On Dose-Adherence Questions Asked and Responses Presentation Developed by Doreen Ofosu
  19. 19. Questionnaire• Q. ART duration (expected doses) A. One month to three years• Q. Missed doses A. Yes or no• Q. Reasons for missing if yes A. Forgetfulness Carelessness Stopping the drug when feeling better / worse Other (Specify) Presentation Developed by Doreen Ofosu
  20. 20. Questionnaire Contd• Q. Ever re-started if defaulted A. Yes or no• Q. Reasons for re-starting if yes A. I got my drugs Returned from journey I was feeling weak Frequent rashes Headaches Swellings Anxiety Frequent coughs Other (Specify) Presentation Developed by Doreen Ofosu
  21. 21. Questionnaire Contd• Q. Difficulty in adhering to dose regimen A. Yes or no• Q. Frequency at which doses were missed (Default Frequency) A. Defaulted continuously for weeks Missed often Missed a few times Never missed Presentation Developed by Doreen Ofosu
  22. 22. Questionnaire ContdFrame of long-term default frequency question • Educational level • OccupationSeasons Used • Religious • Traditional • Farming • Fishing • Academic calendars • National holidays Presentation Developed by Doreen Ofosu
  23. 23. ResultsPresentation Developed by Doreen Ofosu
  24. 24. Result Of Objective AThe Dose-adherence model developed from • Expected doses • Default frequency • Observed doses Presentation Developed by Doreen Ofosu
  25. 25. Results of Objective A ContdComputation of Expected Doses (E) • Number of weeks on ART (ART duration) multiplied by 14Computation of Default Frequency (Literature Based) • 25% [1] • 50% [2] • 80% [3] • 100% [4]Respondent frequency synonymous with doses missed Presentation Developed by Doreen Ofosu
  26. 26. Results of objective A ContdComputation of Observed Doses (O) • Defaulted continuously for weeks = E multiplied by 25% [1] • Missed often = E multiplied by 50% [2] • Missed a few times = E multiplied by 80% [3] • Never missed = E multiplied by 100% [4] Presentation Developed by Doreen Ofosu
  27. 27. The Dose-Adherence Model Presentation Developed by Doreen Ofosu
  28. 28. The Dose-Adherence Model• A Mathematical Model for Determining Long-term Level of Adherence to Dose Regimen: "Level of adherence is the ratio of the observed doses (O) and the expected doses (E)." - Ofosu et al., (2008)Otherwise stated as: "Level of adherence is directly proportional to the frequency at which doses are missed." - Ofosu et al., (2008) Presentation Developed by Doreen Ofosu
  29. 29. The Dose-Adherence Model ContdMathematically:• Level of Adherence (%) = O / E• Level of Adherence (%) = Default Frequency Presentation Developed by Doreen Ofosu
  30. 30. Results of Objective BRespondents statistically significant at p-value of 0.051• 25% - 1.1% of respondents• 50% - 1.7% of respondents• 80% - 14.0% of respondents• 100% - 83.2% of respondents Presentation Developed by Doreen Ofosu
  31. 31. ConclusionThe Dose-Adherence Model • Complements other methods of deducing adherence level • Considers long-term default frequency and short-term recall Presentation Developed by Doreen Ofosu
  32. 32. Recommendation• Digitising long-term adherence computation using the Dose- adherence Model Presentation Developed by Doreen Ofosu
  33. 33. Presentation Developed by Doreen Ofosu
  34. 34. Bibliography1. Bachiller, P., Arrando, F.R., Liceago, G., Iribarren, J.A. & Olloquiegui, E. (1998). Drug Compliance in Patients Starting Saquinavir. 12th World AIDS Conference, Geneva, Abstract 32392.2. Chesney, M.A. (1997). New HAART Therapies: Adherence Challenges and Strategies Evolving HIV Treatments: Advances and the Challenges of Adherence of Adherence. 37th ICAAC Symposium, Toronto, Canada.3. Haubrich R.H., Little S.I., Currier J.S., Forthal D.N., Kemper C.A. and Beall G.N. (1999). The Value of Patient-Reported Adherence to Antiretroviral Therapy in Predicting Virologic and Immunologic Response. California Collaborative Treatment Group. AIDS; 13(9):1099- 107.4. Paterson D.L., Swindels S. & Mohr J. (2000). Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection. Annals of Internal Medicine, 133, 21A.5. Weiser S., Wolfe W., Bangsberg D., Thior I., Gilbert P., Makhema J. (2003). Barriers to Antiretroviral Adherence for Patients Living with HIV Infection and AIDS in Botswana. Acquired Immune Deficiency Syndrome; 34(3):281-8.6. http://twitter.com. Tweets on Drug Adherence (September, 2011).7. http://youtube.com. HIV Treatment Adherence is Essential. Video uploaded by Mindset Health (August 5, 2009). Presentation Developed by Doreen Ofosu
  35. 35. AcknowledgmentCo-Authors• Mr. P. Agyei-Baffour (Academic Supervisor, KNUST)• Rev. Dr. E. Browne (Fmr Head, Community Health, KNUST)• Mr. J.A. Amankwah (Administration, KATH)• Dr. G. Acquah-Hagan (Medical Doctor, KATH)Special Thanks• Dr. S.B. Ofori (Field Supervisor, Regional ART coordinator)• Dr. Akyeampong (HIV Clinic, KATH) Presentation Developed by Doreen Ofosu
  36. 36. Further Information • www.bit.ly/gi8Awh • ww.doseadherencemodel.wordpress.comDo You Have Questions And / Or Comments? Go to: • http://portal.sliderocket.com/Dose-Adherence-Model- Presentation Presentation Developed by Doreen Ofosu
  37. 37. Presentation Developed by Doreen Ofosu

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