Medicine burden experiences of people living with HIV and association with stigma

The medicine burden of people living with HIV (PLWH) is unknown. Between 2018 and 2020,participants completed a survey comprising outcome measures for medicine burden (LMQ-3)and stigma experiences (SSCI-8). Participants were HIV+ adults (≥18 years), using antiretrovirals(ARV) with or without non-ARV medicines, recruited via two outpatient clinics in southeastEngland and online via HIV charities across the UK. Spearman’s correlations between medicineburden levels and stigma scores were calculated. Participants were mostly males (72%, 101/141)of mean (SD) age 48.6 (±12.31) years. Total number of medicines ranged from 1-20. Highmedicine burden was self-reported by 21.3% (30) and was associated with polypharmacy (≥5medicines) (101.52 Vs 85.08,p= 0.006); multiple doses versus once daily regimes (109.31 Vs85.65,p= 0.001); unemployment (98.23 Vs 84.46,p= 0.004); and ethnicity (97 Vs 86.85,p= 0.041for non-White versus White participants). A correlation between medicine burden and stigmawas observed (r = 0.576,p< 0.001). The LMQ-3 demonstrated adequate construct validity andreliability (domain loadings ranging 0.617-0.933 and Cronbach’sαof 0.714-0.932). Assessmentof medicine burden and psychosocial stigma in PLWH could enable identification of thoseneeding additional support in future research and practice

Acute toxicity, antipyretic and antinociceptive study of the crude saponin from an edible vegetable: Vernonia amygdalina leaf

Vernonia amygdalina is commonly used for food and health purposes. Processing of the leaf for food is aimed at removing bitter tasting antinutritional principles like saponins. This study was designed to determine the antipyretic and antinociceptive property of the crude saponin from Vernonia amygdalina leaf. Standard procedure for antipyretic study using Saccharomyces cerevisiae induced pyrexia in rats; and acetic acid induced writhe, hot plate and cold tail flick tests for antinociceptive study in mice were used. Data for the crude saponin showed significant (P &#8804; 0.05) dose dependent anal temperature decrease. The antinociceptive data in mice was significant (P &#8804; 0.05) in the writhing test contrary to the cold tail flick test. In acute toxicity study, an LD50 of 5.1523 g/kg using oral route indicated it was practically non-toxic. Finding suggests that Vernonia amygdalina leaf prepared as diet could be of potential benefit to ailing persons with fever and/or pains, if processing technique adopts minimal loss of principles like saponins.Keywords: Mice, oral, pain, pyrexia, ra

The impact of cardiovascular medication use on patients’ daily lives: a cross-sectional study

Introduction The management of multiple long-term medicines use in patients with chronic diseases creates a burden for patients. However, limited research is performed on patients’ experienced medication-related burden and its impact on daily lives. Therefore, the aim of this study was to explore the impact of cardiovascular medication on different aspects of patients’ daily lives and to examine the differences of these aspects between adherent and non-adherent patients. Methods A cross-sectional study was performed in two community pharmacies in the Netherlands. Patients (?45 years) using cardiovascular medication participated. Data were collected by means of the Living with Medicines Questionnaire (LMQ-2) measuring the burden of medicines use on patients’ daily lives. Two equally group-sized samples of patients non-adherent to prescribed medicines as assessed with pharmacy refill data, and patients adherent to prescribed medicines were selected. Results In total, 196 patients participated (51% male, 71.0±10.6 years), of whom 96 patients were non-adherent to cardiovascular medication. Substantial proportions of patients experienced medication-related burden on different daily life aspects. This burden was mainly related to the acceptance of long-term medication use, medication-related concerns or dissatisfaction, the interference of medicines with social and daily lives, and the interaction and communication with health care providers. No statistically significant results were found when comparing the impact on patients’ daily lives between the adherent and non-adherent sample. Conclusion Health care providers should acknowledge the impact of multiple long-term medicine use on patient’s daily lives and should make an effort to diminish patients’ medication-related burden by improving patient-provider relationships and by providing adequate treatment information incorporating patients’ individual circumstances and preferences. This may facilitate the integration of long-term medicines use in patients’ daily lives

Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals

Sex in the shadow of HIV:A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIVpositive adolescents and youth in sub-Saharan Africa

Background Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Methods Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10-24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. Results 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n=35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored Conclusions Sexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group.</p

Measuring medicine-related experiences from the patient perspective: a systematic review

Barbra Katusiime,1 Sarah Corlett,1 Joanne Reeve,2 Janet Krska1 1Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK; 2Warwick Medical School, University of Warwick, Coventry, UK Background: There is an increasing drive to measure and so improve patients&rsquo; experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients&rsquo; experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients&rsquo; experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. Methods: Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID&reg;, and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes. Results: Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine-related quality of life. None of the identified questionnaires covered all domains. Instruments varied in the extent of patient involvement in both their development and validation. Conclusion: There is a scarcity of psychometrically sound, comprehensive, and generic measures of experiences of using prescription medicines among adult patients living with chronic illnesses. There is a need for further development and/or validation of existing instruments suitable for use in this population. Keywords: prescription medicine, patient experience, questionnaire, patient-reported outcome, development, validatio

Patients&rsquo; Experiences and Preferences for Medicine Information: An International Comparison Between Malaysia, Thailand, Uganda, and England

Pitchaya Nualdaisri,1,2 Sarah A Corlett,2,3 Immaculate Akaso,4 Barbra Katusiime,5 Freddy Eric Kitutu,4 Siew Siang Chua,6 Janet Krska2 1Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand; 2Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK; 3Pharmacy Department, Medway Foundation NHS Trust, Kent, UK; 4Department of Pharmacy, School of Health Sciences, Makerere University, Kampala, Uganda; 5School of Life Sciences, Pharmacy and Chemistry, Department of Pharmacy, Kingston University, London, UK; 6School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, MalaysiaCorrespondence: Pitchaya Nualdaisri, Email [email protected]: Verbal and written medicine information are available to the public but the quality, ease of access, ease of understanding and use of these resources varies greatly between countries. Timely access to quality medicine information is essential to support patient safety.Objective: This international cross-sectional survey, conducted in low-to high-income countries, aimed to compare experiences of and preferences for medicine information sources among respondents with recent medicine use.Methods: The survey was originally developed in England (Kent), then adapted and translated for use in southern Thailand (Songkhla), Malaysia (Klang Valley), and central Uganda (Kampala). Data were analysed using simple descriptive statistics and Chi-squared tests.Results: A total 1588 respondents were involved in the study. Community pharmacies were the primary source of medicines in all four countries (40.7 to 65.3%). Most respondents (1460; 92%) had received at least one form of information with their medicine, but provision of written medicine information (WMI) varied between countries. A manufacturer’s leaflet was the most frequent information source for patients in England, while verbal information was common in Thailand, Malaysia and Uganda. There was commonality across countries in the desire for verbal information with or without WMI (1330; 84.8%); aspects of medicine information wanted most frequently were instructions on medicine use (98.3%), indication (98.2%), name (94.4%) and possible side effects (94.3%); and the importance of providing leaflets with all medicines (87.5%). Fewer than 10% in Uganda would use internet based WMI, compared to between 20% and 55% elsewhere.Conclusion: Preferences for medicine information are similar across countries: verbal information is seen as most desirable, and the most wanted aspects of information are common internationally. Accessibility and understandability are key influences on preferred information sources. In-country regulations and practices should ensure that all medicine users can access the information necessary to maximise safe medicine use.Keywords: medicine information sources, patient information leaflets, patient preference, cross-country comparison, international surve