Factors Affecting Adherence to Antiretroviral Therapy

The success of highly active antiretroviral therapy (HAART) for treating human immunodeficiency virus (HIV) disease depends on maintaining a high level of adherence. Non-adherence is associated with a poor short-term virological response and accelerates the development of drug-resistant HIV. The shift to combination therapies for treating HIV-infected individuals has increased the challenges of adherence for both patients and health-care providers. The cumulative number of people in April 2015 who were eligible for HAART but had not yet started the therapy at the Adam Malik Hospital in Medan City Indonesia was 1,669 out of 6,033 people (27.66%). The cumulative number of absentees and loss to follow-up at >3 months was 1,273 out of 4,364 people (29.17%) up to April 2015.This study was a cross-sectional investigation of the factors associated with adherence to antiretroviral consumption for HIV-infected individuals at the Adam Malik Hospital in 2015. The sample size was 65 people, using consecutive sampling. The data were collected from medical records, observations, and an interview with a questionnaire. The data analysis included descriptive study, the chi-square test, Fisher’s exact test, and logistic regression, using STATA software. The results showed pill adherence in 28 patients (43.08%) and non-adherence in 37 patients (56.92%). The principal factors associated with non-adherence in the logistic regression were patient-related, including occupation (p = 0.062; OR = 0.22) and pill burden (p = 0.080; OR = 6.20). However, another factor that may have contributed was the system of health insurance (p = 0.015; OR = 5.00). The probability of the meaningful factors, based on the results of a multivariate analysis using the logistic function formula, is 0.7365 or 73.65%. The major reasons of HIV-infected individuals for not taking their medications were being employed, pill burden consideration, and without health insurance. Improving adherence probably requires the provision of the easy health insurance system with adequate patient preparation, innovative interventions and must fit into the socio cultural context of each setting. Keywords: adherence, antiretroviral, health insurance, occupation, pill burde

Factors Affecting Adherence to Antiretroviral Therapy

The success of highly active antiretroviral therapy (HAART) for treating human immunodeficiency virus (HIV) disease depends on maintaining a high level of adherence. Non-adherence is associated with a poor short-term virological response and accelerates the development of drug-resistant HIV. The shift to combination therapies for treating HIV-infected individuals has increased the challenges of adherence for both patients and health-care providers. The cumulative number of people in April 2015 who were eligible for HAART but had not yet started the therapy at the Adam Malik Hospital in Medan City Indonesia was 1,669 out of 6,033 people (27.66%). The cumulative number of absentees and loss to follow-up at >3 months was 1,273 out of 4,364 people (29.17%) up to April 2015.This study was a cross-sectional investigation of the factors associated with adherence to antiretroviral consumption for HIV-infected individuals at the Adam Malik Hospital in 2015. The sample size was 65 people, using consecutive sampling. The data were collected from medical records, observations, and an interview with a questionnaire. The data analysis included descriptive study, the chi-square test, Fisher's exact test, and logistic regression, using STATA software. The results showed pill adherence in 28 patients (43.08%) and non-adherence in 37 patients (56.92%). The principal factors associated with non-adherence in the logistic regression were patient-related, including occupation (p = 0.062; OR = 0.22) and pill burden (p = 0.080; OR = 6.20). However, another factor that may have contributed was the system of health insurance (p = 0.015; OR = 5.00). The probability of the meaningful factors, based on the results of a multivariate analysis using the logistic function formula, is 0.7365 or 73.65%. The major reasons of HIV-infected individuals for not taking their medications were being employed, pill burden consideration, and without health insurance. Improving adherence probably requires the provision of the easy health insurance system with adequate patient preparation, innovative interventions and must fit into the socio cultural context of each setting. Keywords: adherence, antiretroviral, health insurance, occupation, pill burde

Effect of partogram use on outcomes for women in spontaneous labour at term

Background: The partogram (sometimes known as partograph) is usually a pre-printed paper form, on which labour observations are recorded. The aim of the partogram is to provide a pictorial overview of labour, to alert midwives and obstetricians to deviations in maternal or fetal wellbeing and labour progress. Charts often contain pre-printed alert and action lines. An alert line represents the slowest 10% of primigravid women's labour progress. An action line is placed a number of hours after the alert line (usually two or four hours) to prompt effective management of slow progress of labour. Objectives: To determine the effect of use of partogram on perinatal and maternal morbidity and mortality. To determine the effect of partogram design on perinatal and maternal morbidity and mortality. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008) and CENTRAL (The Cochrane Library, Issue 3, 2007). Selection criteria: Randomised and quasi-randomised controlled trials involving a comparison of partogram with no partogram, or comparison between different partogram designs. Data collection and analysis: Three authors independently assessed eligibility, quality and extracted data. When one author was also the trial author, the two remaining authors assessed the studies independently. Main results: We have included five studies in this review, involving 6187 women; two studies assessed partogram versus no partogram and the remainder assessed different partogram designs. There was no evidence of any difference between partogram and no partogram in caesarean section (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.24 to 1.70); instrumental vaginal delivery (RR 1.00, 95% CI 0.85 to 1.17) or Apgar score less than seven at five minutes (RR 0.77, 95% CI 0.29 to 2.06) between the groups. When compared to a four-hour action line, women in the two-hour action line group were more likely to require oxytocin augmentation (RR 1.14, 95% CI 1.05 to 1.22). When the three- and four-hour action line were compared, caesarean section rate was lowest in the four-hour action line group and this difference was statistically significant (RR 1.70, 95% CI 1.07 to 2.70, n = 613 , one trial). Authors' conclusions: On the basis of the findings of this review, we cannot recommend routine use of the partogram as part of standard labour management and care. We do recommend that the evidence presented should be used as a basis for discussion between clinicians and women. Further trial evidence is required to establish the efficacy of partogram use. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd

Effect of partogram use on outcomes for women in spontaneous labour at term (Cochrane Library)

Background The partogram (sometimes known as partograph) is usually a pre-printed paper form, on which labour observations are recorded. The aim of the partogram is to provide a pictorial overview of labour, to alert midwives and obstetricians to deviations in maternal or fetal wellbeing and labour progress. Charts often contain pre-printed alert and action lines. An alert line represents the slowest 10% of primigravid women's labour progress. An action line is placed a number of hours after the alert line (usually two or four hours) to prompt effective management of slow progress of labour. Objectives To determine the effect of use of partogram on perinatal and maternal morbidity and mortality. To determine the effect of partogram design on perinatal and maternal morbidity and mortality. Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008) and CENTRAL (The Cochrane Library, Issue 3, 2007). Selection criteria Randomised and quasi-randomised controlled trials involving a comparison of partogram with no partogram, or comparison between different partogram designs. Data collection and analysis Three authors independently assessed eligibility, quality and extracted data. When one author was also the trial author, the two remaining authors assessed the studies independently. Main results We have included five studies in this review, involving 6187 women; two studies assessed partogram versus no partogram and the remainder assessed different partogram designs. There was no evidence of any difference between partogram and no partogram in caesarean section (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.24 to 1.70); instrumental vaginal delivery (RR 1.00, 95% CI 0.85 to 1.17) or Apgar score less than seven at five minutes (RR 0.77, 95% CI 0.29 to 2.06) between the groups. When compared to a four-hour action line, women in the two-hour action line group were more likely to require oxytocin augmentation (RR 1.14, 95% CI 1.05 to 1.22). When the three- and four-hour action line were compared, caesarean section rate was lowest in the four-hour action line group and this difference was statistically significant (RR 1.70, 95% CI 1.07 to 2.70, n = 613 , one trial). Authors' conclusions On the basis of the findings of this review, we cannot recommend routine use of the partogram as part of standard labour management and care. We do recommend that the evidence presented should be used as a basis for discussion between clinicians and women. Further trial evidence is required to establish the efficacy of partogram use

60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths?

BACKGROUND: For the world's 60 million non-facility births, addressing who is currently attending these births and what effect they have on birth outcomes is a key starting point toward improving care during childbirth. OBJECTIVE: We present a systematic review of evidence for the effect of community-based cadres-community-based skilled birth attendants (SBAs), trained traditional birth attendants (TBAs), and community health workers (CHWs)-in improving perinatal and intrapartum-related outcomes. RESULTS: The evidence for providing skilled birth attendance in the community is low quality, consisting of primarily before-and-after and quasi-experimental studies, with a pooled 12% reduction in all cause perinatal mortality (PMR) and a 22%-47% reduction in intrapartum-related neonatal mortality (IPR-NMR). Low/moderate quality evidence suggests that TBA training may improve linkages with facilities and improve perinatal outcomes. A randomized controlled trial (RCT) of TBA training showed a 30% reduction in PMR, and a meta-analysis demonstrated an 11% reduction in IPR-NMR. There is moderate evidence that CHWs have a positive impact on perinatal-neonatal outcomes. Meta-analysis of CHW packages (2 cluster randomized controlled trials, 2 quasi-experimental studies) showed a 28% reduction in PMR and a 36% reduction in early neonatal mortality rate; one quasi-experimental study showed a 42% reduction in IPR-NMR. CONCLUSION: Skilled childbirth care is recommended for all pregnant women, and community strategies need to be linked to prompt, high-quality emergency obstetric care. CHWs may play a promising role in providing pregnancy and childbirth care, mobilizing communities, and improving perinatal outcomes in low-income settings. While the role of the TBA is still controversial, strategies emphasizing partnerships with the health system should be further considered. Innovative community-based strategies combined with health systems strengthening may improve childbirth care for the rural poor, help reduce gross inequities in maternal and newborn survival and stillbirth rates, and provide an effective transition to higher coverage for facility births