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• Adherence to antiretroviral drug therapy in adult patients who are HIV-positive in Northwest Ethiopia: a study protocol
  Kebede A. Beyene
  Published on: 11 November 2013

• Published on: 11 November 2013

  Adherence to antiretroviral drug therapy in adult patients who are HIV-positive in Northwest Ethiopia: a study protocol

  • Kebede A. Beyene, PhD student

  In their proposed study protocol of Adherence to ART among HIV positive patients in North West Ethiopia, Bezabhe et al properly noted the scarcity of information on determinants of long-term adherence to ART medications in Ethiopian context. Given the importance of adherence to long term treatment outcomes, understanding its determinants can be beneficial to improve the quality of healthcare provision to patients and min...

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  In their proposed study protocol of Adherence to ART among HIV positive patients in North West Ethiopia, Bezabhe et al properly noted the scarcity of information on determinants of long-term adherence to ART medications in Ethiopian context. Given the importance of adherence to long term treatment outcomes, understanding its determinants can be beneficial to improve the quality of healthcare provision to patients and minimising cost of treatment. We examined this behaviour sometime ago among HIV/AIDS patients in south and central Ethiopia.1

  Similar to what proposed by the authors of this protocol we employed multiple methods for investigating determinants and prevalence rate of adherence to ART. However, we found that using some of the methods was challenging. It would be interesting if the investigators present their detail plan on how to handle the shortcomings of each technique for measuring adherence. For instance, the protocol lacks clarity about the proposed pill count technique. There are two different techniques for counting pills, namely announced and unannounced pill count. However, the authors did not specify which pill count technique to use for the study. From our experience, using announced pill count (i.e., where patients informed to bring their medicine container on their date of appointment) might be challenging in resource limited settings. One of such a challenge is the technique cannot identify medicines that were shared among patients. Studies in developed countries where there is better health care access reported higher prevalence rates of prescription medicine sharing among family members, friends, or acquaintances2-4; particularly this might be a concern for HIV positive partners who are on the same type of medication. I could imagine that sharing medicine may be a common practice in Ethiopia where most of HIV patients are from lower socioeconomic background and might have difficulty to pay for transportation to collect their medicines from health care facilities.

  The other challenge with pill count technique is pill dumping, this is particularly important for the proposed study, it seems from the explanation given the authors will use pharmacists as data collectors; this is a bit worrisome for me. The study participants might feel being spied by their health care providers about their medication use behaviours, and they might dump some of their unused pills before their medical appointment date. Thus, I suggest to the authors to use neutral data collectors (preferably those that don't have involvement in healthcare provision for the study cohort). In our past study we tried to handle the situation by using unannounced pill count technique; however, it was costly as it required us to go to patients' home and getting their consent to count their unused pills.

  References

  1. Beyene KA, Gedif T, Gebre-Mariam T, et al. Highly active antiretroviral therapy adherence and its determinants in selected hospitals from south and central Ethiopia. Pharmacoepidemiol Drug Saf 2009;18:1007-15.

  2. Petersen EE, Rasmussen SA, Daniel KL, et al. Prescription medication borrowing and sharing among women of reproductive age. J Womens Health 2008;17(7):1073-80.

  3. Goldsworthy R, Schwartz N, Mayhorn C. Beyond Abuse and Exposure: Framing the Impact of Prescription-Medication Sharing. Am J Public Health 2008;98(6):1115-21

  4. Goulding E, Murphy M, Di Blasi Z. Sharing and borrowing prescription medication: a survey of Irish college students. Ir J Med Sci 2011;180(3):687-90.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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