Knowledge and attitudes of HIV-infected patients on antiretroviral therapy regarding adverse drug reactions (ADRs) in selected hospitals in Nigeria.

PURPOSE: The study evaluated the knowledge and attitudes of HIV-infected patients on ART regarding ADRs following routine patient counseling and education in selected hospitals in Nigeria. MATERIALS AND METHODS: From 36,459 HIV-infected patients on ART in the 36 selected hospitals, a study-specific instrument was administered to 3,650 patients in a cross-sectional study. Patients were provided counseling and education on ADRs before and after commencing ART. Factor analysis was performed using principal components extraction. Item score means above midpoint (3.7) on a 5-point scale were regarded as positive attitudes and below as negative attitudes. A chi-square test was used for inferential statistics; P<0.05 was used to determine statistical significance. RESULTS: The mean questionnaire return rate was 47.5%. Data from 2329 (63.8%) participants were analyzed, 63.1% females and 34.4% aged 25-34 years old. A total of 80.1% participants accepted to have been counseled on ADRs; 65.8% knew that all medicines cause some kind of adverse effects; 55.1% knew the adverse effects of their medicines; 60.8% knew what to do when they suspect ADRs and it included mainly reporting to the healthcare provider (88.1%). However, only 31.9% had experienced ADRs previously. The knowledge of ADRs was associated with gender and educational and employment status of the patients (P<0.05). A total of 95.6% reported self-efficacy to ART. Majority of the rated attitude score means were >3.7 which denotes positive attitudes to ADRs. Three extracted factors accounted for 73.1% of cumulative variability. All attitude items had very significant loadings of ≥0.5. CONCLUSION: Overall, participants reported good knowledge and positive attitudes to adverse effects of their medicines compared to what was reported previously. The patient counseling and education on drug therapy provided to patients may have contributed to these findings and are highly recommended.

Assessment of side effects coping practices of HIV-infected patients receiving antiretroviral therapy.

PURPOSE: The study assessed coping practices to HIV treatment side effects among HIV-infected patients receiving antiretroviral therapy (ART) in selected hospitals in Nigeria. METHODS: In a cross-sectional study, Side Effects Coping (SECope) instrument was administered to 3650 HIV-infected patients receiving ART in 36 hospitals. Patients were provided pre-treatment information on side effects of antiretroviral drugs. Factor analysis was performed using principal components extraction with varimax rotation. Factors selected for rotation had eigenvalues >1. Mean scale scores above midpoint of 3.18 on five-point scale were regarded as positive coping practices and below as negative practices. Chi-Square was used for inferential statistics; P < 0.05 used to determine statistical significance. RESULTS: Mean of SECope instrument return rates was 47.5% (95%CI, 37.1-57.9). Data from 2329 (63.8%) participants were analyzed: 63.1% females and 63.9% aged 25 to 44 years old. The mean SECope scale score (±SD) was 3.18 (±0.80); mean subscale scores (±SD) were 3.52 (±0.20) positive emotion focused coping, 2.82 (±0.18) information seeking, 2.57 (±0.30) social support seeking, 2.34 (±0.39) taking side effect medications, and 4.43 (±0.10) non-adherence. Five extracted factors accounted for 67.2% of cumulative variability. All items had very significant loadings of 0.50 or greater. All subscales except positive emotion focused coping were associated with age (p < 0.05). Non-adherence and information seeking subscales were associated with employment status (p < 0.05). Taking side effect medications was associated with educational status (p < 0.05). CONCLUSION: The study reported positive coping practices in positive emotion focused coping and non-adherence subscales. Non-adherence as a coping strategy was not significant contrary to previous research finding.

Improving Monitoring and Reporting of Adverse Drug Reactions (ADRs) in HIV positive patients on Antiretroviral Therapy (ART) in Nigeria.

Under-reporting of ADR may be associated with poor knowledge, attitudes and practices to pharmacovigilance. This study evaluated knowledge, attitudes and practices of healthcare professionals about ADR monitoring and reporting following interventions. This longitudinal study included 36 healthcare professionals participating in ART program in a tertiary hospital. Interventions included group training on pharmacovigilance (PV) and provision of ADR reporting forms amongst others. Assessments were conducted at months 0 and 6 post-interventions using study-specific Likert-type instruments. Mean attitude scores above midpoint of 3.6 on 5-point scale were regarded as positive and below as negative. P<0.05 used to determine statistical significance. Mean age of participants was 36.6 (95%CI, 34.5-38.7) years; 61.1% males; 44.4% doctors, 13.9% pharmacists, 19.4% nurses, 8.3% laboratory scientists, 8.3% record officers and 5.6% welfare officers. None had received training on PV previously. Mean knowledge test score increased from 53.6% (95%CI, 44.6-63.6) at pre-intervention to 77.1% (95%CI, 72.8-81.4) at post-intervention with a mean change of 146.9% (95%CI, 60.5-233.3; p=0.000). Mean rated attitude scores increased from 3.6 (95%CI, 3.4-3.8) at pre-intervention to 4.2 (95%CI, 4.0-4.4) at post-intervention; the difference was statistically significant (p=0.000). 75.8% reported that ADR reporting forms were not readily available at pre-intervention compared to 18.2% at postintervention; 15.2% had reported ADR previously at pre-intervention compared to 69.7% at post-intervention; 12.1% reported providing information regarding ADRs and its management always at pre-intervention compared to 45.5% at post-intervention; these differences were statistically significant (p<0.05). Lack/inadequate knowledge, unavailability of reporting forms and negative attitudes were barriers identified; and addressing them resulted in significant improvement in this setting. Scaling up these interventions to other hospitals can better the situation of under-reporting of ADRs in Nigeria.