Adherence determination using urine-tenofovir point-of-care testing and pharmacy refill records: A cross-sectional study.

Pharmacy refill records (PRR), are an accessible strategy for estimating adherence in low- and middle-income countries (LMICs). However, the low-cost urine-tenofovir point-of-care test opens up the possibility of an objective metric of adherence that is scalable to LMICs. This study compared adherence to tenofovir-based regimens using urine-tenofovir point-of-care (POC) test with pharmacy refill records in a Nigerian population of HIV-positive persons. This was a cross-sectional study among 94 HIV-positive adults, which was conducted from June to August 2021, in a large outpatient clinic in Lagos, Nigeria. Adherence to pharmacy appointments was automatically calculated using a computerized pharmacy appointment system (FileMaker Pro™). Urine drops on the urine-tenofovir POC test strip developed 2 lines for a negative test (tenofovir absent) and one line for a positive test. Fisher's exact test was used to examine the association between pharmacy refill record and urine-tenofovir point-of-care test. Logistic regression was performed to predict viral suppression (<1000 copies/mL, based on WHO recommendations) using both methods of adherence determination. A Receiver Operating Characteristic (ROC) curve of the association between specificity and sensitivity was generated to evaluate the predictive value of adherence determined using pharmacy-refill record and urine-tenofovir point-of-care test in forecasting viral suppression. The statistical significance level was set at 0.05. Fisher's exact test showed no statistically significant difference in adherence using urine-tenofovir point-of-care test or pharmacy refill record. The logistic regression model showed that an increase in pharmacy-refill record of ≥ 95% was associated with viral suppression (P = .019). From the ROC curve, the sensitivity was same at 95.5% for both methods, but the specificity of the urine-tenofovir point-of-care test was greater (96.6% vs 95.5%) than pharmacy refill record (P = .837). Urine-tenofovir point-of-care test provided equivalent adherence data to pharmacy refill data.

Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria

Background: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals. Objective: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes Methods: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients’ laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95%CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes. Conclusions: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM (AU)

Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria.

BACKGROUND: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals. OBJECTIVE: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes. METHODS: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients' laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms. RESULTS: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95% CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes. CONCLUSIONS: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.

High Acceptability of Donating Hair and Other Biological Samples for Research Among People Living with HIV in an Outpatient Clinic in Lagos, Nigeria.

Willingness to donate hair samples is a rate-limiting step for assaying antiretroviral (ARV) concentrations in hair, an emerging technique for HIV prevention and treatment monitoring. We surveyed ethnically diverse Nigerians to determine their willingness to donate hair for biomedical research. A cross-sectional survey of people living with HIV on ARV therapy (ART) was conducted at the HIV clinic of Nigerian Institute of Medical Research, using systematic sampling. The researcher-administered questionnaire was designed to capture sociodemographic data, length of time on ART, and willingness to donate hair. Univariate analysis was performed on sociodemographic characteristics, and independent-samples t-test and chi-square tests were used for bivariate analysis. Multivariable logistic regression analysis was performed to assess factors associated with willingness to donate hair samples, with a significance level of 0.05. Of the 398 participants enrolled in the study, 258 (64.8%) were female, the average age was 40 years (±9.8), and the average time spent on ART was 7.3 years (±4.2). More than half (64.8%) of the respondents were willing to donate hair samples for biomedical research and they were 1.5 times more likely to donate hair than blood. For one-third of the participants, the anticipated benefit from the eventual research findings was the primary motivation to donate hair samples. Fear of use of hair for rituals was the most common stated reason for unwillingness to donate hair samples (21.2%). In an ethnically diverse, urban-based Nigerian study population, nearly two-thirds of the participants were willing to donate hair samples for biomedical research. These findings support the feasibility of hair sampling for future HIV clinical research conducted within Nigeria.

Assessment of use of psychoactive and other non-prescription drugs among students of selected tertiary institutions in Ekiti State South West Nigeria - A baseline study.

BACKGROUND: Substance abuse is causing increasing threats to the stability of young minds, from teenage to the older youths and is an issue of public health concern in Nigeria. This study was carried out to determine the prevalence of drug abuse among students of tertiary institutions in Ekiti State. METHODOLOGY: A comparative cross-sectional survey was carried out among students in tertiary institutions in Ekiti state with participants selected from Year 1 to Year 4. Data collection tool was the WHO questionnaire (STASSIS). Data was analysed to obtain descriptive and inferential data, Kruskal-Wallis test and chi square were used for analysis of variance and test of association. RESULT: The majority of the students reported low use of all the drugs (64-90.1%) though moderate to high use were reported for: alcohol 35.1%, marijuana 15.7%, heroine 15.3%, tobacco 13.8% and cocaine 10.2%. There was a significant association between student's moderate to high use and university type. Students in private universities reported more use, especially heroine. Difference in substance use across the four years surveyed was significant with final year students (400 level) showing highest use. CONCLUSION: Tertiary students in Ekiti state are low users of psychoactive substances with a prevalence of 60-91%. Moderate to high prevalence of 10-31% was reported with alcohol as the substance with highest usage. Substance use varied significantly with university type with highest prevalence in the private institution and students at different academic levels with final year students being the highest users.

Prevalence and perception of drug use amongst secondary school students in two local government areas of Lagos State, Nigeria.

BACKGROUND: Drug abuse, an excessive and persistent self-administration of a drug without regard to the medically or culturally accepted patterns, has been reported amongst teenagers and adolescents in various regions of the world. AIM: This study aimed to measure the prevalence of drug use amongst students of junior and senior secondary schools (aged 10-15 years). SETTING: This study was conducted at two local government areas in Lagos State. METHODS: The cross-sectional study was carried out in Ikotun or Igando local council development area (LCDA) and Ikoyi LCDA of Lagos State. Students were sampled using stratified random sampling with classes as strata and sampling performed by balloting. The modified WHO Model Drug Use Survey Questionnaire was distributed to the students for self-reporting. Ethical approval was received from district school boards. RESULTS: A total of 1048 students participated in the survey. In this study, alcohol had the highest lifetime drug prevalence rate (29.1%), followed by pharmaceutical opioids (9%). Gender, educational level, type of school management, and geographical economic distribution were found to be predictors of prevalence of drug use. This study demonstrated significant differences in the prevalence of tobacco and opioids use among students in private and public schools; and documented statistically significant differences in the prevalence of cocaine use between low income and high-income areas in two LCDAs in Lagos, Nigeria. CONCLUSION: Prevalence of lifetime, recent use, and current use of drugs among secondary school students in two LCDAs located in Lagos State, Nigeria were documented with alcohol as the drug with the highest prevalence.

The relationship between patient-related factors and medication adherence among Nigerian patients taking highly active anti-retroviral therapy.

BACKGROUND: Through several initiatives, there are increasingly more people who have access to anti-retroviral therapy. Adherence to therapy is, however, necessary for successful management of disease. OBJECTIVES: The objectives of this study were to describe adherence rates and determine what patient-related factors are related to adherence to anti-retroviral therapy among adult patients in an HIV clinic located in Lagos, Nigeria. METHODS: Adherence was measured using the two-week self-recall method. Barriers, satisfaction with therapy, and socio-demographic and clinical variables served as independent variables. Data were collected via self-administered surveys. RESULTS: Most of the patients (79.5%) reported 100% adherence. The significant (p<0.05) barriers to adherence were forgetfulness, running out of medication, alcohol use, and medication side effects. For every unit increase in the number of barriers, patients were 60.8% less likely to be 100% adherent (p <0.05, odds ratio, OR = 0.392, 95% CI = 0.295-0.523). CONCLUSION: Interventions should target helping patients cope with forgetfulness, specifically employing strategies to overcome busyness in schedules, being away from home, and tiredness.

Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria.

BACKGROUND: Malaria in pregnancy (MIP) is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn. Information is required on how to improve its prevention and treatment from both the providers' and consumers' perspectives. METHODS: The study sites were two public and two private hospitals in Enugu, southeast Nigeria. Data was collected using a pre-tested structured questionnaire. The respondents were healthcare providers (doctors, pharmacists and nurses) providing ante-natal care (ANC) services. They consisted of 32 respondents from the public facilities and 20 from the private facilities. The questionnaire elicited information on their: knowledge about malaria, attitude, chemotherapy and chemoprophylaxis using pyrimethamine, chloroquine proguanil as well as IPTp with sulphadoxine-pyrimethamine (SP). The data was collected from May to June 2010. RESULTS: Not many providers recognized maternal and neonatal deaths as potential consequences of MIP. The public sector providers provided more appropriate treatment for the pregnant women, but the private sector providers found IPTp more acceptable and provided it more rationally than public sector providers (p < 0.05). It was found that 50 % of private sector providers and 25 % of public sector providers prescribed chemoprophylaxis using pyrimethamine, chloroquine and proguanil to pregnant women. CONCLUSIONS: There is sub-optimal level of knowledge about current best practices for treatment and chemoprophylaxis for MIP especially in the private sector. Also, IPTp was hardly used in the public sector. Interventions are required to improve providers' knowledge and practices with regards to management of MIP.

Formulation of quinine suppository for initiation of early treatment of malaria - a preliminary study.

Background: In the management of malaria, there is the need for early initiation of treatment. An antimalarial drug for home use must be easy to administer, safe, effective and affordable. Parenteral quinine is the gold standard for treatment of severe malaria. A rectal formulation of quinine will therefore serve the purpose of early initiation of care in patients that lack easy access to medical centers. The main objective of this preliminary work was to develop a quinine suppository with adequate release properties that also meets the dual conditions of affordability and ease of administration. Materials and Methods: Cocoa butter and Fattibase™ were used in the preparation of suppositories containing 200 mg quinine bisulphate. The release profiles of formulations with varying concentrations of polysorbate 80 (0 - 5%) were evaluated by in vitro dissolution in pH 8 buffer medium. Results: The addition of polysorbate 80 improved the release of quinine significantly at 2 and 5%. Cocoa butter suppository with 1% polysorbate 80 released 73.6 mg quinine bisulphate in 1 hr while release from suppositories with 2% and 5% surfactant was higher. Fattibase™ suppositories had better release profiles than cocoa butter formulations. The formulation with 5% polysorbate 80 released 170 mg quinine in 1 hr. Formulations with the two bases released quinine in adequate quantities for the management of malaria. Conclusions: The particle size of quinine is an important factor affecting the physical appearance and drug release from the suppository. The Fattibase™ suppositories were more stable but cost five times the price of the cocoa butter formulations. The cocoa butter formulations, however, still released quinine in sufficient quantities for the management of malaria. Cocoa butter formulations will be more affordable in resource-limited malaria-endemic regions of the world.