Causes for antiretroviral regimen change among HIV/AIDS patients in Addis Ababa, Ethiopia.

Highly active antiretroviral therapy has markedly decreased the morbidity and mortality due to HIV/AIDS. Once antiretroviral therapy (ART) is initiated, patients generally remain on medications indefinitely. A switch in the antiretroviral regimen is often necessary because of both acute and chronic toxicities, concomitant clinical conditions, and development of virologic failure. The objective of this study was to assess the causes of initial highly active antiretroviral therapeutic regimen changes among patients on ART in Addis Ababa, Ethiopia. This was a retrospective cross-sectional study conducted from January 1 to March 1, 2010 in two primary hospitals and one health centre in central Ethiopia. Information cards of HIV/AIDS patients who have had their antiretroviral regimen switched were reviewed. Data from patients below 18 years old and those who did not switch HAART regimen were excluded. Data were then analyzed using SPSS for windows version 16.0. A total of 300 patients' information card was reviewed and the mean age of the patients was 38.6±7 years. Females accounted for 59% (177) of the total patients. The most common first regimen before first switch was D4T/3TC/NVP (63%) and D4T/3TC/EFV (18%). The main reasons for modification were toxicity (65%), co-morbidity (25%), pregnancy (5%) and treatment failure (3%). The main types of toxicities observed were peripheral neuropathy (39%), rash (20%) and anaemia (13.33%). Drug toxicity was the main reason for modification of initial antiretroviral regimen and initial Efavirenz-based regimens are less likely to be changed. The occurrence of drug toxicity should be assessed early among patients commencing HAART and health professionals should be empowered to make appropriate regimen changes.

Drug Information: Prescribers' Need for and Access to Drug Information Resources in Ethiopia.

Rational and cost-effective prescription of drugs requires up-to-date and readily accessible drug information (DI). Availability of and access to DI resources are major factors that affect quality of prescription. The aim of the study was to assess prescribers' DI needs and access to DI resources in Ethiopia. A facility-based, cross-sectional, quantitative study was conducted from February to April 2011 in 4 selected public health facilities in southwest Ethiopia. Data on areas of DI needs, access to DI resources, and attitudes of prescribers toward DI services were collected using a structured, self-administered questionnaire. The study population consisted of 410 of 447 initially contacted prescribers. The majority of the prescribers (93.4%) explained their needs for DI services. About 32.4% of the participants do not frequently refer to DI resources mainly due to the difficulty of acquiring the required information promptly and/or because they do not have access to DI resources. Compared with participants from a health center, participants from specialized referral, zonal, and district hospitals were found to be 6 (adjusted odds ratio [AOR], 5.81; 95% confidence interval [CI], 2.77-12.20), 5 (AOR, 4.77; 95% CI, 2.43-9.38), and 4 (AOR, 4.00; 95% CI, 1.50-10.66) times more likely to consult DI resources, respectively. Lack of access to DI resources and difficulty in acquiring the required information on time were the main reasons that prescribers gave for not frequently referring to DI resources. DI services should be established and expanded in health facilities.

Lipodystrophy Is Common Among Ethiopian Patients on Highly Active Antiretroviral Therapy but Is Not Associated With Quality of Life or Medication Adherence.

Clinical experience suggests that lipodystrophy (LD) can have a profound impact on quality of life (QOL) and medication adherence (MA). Thus, a hospital-based, cross-sectional study was conducted to determine the prevalence of LD and its association with QOL and MA. A total of 405 participants were included in the study. The majority of participants were female (64.5%), with a mean age of 35.69 years (SD = 9.63 years). The prevalence of LD was 30.9%. Multiple logistic regression analysis showed that type of regimen initially used is an independent predictor of severity of LD (adjusted odds ratio, 44.16; 95% confidence interval, 10.56-184.59; P = .001). Quality of life was assessed with the World Health Organization Quality of Life short form instrument (WHOQOL-BREF), and medication adherence was assessed by self-report. The mean WHOQOL-BREF score of the participants was 53.48; the highest mean value was in the domain of physical health (68.56) and the lowest was in the social relationships domain (47.09). The majority of the patients scored lower (ie, in the lowest 5 deciles) in the domains of psychological health, social relationships, and environment compared with physical health. No differences in the WHOQOL-BREF measurements were observed, except in the environment domain, between patients with moderate LD and severe LD ( P = .02). The LD severity was not associated with self-reported MA ( P = .42). With the exception of the psychological health domain ( P = .044), participants' WHOQOL-BREF scores were not significantly associated with MA. Lipodystrophy was not associated with QOL or MA. The prevalence of LD in the present study was within the range of previous reports; however, the mean WHOQOL-BREF score of Ethiopian patients in this study is lower compared with reports from developed countries.

Adherence to medication for the treatment of psychosis: rates and risk factors in an Ethiopian population.

BACKGROUND: Medication-taking behavior, specifically non-adherence, is significantly associated with treatment outcome and is a major cause of relapse in the treatment of psychotic disorders. Non-adherence can be multifactorial; however, the rates and associated risk factors in an Ethiopian population have not yet been elucidated. The principal aim of this study was to evaluate adherence rates to antipsychotic medications, and secondarily to identify potential factors associated with non-adherence, among psychotic patients at tertiary care teaching hospital in Southwest Ethiopia. METHODS: A cross-sectional study was conducted over a 2-month period in 2009 (January 15th to March 20th) at the Jimma University Specialized Hospital. Adherence was computed using both a compliant fill rate method and self-reporting via a structured patient interview (focusing on how often regular medication doses were missed altogether, and whether they missed taking their doses on time). Data were analyzed using SPSS for windows version 16.0, and chi-square and Pearsons r tests were used to determine the statistical significance of the association of variables with adherence. RESULT: Three hundred thirty six patients were included in the study. A total of 75.6% were diagnosed with schizophrenia, while the others were diagnosed with other psychotic disorders. Most (88.1%) patients were taking only antipsychotics, while the remainder took more than one medication. Based upon the compliant fill rate, 57.5% of prescription fills were considered compliant, but only 19.6% of participants had compliant fills for all of their prescriptions. In contrast, on the basis of patients self-report, 52.1% of patients reported that they had never missed a medication dose, 32.0% sometimes missed their daily doses, 22.0% only missed taking their dose at the specific scheduled time, and 5.9% missed both taking their dose at the specific scheduled time and sometimes missed their daily doses. The most common reasons provided for missing medication doses were: forgetfulness (36.2%); being busy (21.0%); and a lack of sufficient information about the medication (10.0%). Pill burden, medication side-effects, social drug use, and duration of maintenance therapy each had a statistically significant association with medication adherence (P ≤ 0.05). CONCLUSION: The observed rate of antipsychotic medication adherence in this study was low, and depending upon the definition used to determine adherence, it is either consistent or low compared to previous reports, which highlights its pervasive and problematic nature. Adherence must therefore be considered when planning treatment strategies with antipsychotic medications, particularly in countries such as Ethiopia.

Medication adherence and its determinants among patients on concomitant tuberculosis and antiretroviral therapy in South west ethiopia.

BACKGROUND: To benefit from therapy and to avoid contracting treatment resistant strains, the individuals must adhere to medications. AIM: The study was designed to assess the degree of drug adherence and its determinants in patients living with HIV/AIDS and TB comorbidity. MATERIALS AND METHODS: A cross-sectional study was conducted to assess the degree of drug adherence and its determinants with the help of self-administered questionnaires in Tercha District Hospital in South Ethiopia. RESULT: A total of 24 patients were included in the study. The majority were females (54.2%) and the mean age was 32.4 (SD±9.6) years. Adherence level was 95.8% for Antiretroviral (ARV) medications and 79.2% for anti TB medications. Educational status was associated with anti TB (P=0.021) medication adherence. The reason for the missed doses were mostly lack of money for transport (23.7% for antiretroviral therapy (ART), 26.0% for TB treatment) and forgetting to take medications (18.4% for ART, 17.4% for TB treatment. CONCLUSION: The adherence level obtained for both ARV and anti-TB where high. Transportation costs for patients could be reduced by bringing the services close to where they live.

Pregnant women and non-steroidal anti-inflammatory drugs: knowledge, perception and drug consumption pattern during pregnancy in ethiopia.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the widely used drugs and are often used by pregnant women. However, they can have significant teratogenic effects. The aim of the study was to investigate pregnant women's knowledge about NSAIDs use during pregnancy and their perception and consumption pattern. MATERIALS AND METHODS: The study was a cross sectional study on women waiting for a consultation in the selected maternity hospitals in Addis Ababa, Ethiopia. The pregnant women were selected randomly and then interviewed by using standardized questionnaires. RESULT: A total of 224 pregnant women were involved in the study. Out of those, 203 (90.6%) of them have taken NSAIDs since the beginning of their pregnancy. About 201 (89.7%), 198 (88.4%) and 189 (84.4%) of the pregnant women considered that ibuprofen, diclofenac and aspirin are not NSAIDs respectively. Regarding analgesic effect of NSAIDs, 97 (43.3%) of the pregnant women believed that NSAIDs are effective for treating pain. Acetaminophen was considered as the most effective treatment for pain by 84 (37.50%) of the patients. CONCLUSION: Acetaminophen is the most common analgesic that was taken by most pregnant women. The knowledge of pregnant women about NSAIDs is poor.

The Reason for Regimen Change Among HIV/AIDS Patients Initiated on First Line Highly Active Antiretroviral Therapy in Southern Ethiopia.

BACKGROUND: Highly active antiretroviral therapy (HAART) has markedly decreased the morbidity and mortality due to HIV disease. However, toxicities, comorbidity, pregnancy, and treatment failure, among others, would result in frequent initial HAART regimen change. AIM: The study was designed to assess the causes of initial highly active antiretroviral therapeutic regimen changes among patients on HAART. MATERIALS AND METHODS: The study was conducted using a retrospective institution-based study, by reviewing the patient information sheet and physician diagnosis cards. Patient cards that showed a change in the initial treatment regimen were assessed and analyzed, to identify the common reason that resulted in a change from the initial treatment regimen. The data was analyzed using SPSS version 16.0. RESULTS: A total of 340 patient cards were assessed. The majority of the patients (69.29%) were females. The most common first regimen, before the first switch, was stavudine / lamivudine / nevirapine (D4T/3TC/NVP) (54.70%) and stavudine / lamivudine / Efavirenz (D4T/3TC/EFV) (20.88%). The main reasons for modification were toxicity, comorbidity, pregnancy, and treatment failure. The main types of toxicities observed were peripheral neuropathy (36.52%), rash (17.83%), and anemia (17.39%). CONCLUSION: Toxicity was the main reason for the modification of initial HAART among the study population. Efavirenz-based regimens had the lowest hazard for change relatively, except in pregnancy-related cases.

Management of common adverse effects in the era of highly active antiretroviral therapy in south east Ethiopia.

BACKGROUND: The combination of antiretroviral therapy is the corner stone of management of patients with human immune deficiency virus infection. Although antiretroviral therapy can reduce viral load to undetectable level, improve the immunity and prolong survival of patients, antiretroviral drugs are associated with many adverse effects that may be severe and affect patient adherence and quality of life. AIMS: The aim of this study was to assess management strategies under taken in patient's experienced common adverse effects of highly active antiretroviral therapy in Goba Hospital antiretroviral clinic. PATIENTS AND METHODS: A cross sectional study of patient record chart of patients who had follow-up during data collection period was done followed by patient interview. Data was filled on well structured questionnaire and analyzed using SPSS for window version 16.0. RESULTS: The common adverse effects were Rash (48.8%), Peripheral neuropathy (36.9%) and Anemia (20.24%). The rate of management was 39.3%. Pyridoxine (36.8%) was commonly prescribed drug for management of Peripheral neuropathy. Chlorphenarimine gel and Iron gluconate were common drugs for management of Rash and Anemia respectively. Use of traditional healers (57.7%) was leading reason for non-management. CONCLUSION: Rate of management for common adverse effect is low. Education should be given on adverse effects for patients.

Chemistry, pharmacology, and toxicology of khat (catha edulis forsk): a review.

Catha edulis (khat) is a plant grown commonly in the horn of Africa. The leaves of khat are chewed by the people for its stimulant action. Its young buds and tender leaves are chewed to attain a state of euphoria and stimulation. Khat is an evergreen shrub, which is cultivated as a bush or small tree. The leaves have an aromatic odor. The taste is astringent and slightly sweet. The plant is seedless and hardy, growing in a variety of climates and soils. Many different compounds are found in khat including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins and minerals. The phenylalkylamines and the cathedulins are the major alkaloids which are structurally related to amphetamine. The major effects of khat include those on the gastro-intestinal system and on the nervous system. Constipation, urine retention and acute cardiovascular effects may be regarded as autonomic (peripheral) nervous system effects; increased alertness, dependence, tolerance and psychiatric symptoms as effects on the central nervous system. The main toxic effects include increased blood pressure, tachycardia, insomnia, anorexia, constipation, general malaise, irritability, migraine and impaired sexual potency in men. Databases such as Pubmed, Medline, Hinary, Google search, Cochrane and Embase were systematically searched for literature on the different aspects of khat to summarize chemistry, pharmacology, toxicology of khat (Catha edulis Forsk).