Pub Date : 2012-08-01DOI: 10.1177/1545109712446921
J. Shuter
Dr Chitsaz points out several concerns about our study. Most of the criticism stems from the lack of follow-up data on the complete cohort. They are correct in pointing out that the final sample in study II represents just 57% of the original 84 participants enrolled in study I. Follow-up information on deceased or lost to follow-up participants was, by definition, unavailable. As a consequence, we were unable to comment on the correlation of adherence rates in these participants between the 2 studies. We agree with Dr Chitsaz that it is likely that these individuals had more advanced disease. It is also reasonable to consider that survivor bias may have selected for a cohort with better outcomes in study II. Whether those who died or were lost to follow-up would have had poorer correlation of adherence rates between the 2 time points is purely speculative. With regard to the participants who switched to new regimens, 11 of the 12 switched from twice-daily to once-daily regimens. In contrast to the remainder of the cohort, adherence rates among these 12 increased, although not significantly, from study I to study II. It is likely that the lack of significant correlation in adherence rates in these participants was due to the change in the dosing schedule. Certainly, an idealized version of this study would have collected a complete complement of data on all participants. Nonetheless, the correlation of adherence rates between the 2 studies in the final cohort was noteworthy, particularly among the best adherers. The substantial lost to follow-up rate was acknowledged in the Discussion section, but we thank Dr Chitsaz for pointing out several potential biases that attrition from the study may have engendered.
{"title":"Response to Letter to the Editor","authors":"J. Shuter","doi":"10.1177/1545109712446921","DOIUrl":"https://doi.org/10.1177/1545109712446921","url":null,"abstract":"Dr Chitsaz points out several concerns about our study. Most of the criticism stems from the lack of follow-up data on the complete cohort. They are correct in pointing out that the final sample in study II represents just 57% of the original 84 participants enrolled in study I. Follow-up information on deceased or lost to follow-up participants was, by definition, unavailable. As a consequence, we were unable to comment on the correlation of adherence rates in these participants between the 2 studies. We agree with Dr Chitsaz that it is likely that these individuals had more advanced disease. It is also reasonable to consider that survivor bias may have selected for a cohort with better outcomes in study II. Whether those who died or were lost to follow-up would have had poorer correlation of adherence rates between the 2 time points is purely speculative. With regard to the participants who switched to new regimens, 11 of the 12 switched from twice-daily to once-daily regimens. In contrast to the remainder of the cohort, adherence rates among these 12 increased, although not significantly, from study I to study II. It is likely that the lack of significant correlation in adherence rates in these participants was due to the change in the dosing schedule. Certainly, an idealized version of this study would have collected a complete complement of data on all participants. Nonetheless, the correlation of adherence rates between the 2 studies in the final cohort was noteworthy, particularly among the best adherers. The substantial lost to follow-up rate was acknowledged in the Discussion section, but we thank Dr Chitsaz for pointing out several potential biases that attrition from the study may have engendered.","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"11 1","pages":"219 - 219"},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109712446921","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-07-01DOI: 10.1177/1545109710376486
{"title":"5th International Conference on HIV TREATMENT ADHERENCE","authors":"","doi":"10.1177/1545109710376486","DOIUrl":"https://doi.org/10.1177/1545109710376486","url":null,"abstract":"","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"9 1","pages":"240 - 267"},"PeriodicalIF":0.0,"publicationDate":"2010-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109710376486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-09-01DOI: 10.1177/1545109708326073
J. Zuniga
H ealth literacy has a significant impact on our daily lives, affecting almost every aspect of our ability to understand and process information regarding our health. According to the American Medical Association (AMA), poor health literacy is ‘‘a stronger predictor of a person’s health than age, income, employment status, education level, and race.’’ In Health Literacy: A Prescription to End Confusion, the Institute of Medicine (IOM) reported that 90 million people in the United States, nearly half the population, have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments, and/or do not understand instructions such as ‘‘take on an empty stomach.’’ There are various examples of low health literacy’s impact. For example, a study of 483 asthma patients found that although two thirds reported graduating from high school, only 60% could read above the sixth-grade level. Reading ability was the single strongest predictor of asthma knowledge. Twice as many patients reading below the third-grade level had poor metered-dose inhaler technique as patients reading at high-school level (89% vs. 48%). And in a study involving 659 public hospital patients, those with poor health literacy skills were 5 times more likely to misinterpret their prescriptions than those with adequate skills. Likewise, in the management of HIV disease, a patient’s level of HIV literacy is critical for treatment success, one of the most important predictors of which is levels of adherence to antiretroviral therapy. A study of 182 HIV-positive adults found that those with low health literacy were more likely to miss doses than those with high health literacy because of confusion about the instructions. Yet another study involving 204 HIV-positive patients showed that low HIV literacy doubled the likelihood of nonadherence to antiretroviral therapy. Low HIV literacy was also demonstrated in the recent AIDS Treatment for Life International Survey (ATLIS), the results of which were published in the July/August 2008 issue of the Journal of the International Association of Physicians in AIDS Care (JIAPAC). This multicountry survey of almost 3000 HIV-positive patients from 6 geographical regions identified some major gaps in HIV literacy. When respondents were asked to describe how HIV drug resistance develops, for example, only 17% accurately answered the question; a total of 54% answered incorrectly or did not know the answer and 29% provided only partially accurate answers. North American (48%) and Asian/Pacific (20%) respondents were most likely to select the correct answer to the question, whereas African respondents were more likely to select an inaccurate answer or did not know (79%), followed by respondents from Latin America (58%) and Europe (54%). Previous studies have shown a strong correlation between a good understanding of HIV drug resistance and improved treatment adherence. Among th
{"title":"Promoting HIV Literacy","authors":"J. Zuniga","doi":"10.1177/1545109708326073","DOIUrl":"https://doi.org/10.1177/1545109708326073","url":null,"abstract":"H ealth literacy has a significant impact on our daily lives, affecting almost every aspect of our ability to understand and process information regarding our health. According to the American Medical Association (AMA), poor health literacy is ‘‘a stronger predictor of a person’s health than age, income, employment status, education level, and race.’’ In Health Literacy: A Prescription to End Confusion, the Institute of Medicine (IOM) reported that 90 million people in the United States, nearly half the population, have difficulty understanding and using health information. As a result, patients often take medicines on erratic schedules, miss follow-up appointments, and/or do not understand instructions such as ‘‘take on an empty stomach.’’ There are various examples of low health literacy’s impact. For example, a study of 483 asthma patients found that although two thirds reported graduating from high school, only 60% could read above the sixth-grade level. Reading ability was the single strongest predictor of asthma knowledge. Twice as many patients reading below the third-grade level had poor metered-dose inhaler technique as patients reading at high-school level (89% vs. 48%). And in a study involving 659 public hospital patients, those with poor health literacy skills were 5 times more likely to misinterpret their prescriptions than those with adequate skills. Likewise, in the management of HIV disease, a patient’s level of HIV literacy is critical for treatment success, one of the most important predictors of which is levels of adherence to antiretroviral therapy. A study of 182 HIV-positive adults found that those with low health literacy were more likely to miss doses than those with high health literacy because of confusion about the instructions. Yet another study involving 204 HIV-positive patients showed that low HIV literacy doubled the likelihood of nonadherence to antiretroviral therapy. Low HIV literacy was also demonstrated in the recent AIDS Treatment for Life International Survey (ATLIS), the results of which were published in the July/August 2008 issue of the Journal of the International Association of Physicians in AIDS Care (JIAPAC). This multicountry survey of almost 3000 HIV-positive patients from 6 geographical regions identified some major gaps in HIV literacy. When respondents were asked to describe how HIV drug resistance develops, for example, only 17% accurately answered the question; a total of 54% answered incorrectly or did not know the answer and 29% provided only partially accurate answers. North American (48%) and Asian/Pacific (20%) respondents were most likely to select the correct answer to the question, whereas African respondents were more likely to select an inaccurate answer or did not know (79%), followed by respondents from Latin America (58%) and Europe (54%). Previous studies have shown a strong correlation between a good understanding of HIV drug resistance and improved treatment adherence. Among th","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"7 1","pages":"215 - 216"},"PeriodicalIF":0.0,"publicationDate":"2008-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109708326073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-05-01DOI: 10.1177/1545109708319459
J. Zuniga
Among the many interesting articles in this issue of the Journal, I would like to bring to your attention the paper by Dr. Eisenberg and his colleagues entitled ‘‘Chronic Ambulatory Monitoring: Results of a Large Single-Center Experience’’. The authors evaluated the diagnostic yield of a wearable cardiac monitoring device. They reviewed data from 524 patients who were prescribed the monitor for a variety of indications including monitoring for atrial fibrillation and elucidating the mechanism of palpitations. This study resulted in many interesting findings the most important of which in my opinion is that the majority of atrial fibrillation episodes detected by the long-term monitoring device were asymptomatic.
{"title":"Letter from the Editor-in-Chief","authors":"J. Zuniga","doi":"10.1177/1545109708319459","DOIUrl":"https://doi.org/10.1177/1545109708319459","url":null,"abstract":"Among the many interesting articles in this issue of the Journal, I would like to bring to your attention the paper by Dr. Eisenberg and his colleagues entitled ‘‘Chronic Ambulatory Monitoring: Results of a Large Single-Center Experience’’. The authors evaluated the diagnostic yield of a wearable cardiac monitoring device. They reviewed data from 524 patients who were prescribed the monitor for a variety of indications including monitoring for atrial fibrillation and elucidating the mechanism of palpitations. This study resulted in many interesting findings the most important of which in my opinion is that the majority of atrial fibrillation episodes detected by the long-term monitoring device were asymptomatic.","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"7 1","pages":"103 - 103"},"PeriodicalIF":0.0,"publicationDate":"2008-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109708319459","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-06-01DOI: 10.1177/154510970600500202
{"title":"NIMH/IAPAC International Conference on HIV Treatment Adherence","authors":"","doi":"10.1177/154510970600500202","DOIUrl":"https://doi.org/10.1177/154510970600500202","url":null,"abstract":"","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"5 1","pages":"57 - 82"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/154510970600500202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65511063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-03-01DOI: 10.1177/1545109706287005
{"title":"NIMH/IAPAC International Conference on HIV Treatment Adherence","authors":"","doi":"10.1177/1545109706287005","DOIUrl":"https://doi.org/10.1177/1545109706287005","url":null,"abstract":"","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"5 1","pages":"29 - 39"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109706287005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2006-03-01DOI: 10.1177/1545109706287006
{"title":"NIMH/IAPAC International Conference on HIV Treatment Adherence","authors":"","doi":"10.1177/1545109706287006","DOIUrl":"https://doi.org/10.1177/1545109706287006","url":null,"abstract":"","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"5 1","pages":"11 - 28"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109706287006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-07-01DOI: 10.1177/154510970500400301
{"title":"Submission Guidelines for Contributors","authors":"","doi":"10.1177/154510970500400301","DOIUrl":"https://doi.org/10.1177/154510970500400301","url":null,"abstract":"","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"4 1","pages":"56 - 57"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/154510970500400301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-04-01DOI: 10.1177/1545109705279845
J. Bartlett, P. Mugyenyi
{"title":"New Management, Consistent Focus","authors":"J. Bartlett, P. Mugyenyi","doi":"10.1177/1545109705279845","DOIUrl":"https://doi.org/10.1177/1545109705279845","url":null,"abstract":"","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"4 1","pages":"31 - 31"},"PeriodicalIF":0.0,"publicationDate":"2005-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1545109705279845","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65511031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-10-01DOI: 10.1177/154510970400300404
Ross M. Hewitt
Background: While the notion of a “dose” is a basic construct in treatment research and practice, neither the parameters used to characterize a missed dose, nor what should be done to correct a missed dose and maintain adherence are widely shared by patients, nor agreed upon between clinicians and patients. This study examines clinician and patient understandings of the parameters of a missed dose and of what should be done when a dose is missed. Methods: Sixty African Americans taking [highly active antiretroviral therapy (HAART)] (20 women, 40 men) and 20 of their physicians and nurses, all of whom are enrolled in a longitudinal study on HAART adherence, were interviewed. Measures included: self-definition of a medication dose, missed dose, and corrective actions; adherence (CPCRA three-day pilltaking recall, three-month self assessment, Medical Outcomes Study adherence scale [Kravitz et al, 1993] and a visual analogue), and biomarkers of adherence (viral load and CD4 counts). Open-ended interviews and standardized techniques were used. Results: We found consistent systematic definitions of a missed dose and of dose management. Three definitions marking different sets of parameters for a missed dose were identified: medication not taken at the exactly same time every day (15 percent of clinicians, 20 percent of patients); medication taken outside a threeto four-hour window each day (75 percent of clinicians, 60 percent of patients); medication not taken some time within the waking day (10 percent of clinicians, 20 percent of patients). Clinicians and patients agreed that one should not double up on doses to make up for a missed dose but expressed a range of acceptable means to address a missed dose. Conclusions: Efforts to refine the measurement of HAART adherence need to be aware of the threats to validity posed by the range of working definitions of a missed dose. 2 – Adaptive Poisson regression analysis of MEMS adherence data
{"title":"Select Abstracts from Elements of Success 2004: An International Conference on Adherence to Antiretroviral Therapy","authors":"Ross M. Hewitt","doi":"10.1177/154510970400300404","DOIUrl":"https://doi.org/10.1177/154510970400300404","url":null,"abstract":"Background: While the notion of a “dose” is a basic construct in treatment research and practice, neither the parameters used to characterize a missed dose, nor what should be done to correct a missed dose and maintain adherence are widely shared by patients, nor agreed upon between clinicians and patients. This study examines clinician and patient understandings of the parameters of a missed dose and of what should be done when a dose is missed. Methods: Sixty African Americans taking [highly active antiretroviral therapy (HAART)] (20 women, 40 men) and 20 of their physicians and nurses, all of whom are enrolled in a longitudinal study on HAART adherence, were interviewed. Measures included: self-definition of a medication dose, missed dose, and corrective actions; adherence (CPCRA three-day pilltaking recall, three-month self assessment, Medical Outcomes Study adherence scale [Kravitz et al, 1993] and a visual analogue), and biomarkers of adherence (viral load and CD4 counts). Open-ended interviews and standardized techniques were used. Results: We found consistent systematic definitions of a missed dose and of dose management. Three definitions marking different sets of parameters for a missed dose were identified: medication not taken at the exactly same time every day (15 percent of clinicians, 20 percent of patients); medication taken outside a threeto four-hour window each day (75 percent of clinicians, 60 percent of patients); medication not taken some time within the waking day (10 percent of clinicians, 20 percent of patients). Clinicians and patients agreed that one should not double up on doses to make up for a missed dose but expressed a range of acceptable means to address a missed dose. Conclusions: Efforts to refine the measurement of HAART adherence need to be aware of the threats to validity posed by the range of working definitions of a missed dose. 2 – Adaptive Poisson regression analysis of MEMS adherence data","PeriodicalId":81716,"journal":{"name":"Journal of the International Association of Physicians in AIDS Care","volume":"3 1","pages":"130 - 143"},"PeriodicalIF":0.0,"publicationDate":"2004-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/154510970400300404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65510841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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