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Background: Pharmacological drugs and medications are being widely used for the control of non-communicable diseases like hypertension. Hill-Bone--Compliance to High Blood Pressure Therapy Scale (HB-HBP) is a newly developed specific questionnaire for assessing the anti-hypertensive medication adherence. Hence, this study was done to translate the HB-HBP in Tamil and to assess the construct validity and reliability of the Tamil version. Materials and Methods: Translation of HB-HBP to native language, Tamil was done by experts and piloted with subsample of hypertensive patients from rural Puducherry. Final Tamil-translated HB-HBP was administered among 328 Tamilspeaking hypertensive patients in the selected villages of rural Puducherry (union territory in South India). Construct validity was assessed by exploratory factor analysis (EFA) through the principal component method. Based on the minimum average partial and parallel analysis, three-factor model was distinguished. Confirmatory factor analysis was done to obtain the goodness-of-fit. Reliability of questionnaire was assessed through Cronbach's alpha coefficient. Results: Three factor structures were obtained with eigenvalues of 6.5045, 2.8165, and 1.2261, respectively, which accounted for 75.34% of variance. Three-factor model assessed by the confirmatory factor method found Chi-square value of 1055.048 (P value <0.001). Goodness of fit revealed acceptable comparative fit index (0.773), Tucker-Lewis index (0721), standardized root mean square residual (0.077), and root mean square error of approximation (0.201). The reliability coefficient (Cronbach's alpha) for the scale was 0.9020. Conclusion: Our study concludes that the HB-HBP questionnaire is internally valid and consistent with a good reliability coefficient for application in Tamil-speaking patients with hypertension. [ABSTRACT FROM AUTHOR]

Background: Statins are widely prescribed for the management of hyperlipidemia and the prevention of cardiovascular diseases. Atorvastatin and rosuvastatin are among the most commonly used statins, with varying impacts on lipid profiles, side effect profiles, patient adherence, and health-care costs. Understanding these differences within specific populations can inform more tailored and cost-effective treatment strategies. Aims and Objectives: This study aimed to evaluate the differences in side effect management, patient outcomes, and health-care costs between atorvastatin and rosuvastatin therapies in a cohort from Coimbatore, Tamil Nadu, India. Materials and Methods: An observational study was conducted with 100 patients at the Karpagam Faculty of Medical Sciences and Research, evenly split between atorvastatin (n=50) and rosuvastatin (n=50) groups. Data on demographic characteristics, side effects, low-density lipoprotein (LDL) cholesterol reduction, medication adherence, and health-care costs were collected and analyzed. Results: The cohort had an average age of 62 years, with a higher prevalence of males (57%). Socioeconomic analysis showed 30% from low-income, 50% from middle-income, and 20% from highincome backgrounds. Side effects were more common in the atorvastatin group (35%) compared to the rosuvastatin group (28%), with muscle pain and gastrointestinal issues being predominant. Rosuvastatin treatment resulted in higher adherence rates (90%) and more significant LDL cholesterol reduction but incurred higher annual health-care costs (INR 28,000) versus atorvastatin (INR 25,000) (P=0.04). Conclusion: Both statins effectively reduced LDL cholesterol; however, rosuvastatin demonstrated higher patient adherence but at an increased cost. These findings underscore the need for individualized statin therapy that considers both clinical outcomes and economic constraints, particularly in settings with limited health-care resources. [ABSTRACT FROM AUTHOR]

Background: Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and are associated with Increased risks of coronary and cerebrovascular events. Aim and Objective: The present study aimed to analyze medication adherence and its effect on blood pressure (BP) control and assess the prevalence of treatment-resistant hypertension (TRH) among newly treated hypertensive patients. Method and Material: A cross-sectional, observational study was conducted in department of general medicine, Rani Durgawati Medical College, Banda, Uttar Pradesh. 100 adults (age 18 years) with hypertension on treatment for at least 6 months, fulfilling the criteria of apparent treatment resistance, were Observation and Result: Males constituted 70% and females constituted 30% of the study population. The mean age was 52.11 years. 48% were diabetics, 38% had CKD, 27% had COPD, and 22 had CKD. 51% were smoker, and 18% were alcoholics. Almost all the patients with aTRH were found to have low adherence (98%). Female s ex, financial dependency, lower socioeconomic status, alcohol, smoking, knowledge about medication and the presence of depression were significant factors associated with low medication adherence in a RTH. Conclusion: Our study find that significant low medication adherence among patients with TRH. The study stresses that medication adherence be checked in each and very aTRH patient, and specific underlying causes must be addressed. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB), a highly contagious and dangerous disease, impacts millions globally, with India topping the list of affected countries. The study aimed to evaluate the knowledge, attitude, practice, and medication adherence of TB patients. Materials and Methods: A prospective observational study was conducted in total of 150 tuberculosis patients. The study aimed to understand patients' knowledge, attitude, and practice towards medication and disease, through a binary questionnaire. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Based on a 50% cut-off, the knowledge, attitude, practice and medication adherence scores were separated into good and poor categories. Results were analyzed using SPSS and obtained through Chi-Square test, with a p-value<0.05 considered significant. Results: In this study, the average patient age was 42.27 with a range of 18 to 80, with the largest group being 61 to 70. The highest KAP level was in the 41-50 age group and the lowest in the 71-80 age group. Education level had a significant impact, with 62% being literate and having higher KAP levels than illiterate patients. A significant association was found between home location and KAP level, with 80% of rural patients having lower KAP levels compared to urban residents. The study found no significant relationship between age and medication adherence, but education and location did play a role, with higher education and urban residency linked to better adherence. Conclusion: Study revealed that pressing need for increased education and awareness about tuberculosis. The disparity in knowledge, particularly about drug-resistant TB, presents a major obstacle to effective management of the disease. The study found that socio-demographic factors, such as education and location, play a crucial role in treatment adherence, with higher levels of knowledge positively impacting adherence. Addressing disparities in these areas is crucial to reducing the spread of TB and improving health outcomes. [ABSTRACT FROM AUTHOR]

Background: Only a few studies have explored the relationship between psychosocial factors and medication adherence in Indian patients with noncommunicable diseases (NCDs). We aimed to examine the association of psychosocial variables with medication adherence in people with NCDs and comorbid common mental disorders (CMDs) from primary care in rural southern India. Methods: We performed a secondary analysis using baseline data from a randomized controlled trial in 49 primary care health centers in rural southern India (HOPE study). Participants were adults (≥30 years) with NCDs that included hypertension, diabetes, and/or ischemic heart disease, and comorbid depression or anxiety disorders. Medication adherence was assessed by asking participants if they had missed any prescribed NCD medication in the past month. Data were collected between May 2015 and November 2018. The association between psychosocial and demographic variables and medication nonadherence were assessed via logistic regression analyses. Results: Of the 2486 participants enrolled, almost one-fifth (18.06%) reported missing medication. Male sex (OR = 1.74, 95% CI 1.37–2.22) and higher internalized mental illness stigma (OR = 1.46, 95% CI 1.07–2.00) were associated with higher odds of missing medication. Older age (OR = 0.40, 95% CI 0.26–0.60, for participants aged 64–75 years vs 30–44 years), reporting more social support (OR = 0.65, 95% CI 0.49–0.86), and higher satisfaction with health (OR = 0.74, 95% CI 0.61–0.89) were associated with lower odds of missing medication. Conclusions: Greater internalized mental illness stigma and less social support are significantly associated with lower rates of medication adherence in patients with NCDs and comorbid CMDs in rural India. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation’s ‘Study on global AGEing and adult health (SAGE)’, a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40–0.56). Tobacco use (OR = 0.76, CI 0.59–0.98) and never having attended school (OR = 0.75, CI 0.62–0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48–1.02), feelings of anxiety (OR = 0.84, CI 0.66–1.08) and feelings of depression (OR = 0.90, CI 0.70–1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51–2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions—as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status. [ABSTRACT FROM AUTHOR]

Background: 99DOTS is a cellphone-based digital adherence technology. The state of Himachal Pradesh, India, made 99DOTS available to all adults being treated for drug-sensitive tuberculosis (TB) in the public sector in May 2018. While 99DOTS has engaged over 500,000 people across India, few studies have evaluated its effectiveness in improving TB treatment outcomes. Methods: We compared treatment outcomes of adults with drug-sensitive TB before and after Himachal Pradesh's 99DOTS launch using data from India's national TB database. The pre-intervention group initiated treatment between February and October 2017 (N = 7722), and the post-intervention group between July 2018 and March 2019 (N = 8322). We analyzed engagement with 99DOTS and used multivariable logistic regression to estimate impact on favorable treatment outcomes (those marked as cured or treatment complete). Results: In the post-intervention group, 2746 (33.0%) people called 99DOTS at least once. Those who called did so with a wide variation in frequency (< 25% of treatment days: 24.6% of callers; 25–50% of days: 15.1% of callers, 50–75% of days: 15.7% of callers; 75–100% of days: 44.6% of callers). In the pre-intervention group, 7186 (93.1%) had favorable treatment outcomes, compared to 7734 (92.9%) in the post-intervention group. This difference was not statistically significant (OR = 0.981, 95% CI [0.869, 1.108], p = 0.758), including after controlling for individual characteristics (adjusted OR = 0.970, 95% CI [0.854, 1.102]). Conclusions: We found no statistically significant difference in treatment outcomes before and after a large-scale implementation of 99DOTS. Additional work could help to elucidate factors mediating site-wise variations in uptake of the intervention. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to medication is the major challenge in treating mental illness, resulting in worsening symptoms and prolonging the course of the illness. Caregivers spend a considerable amount of time with the patients. Therefore, proper training and education for caregivers help to improve treatment outcomes. Aim: This study aims to evaluate the effectiveness of caregiver intervention for improving medication adherence (CIIMA) on level of medication adherence and attitude toward medications among nonadherent patients with mental illness. Methods: This study was an experimental study using a randomized pretest posttest control group design. The study was conducted in the psychiatric outpatient department of tertiary care hospital in the eastern India. Eighty nonadherent patients with mental illness and their primary caregivers were randomly allocated to the experimental and control group using the concealment allocation method. Patients were assessed for their level of medication adherence using medication adherence rating scale, their attitude toward medication were assessed using drug attitude inventory and reasons for medication nonadherence were assessed using the Rating of Medication Influence. CIIMA consisted of individual psycho-education, pill card monitoring, weekly telephonic and text reminders provided to the experimental group, and routine treatment was provided to the control group. The level of medication adherence and attitude toward medication were reassessed for both groups after 1 month of the initial assessment. Results: After 1 month of CIIMA, 87.2% of patients in the experimental group were adherent to medication as compared 18.4% in the control group (P < 0.001), significant improvement in their attitude toward medication and treatment in the experimental group as compared to the control group (P = 0.001). Conclusion: CIIMA is an effective, low-cost, nurse-led intervention can be delivered in the inpatient and outpatient units for improving medication adherence thereby preventing future relapse of their mental illness. [ABSTRACT FROM AUTHOR]

Background: Hypertension, one of the most important risk factors for cardiovascular disease, which includes coronary artery disease, heart failure, and cerebral stroke. It has been confirmed that an increase in systolic blood pressure by 20 mmHg and diastolic blood pressure by 10 mmHg doubles the risk of death. There is an increasing rate of mortality as a result of cardiovascular disease, the number of deaths associated with hypertension in the United States increased by 61.8%. The prevalence of hypertension in India is about 30%, and the urban population had markedly high level of hypertension compared to rural population. A metaanalysis revealed that the pooled prevalence of hypertension for the rural and urban north Indian population was 14.5% (13.3-15.7) and 28.8% (26.9-30.8), respectively. Aims: To evaluate Medication Adherence among Hypertensive patients. Methods: A cross-sectional study was conducted at Department of Pharmacology in collaboration with Department of Medicine, Govt. Medical College, Patiala. Patients attending Medicine OPD with a diagnosis of Hypertension, who satisfy the inclusion criteria will be selected. Medication adherence was tested using the validated nine item Hill-Bone Medication Adherence Scale (HB-MAS). The data will then be evaluated and computed for statistical analysis of various interactions and correlations. Results: Out of 200 patients, the mean age of the participants was 63.45±11.09 years. The male to female ratio was 1:0.9. 53% patients were males. 58% of the patients were obese, 28% overweight, 13% normal and 1% underweight. 72.5% patients' treatment adherence was good, for 14.5% moderate and for, it was 13% poor. Conclusion: The outcome of the current study revealed that there is a good adherence status among the study participants. The analysis clearly demonstrated that younger age and lower BMI were the main factors responsible for poor treatment adherence. [ABSTRACT FROM AUTHOR]

Objectives To assess the rate of medication adherence, facilitators and barriers to medication adherence among elderly. Methods A cross-sectional study was conducted to assess the medication adherence level and the patient reported facilitators and barriers using medication adherence rating scale and a prevalidated questionnaire, respectively amongst the geriatric patients who were hospitalised in a south India tertiary care hospital. Data thus collected were categorically analysed. Predictors were assessed using odds ratio at 95% confidence interval. Key Findings A total of 401 patients were enrolled, majority [220 (54.86%)] were adherent to the medications. The barriers identified included forgetfulness, carelessness, lack of awareness about the disease and medication, illiteracy, lack of regular follow up and visit, social stigma on disease, polypharmacy and adverse effects. The facilitators included good access to the health care system, patient counselling, regular follow-up, and refill. The age group of 71–80 years [OR 2.02 (95% CI, 1.31–3.13)], illiteracy [OR 2.34 (95% CI 1.38–3.98)], single as marital status [OR 3.64 (95% CI, 1.13–11.67)], comorbidities (≥5) [OR 3.91 (95% CI, 1.78–8.60)], discharge medications (>11) [OR 3.11 (95% CI, 1.55–6.26)], lack of awareness about the disease [OR 1.99 (95% CI, 1.30–3.032)] were found to be significant predisposing factors. Conclusions This study reveals as several predictive factors were identified for medication nonadherence which can aid in developing strategies to improve medication adherence. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. Methods: Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. Results: Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. Discussion: Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are a category of heart and blood vessel disorders that include coronary disorders, cerebrovascular diseases, rheumatic pain, and other conditions. One of the major risk factors for CVDs is high blood pressure (BP). Furthermore, it is poorly managed due to a lack of understanding of hypertension, a lack of proper primary care, and a lack of follow-up. The patient education improves the patient's response to the disease and its management and their quality of life. Objectives: The objectives of this study were to evaluate the effect of clinical pharmacist intervention by the provision of patient counseling, on medication adherence and differences in laboratory parameters in patients with cardiovascular disease in a tertiary care hospital in Vadodara, Gujarat, India. Methods: For 6 months, a prospective interventional study was conducted in a tertiary care hospital. The patients with cardiovascular disease, in addition to the usual care, were given patient counseling and patient information leaflets on discharge. BP was compared before and after intervention and medication adherence (as measured by the MMAS-8 Questionnaire) was calculated. The data obtained were analyzed by Chi-Square and Paired-t test comparing data from two independent samples. Results: In total, 97 patients were enrolled in the study. The average age of the group was 58.98 ± 8.55 years. Medication adherence was observed to be increased post-intervention, with the average score increasing from 3.11 to 4.70, that is, a percentage increase of 58.3%. It was also observed that in the average population, the severity of hypertension had decreased after the intervention. Conclusion: Clinical pharmacists have a significant impact in a variety of capacities in both inpatient and outpatient settings, primarily through increasing the medication adherence in the patients, drug optimization, the prevention of adverse drug events, and critical treatment practices such as prescription exchange and patient education. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and at present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). A key reason for poor outcomes is non-adherence to medication., Methods: The intervention is a 2 × 2 factorial design trial applying two interventions individually and in combination with 1:1 allocation ratio: (i) ASHA-led medication adherence initiative comprising of home visits and (ii) m-health intervention using reminders and self-reporting of medication use. This design will lead to four potential experimental conditions: (i) ASHA-led intervention, (ii) m-health intervention, (iii) ASHA and m-health intervention combination, (iv) standard of care. The cluster randomized trial has been chosen as it randomizes communities instead of individuals, avoiding contamination between participants. Subcenters are a natural subset of the health system, and they will be considered as the cluster/unit. The factorial cluster randomized controlled trial (cRCT) will also incorporate a nested health economic evaluation to assess the cost-effectiveness and return on investment (ROI) of the interventions on medication adherence among patients with CVDs. The sample size has been calculated to be 393 individuals per arm with 4-5 subcenters in each arm. A process evaluation to understand the effect of the intervention in terms of acceptability, adoption (uptake), appropriateness, costs, feasibility, fidelity, penetration (integration of a practice within a specific setting), and sustainability will be done., Discussion: The effect of different types of intervention alone and in combination will be assessed using a cluster randomized design involving 18 subcenter areas. The trial will explore local knowledge and perceptions and empower people by shifting the onus onto themselves for their medication adherence. The proposal is aligned to the WHO-NCD aims of improving the availability of the affordable basic technologies and essential medicines, training the health workforce and strengthening the capacity of at the primary care level, to address the control of NCDs. The proposal also helps expand the use of digital technologies to increase health service access and efficacy for NCD treatment and may help reduce cost of treatment., Trial Registration: The trial has been registered with the Clinical Trial Registry of India (CTRI), reference number CTRI/2023/10/059095., (© 2024. The Author(s).)

Background: There are little data on the use of smartphone-based applications for medication adherence and risk-factor control for the secondary prevention of stroke in low-and-middle-income countries (LMICs)., Aims: The aim was to determine whether a smartphone-based app improved medication adherence, risk-factor control, and provided health education to stroke survivors for lifestyle and behavioral modifications., Methods: An unblinded, single-center randomized controlled double arm trial with 1:1 allocation among stroke survivors was performed in South India. The primary outcome was medication adherence, with co-primary outcomes of lifestyle and behavioral factors and control of vascular risk factors, at 3 and 6 months., Results: Among 351 stroke survivors screened, 209 were recruited. The mean (standard deviation (SD)) age of the intervention (n = 105) group was 60 (12) years and that of the control (n = 104) group was 60 (10) years. In the primary outcome, mean medication adherence significantly improved in the intervention group with a between group difference of 0.735 (95% confidence interval (CI) = 0.419 to 1.050), p < 0.001. Being in intervention group (OR = 4.5; 95% CI = 2.3 to 8.9), stroke recurrence (OR = 3.3 (95% CI = 1.9 to 7.8)), and regular physician visits (OR = 2.1; 95% CI = 1.0 to 4.4) were significant predictors of good medication adherence. Considering the co-primary outcomes, compared to the control group, participants in the intervention group had a greater improvement in self-reported healthy diet intake (p = 0.003), intake of fruits (p = 0.005), and were physically more active (p = 0.001). At 6 months, mean fasting blood sugar (p = 0.005) and high-density lipoprotein cholesterol higher (p = 0.024) in the intervention group., Conclusions: The use of a mobile app is an effective method to improve medication adherence and risk-factor control in stroke survivors and is feasible in LMICs like India., Data Access Statement: Data used during the study are available from the corresponding author on request., Trial Registration: The study is registered in Clinical Trial Registry of India (CTRI/2022/06/042980)., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To determine perspectives on reasons for non-adherence to antihypertensive therapy and its socioeconomic determinants among patients attending a primary care center in a low-income area in Delhi, India. Methods: We conducted in-depth interviews with a total of 30 patients having hypertension at a primary care facility located in a low-income urban area in Delhi. Results: All the participants were aware that hypertension was a serious illness, and medication intake was necessary throughout life to prevent uncontrolled hypertension. All participants in varying quantities practiced salt restriction, but the consumption of fresh fruit and vegetables was low primarily due to economic reasons. The participants were unable to differentiate the concept of exercise from physical activity. Medication adherence was suboptimal, and significant reasons for non-adherence were forgetfulness, carelessness and running out of drug stocks. Blood pressure control was also suboptimal in a majority of the participants, but combination therapy was restricted due to limited medical armamentarium at the clinic. Laboratory investigations for monitoring target end-organ damage were either delayed or not conducted in most participants. Discussion: Hypertensive patients undergoing treatment at primary care facilities often report suboptimal medical adherence and treatment outcomes, with socioeconomic causes being a major driver of non-adherence. [ABSTRACT FROM AUTHOR]

Background: Adherence to medication for tuberculosis (TB) has been found to be deleteriously affected by psychosocial issues, including internalized and perceived stigma (IPS) and depression, usually resulting in the emergence of multidrug-resistant TB (MDR-TB). The objective of the study was to find the prevalence of depression among patients receiving treatment for pulmonary TB, and how stigma and depression affect the relationship between drug sensitivity status (DSS) and treatment adherence. Method: It was a cross-sectional observational study conducted between January 2019 and July 2020 in two centers in Sikkim, India. The Patient Health Questionnaire-9 (PHQ-9), Internalized Social Stigma Scale (ISSS), and Tuberculosis Medication Adherence Scale were used to assess depression, IPS, and medication adherence, respectively. A path analysis was performed with DSS, treatment adherence, IPS, and depression. Education in years was included in the model as it was significantly correlated with IPS. Results: A total of 71 patients who were on drug-sensitive TB (DS-TB) regimen (n = 26) and MDR-TB regimen (n = 45) participated in the study. Notably, 56.3% (n = 40) of the participants were found to have depression. Among the depressed participants, 32.5% were on the DS-TB regimen and 67.5% were on the MDR-TB regimen. The path analysis indicated that IPS and depression were serially mediating the relationship between DSS and treatment adherence (β = −0.06, p < 0.05, 95% CI = −3.20, −0.02). Finally, years of education had an exogenous predictor role, not only directly affecting IPS (β = −0.38, p < 0.001, 95% CI = −0.99, −0.31) but also affecting treatment adherence through IPS and depression (β = 0.08, p = 0.02, 95% CI = 0.03, 0.47). This indicated that with more years of education, the IPS decreases, which decreases depression and ultimately leads to better adherence. Conclusion: We found an important relationship between different psychosocial factors which may affect treatment adherence. Patients who have higher IPS are more likely to develop depression which negatively affect adherence. Patients on the MDR-TB regimen have higher stigma. There is an urgent need to integrate mental health services with TB Control Programs. [ABSTRACT FROM AUTHOR]

Nonadherence to antiepileptic drugs (AEDs) is a prevalent issue in India, contributing to suboptimal seizure control, higher morbidity and mortality, increased hospitalization rates, and a substantial effect on the overall quality of life for individuals with epilepsy. This study aimed to measure the prevalence of medication adherence among individuals with epilepsy in India and to identify factors associated with nonadherence. Following PRISMA guidelines, we searched PubMed, Scopus, Embase, and Google Scholar for studies on AED adherence in India. Quality assessment employed Newcastle Ottawa Scale adapted for cross-sectional studies. Pooled prevalence was ascertained using a random-effects model in R software (version 4.2.2), with a 95% confidence interval. Heterogeneity was estimated with the I2 statistic, and publication bias was appraised via a funnel plot. Subgroup analyses, based on study region and adherence measurement tool, were done to investigate heterogeneity. Nine cross-sectional studies with 1772 participants were analyzed. The pooled prevalence of adherence to AEDs in India stood at 49.9% (95% CI: 39.8%-60.1%). Subgroup analyses showed comparable adherence rates in the South (50.9%) and North (46.5%) regions of India. However, adherence rates varied substantially based on the measurement tool: Morisky Medication Adherence Scale-4 (MMAS-4) reported 71.3%, MMAS-8 indicated 45.9%, and Morisky Green Levine (MGL) adherence scale exhibited 42.0%. Factors contributing to non-adherence to antiepileptic therapies involved poor socioeconomic status, lower education levels, polytherapy, drug-related side effects, and substance abuse. Almost half of persons with epilepsy in India were non-adherent to their AEDs. This underscores the importance for healthcare professionals to pay greater attention to improving the adherence rate to AEDs within the healthcare service. • Nonadherence to AEDs may lead to uncontrolled seizures, causing complications and impairing quality of life. • The low pooled adherence rate draws attention to a significant gap in therapeutic management. • Adherence rates varied by tools utilized, emphasizing the importance of tool selection. • Poor socioeconomic status, lower education, polytherapy, and drug-related side effects were contributors to nonadherence. • Effective epilepsy management needs personalized interventions, consistent treatment access, and simpler treatment plans. [ABSTRACT FROM AUTHOR]

Drug adherence is an important problem faced worldwide by patients of all age groups. This article aims to address the factors hindering patient adherence to a proper medication regime. Numerous studies have demonstrated that complex dosing schedules and polypharmacy along with financial constraints are the main problems faced by patients. The problems also tend to vary among different patient populations such as diabetics, hypertensives, Chronic Kidney Disease (CKD) patients, and Chronic Obstructive Pulmonary Disease (COPD) patients, posing different challenges in each of the chronic diseases. Multifactorial solutions are needed to improve medication adherence including efforts to improve a patient's understanding of medication benefits, trust in their doctor and health system, and improving the physician's recognition and understanding of patients' beliefs, fears, and values to achieve increased medication adherence. [ABSTRACT FROM AUTHOR]

Background Nonadherence to tuberculosis medications is associated with poor outcomes. However, measuring adherence in practice is challenging. In this study, we evaluated the accuracy of multiple tuberculosis adherence measures. Methods We enrolled adult Indians with drug-susceptible tuberculosis who were monitored using 99DOTS, a cellphone-based technology. During an unannounced home visit with each participant, we assessed adherence using a pill estimate, 4-day dose recall, a last missed dose question, and urine isoniazid metabolite testing. We estimated the area under the receiver operating characteristic curve (AUC) for each alternate measure in comparison to urine testing. 99DOTS data were analyzed using patient-reported doses alone and patient- and provider-reported doses, the latter reflecting how 99DOTS is implemented in practice. We assessed each measure's operating characteristics, with particular interest in specificity—that is, the percentage of participants detected as being nonadherent by each alternate measure, among those who were nonadherent by urine testing. Results Compared with urine testing, alternate measures had the following characteristics: 99DOTS patient-reported doses alone (area under the curve [AUC], 0.65; specificity, 70%; 95% CI, 58%–81%), 99DOTS patient- and provider-reported doses (AUC, 0.61; specificity, 33%; 95% CI, 22%–45%), pill estimate (AUC, 0.55; specificity, 21%; 95% CI, 12%–32%), 4-day recall (AUC, 0.60; specificity, 23%; 95% CI, 14%–34%), and last missed dose question (AUC, 0.65; specificity, 52%; 95% CI, 40%–63%). Conclusions Alternate measures missed detecting at least 30% of people who were nonadherent by urine testing. The last missed dose question performed similarly to 99DOTS using patient-reported doses alone. Tuberculosis programs should evaluate the feasibility of integrating more accurate, objective measures, such as urine testing, into routine care. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the effectiveness of nurse-led interventions in managing leprosy due to a shortage of dermatologists and other healthcare professionals., Methods: A total of 100 leprosy patients were divided into experimental (n=50) and control groups (n=50). The intervention included face-to-face counseling by a trained nurse, motivational videos and exercise demonstrations. The control group received standard care. The primary outcome of interest was treatment adherence (Adherence to Refills and Medications Scale); other assessed outcomes included changes in perceived stigma (Stigma Assessment and Reduction of Impact scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder seven-item) and quality of life (WHO QOL-BREF Scale) from baseline to week 8., Results: The intervention group had better treatment adherence (p<0.001). At baseline, moderately severe and severe depression prevalence was 18% and 28%, respectively, and anxiety was 25%, with no intergroup differences. Anxiety significantly decreased in the intervention group (p<0.001), but depression remained similar (p=0.291). Perceived stigma improved notably, especially in disclosure of concern (p<0.001), internal stigma (p<0.001) and anticipated stigma (p<0.001). Quality of life scores improved in the intervention group vs controls., Conclusion: Nurse-led interventions effectively enhanced quality of life and treatment adherence and reduced anxiety, depression and perceived stigma among leprosy patients. The study recommends strengthening the capacity of nurses for active involvement in leprosy care., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Methadone take-home doses for opioid dependence treatment are strictly regulated due to diversion and overdose concerns, so patients must visit the clinic daily for dispensing. This was also done in India until the COVID-19 pandemic, when lockdown restriction compelled take- home dispensing of methadone. This study examined experience of patients who received take- home methadone during COVID-19 pandemic in India., Methods: Observational, cross-sectional design. We contacted all consenting methadone centres in India during the lockdown and selected those that provided take-home doses for the study. Patients who received daily methadone before the lockdown and take-home doses after were interviewed using a study-specific questionnaire., Results: The study had 210 participants. Take-home methadone was dispensed for 2.5 days on average in each dispensing. When taking methadone at home, 3.3% split their dose 25% took less than the prescribed dose to save it for a rainy days, and 3.3% reported an overdose episode. Adherence improved in 58.6% participants after take-home methadone. Participants perceived many benefits from take-home methadone such as reduced hospital visits and travel time to collect methadone, improvement in work, and financial savings. About 54.3% participants reported storing their take-home doses safely, and 1.9% reported that their family consumed methadone by mistake., Conclusions: Take-home methadone was found to be beneficial to most participants in terms of time saved and improved productivity. Preconceived concerns of providing take-home methadone in terms of its overdose, diversion, or accidental ingestion by others are not commonly seen when individuals are provided take-home doses of methadone., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: In tuberculosis (TB) care and management, there are practical challenges existing at the patient-provider level leading to implementation barriers at the primary care level., Objectives: The objective of the study is to explore the challenges and barriers faced by people with TB and health-care workers in TB care and management., Materials and Methods: This study was done as a part of a community intervention study between November 2021 and December 2022. Twenty interviews were taken with treatment for TB (n = 7) and health-care personnel (n = 13). Health-care personnel include nursing staff, medical officers, laboratory technicians, community health workers, and medical personnel from tertiary care hospital. Participants were recruited across all levels of health-care systems. Interviews were carried out in the Hindi language, audio recorded, and translated to English. Participants were asked about their experiences of challenges and barriers faced during TB care and management. Qualitative data were coded, and thematic analysis was done manually., Results: The challenges and barriers at the level of people with TB were issues with communication between providers and people with TB, out-of-pocket expenditure, poor adherence to medicines, lack of proper diet, gender issues, and stigma. The challenges and barriers at the level of health-care providers were a lack of infrastructure and logistics, lack of awareness, COVID-19-related issues, lack of workforce, and technical issues., Conclusion: Communication between providers and people with TB must be improved to improve the drug adherence and satisfaction of the end user. Proper funding must be provided for the TB programs. People with TB must be counseled properly regarding the free health care services available near their homes to prevent out-of-pocket expenditure. These will help in fast-tracking the elimination of TB., (Copyright © 2024 Copyright: © 2024 Indian Journal of Public Health.)

Context: Control of diabetes mellitus is a global challenge and nonadherence to diabetic medications is a public health concern. Factors related to patients, medications, and system can contribute to nonadherence. Aims: We aimed to determine self-reported adherence to oral hypoglycemics and to understand the determinants of medication adherence in a group of adult diabetics in South Kerala. Methods: A cross-sectional survey was conducted among 218 diabetic individuals. An eight-item questionnaire to assess the level of adherence and a structured interview schedule were administered to meet the objectives. Adherence was categorized as poor, moderate and high, based on k-means cluster analysis. Results: The proportion of good adherence was 60.09%. Higher age, male gender, nonalcoholic, higher family income, higher frequency of blood glucose monitoring, and controlled blood sugar level were independent predictors of good adherence. Conclusion: The proportion of individuals with poor medication adherence is low. Focus must be on determining factors influencing medication nonadherence. [ABSTRACT FROM AUTHOR]

Purpose: While two-thirds of epilepsy patients can become seizure free on medical treatment, poor adherence to medication is a major problem to sustained remission and functional restoration. The aim of this study was to assess the prevalence and associated factors of antiepileptic drug (AED) non-adherence. Methods: We conducted a subgroup analysis based on results that emerged from a single center, cross-sectional study. Patients who were 18 years or older were included. The 4-item Morisky Medication Adherence Scale was used to measure adherence to AED (s). Multivariable logistic regression analysis was used to predict factors associated with AED non-adherence. Results: A total of 268 patients fulfilled inclusion criteria and were included in this subgroup analysis. Among the participants, 81 (30%) were non-adherent to medication. Three factors associated with non-adherence were AED polytherapy [OR: 4.5 (2.1-9.5) P = 0.001], drug related adverse events [OR: 3.9 (2.1-7.3) P = 0.001], and treatment duration exceeding 3 years [OR: 2.6 (1.3-5.0) P = 0.003]. Conclusion: About one-third patients were not compliant with their medication. If the treatment of patients is restricted to monotherapy as far as possible and patients are educated about duration of treatment and possible adverse effects of AEDs, non-adherence may be reduced. [ABSTRACT FROM AUTHOR]

Introduction: Suboptimal medication adherence contributes enormously to patient mortality, morbidity, and related health-care costs. Health-care providers (HCPs) have a pivotal role in supporting medication adherence in their patients through appropriate health communication. We assessed the perspectives and practices of medical doctors and nurses toward the assessment and support for patient medication adherence in Indian health settings. Materials and Methods: We conducted a cross-sectional study at a secondary-care hospital in Delhi. Data were collected from medical doctors, interns, and nursing staff using a self-administered questionnaire on the following domains: Medication Adherence, frequency, methods and tools of assessment, high-risk patient identification and interventions applied to promote adherence. Results: We recruited a total of 117 HCPs. The common modes of assessment of medication adherence used by the HCPs included a general question (78.6%), observing missed appointments (43.6%), and querying for forgetfulness (29.9%). However, none of the HCPs were aware of validated questionnaire (scales) for the assessment of medication adherence. Drug-related adverse effects as a cause of nonadherence were evaluated by 38.3% HCPs only. Conclusions: The development of simple and validated methods for assessing medication adherence applicable in resource-constrained settings along with the curricular training of HCPs on patient adherence and related know-how needs urgent prioritization. [ABSTRACT FROM AUTHOR]

Objective: Geriatric populations are most at risk for the tuberculosis pandemic, and as people age, the rate of infection rises steadily and drastically. Geriatric individuals frequently experience diagnostic challenges with a wide range of comorbidities, but employing all available standard and novel methods to diagnose any infection is crucial. The prophylactic and therapeutic management for the geriatric population presents a significant difficulty and challenge in assessing an appropriate and effective therapeutic outcome due to prolonged drug therapy and adverse drug reactions. The present study aims to determine the prevalence of tuberculosis in the geriatric population in the Indian subcontinent, its risk factors, clinical outcomes, and adherence to the medication., Patients and Methods: A prospective observational investigation was conducted in a tertiary care Hospital in Erode, Tamil Nadu, India, from April 2021 to September 2022. A total of 1,014 patients were screened, and 176 participants were selected. The participants were then subjected to medication adherence evaluation, and clinical data was collected.  The statistical analysis was performed using SPSS version 20.0., Results: Among 176 participants, 135 (76.70%) were old (65-74 age), 37 (21.02%) were very old (75-84 age) TB patients, and 4 (2.27%) patients were extremely old TB patients (>85). Medication adherence was improved from baseline to the end of the study (p≤0.000). 110 patients completed the treatment (62.5%). 41 patients were cured in between treatments (23.29%), 13 patients died during the treatment (7.38%), 9 patients lost their follow-up (5.11%), 3 patients failed to respond to the treatment (1.70%)., Conclusions: The effectiveness of therapy critically depends on the patient's medication adherence to anti-TB therapy. In addition to having a higher likelihood of therapy failure, elderly patients did not appropriately respond to the treatment and completely recovered from the infection even after effective pharmacotherapy.

Aim: Adherence to medication is important in older patients with non‐communicable diseases, and there is a need to investigate various interventions to enhance adherence in our Indian setting. This pilot randomized controlled trial aimed at testing the effectiveness of systematic education and behavioral intervention in enhancing medication adherence among older adults. Methods: It was a single center, open label, parallel arm, randomized controlled trial carried out among older (age >60 years) inpatients of general medicine wards diagnosed with select non‐communicable diseases, such as diabetes, hypertension, dyslipidemia and coronary artery disease. Participants were randomized either to receive the usual standard of care or the intervention that comprises of systematic education, patient diary to mark daily medicine intake and periodic telephone reminders. Barriers to medication adherence were identified and interventions were tailored according to the identified barriers over a 6‐month follow‐up period. The primary end‐points were change in the reported pill count (RPC) within groups and between groups at the third and sixth month. Results: The RPC in control and intervention arms at the thrid month were 78.20% and 91.88% (P = 0.007), whereas at 6 months they were 68.64% and 83.08% (P = 0.003), respectively. Similarly, change in RPC in intervention arm between baseline and the third month (mean difference 24.08%, P = 0.001), and between baseline and the sixth month (mean difference 15.280%, P = 0.006) were statistically significant. However, the RPC between the third and sixth month showed a significant decline (mean difference 8.8%, P = 0.016). Conclusion: In this pilot study, we prove that behavioral interventions have improved medication adherence among older adults, and it is feasible to carry out such studies among older adults in India. Geriatr Gerontol Int 2020; 20: 1079–1084. [ABSTRACT FROM AUTHOR]

99DOTS is a cellphone-based strategy for monitoring tuberculosis medication adherence. In a sample of 597 Indian patients with tuberculosis, we compared 99DOTS' adherence assessments against results of urine isoniazid tests collected during unannounced home visits. 99DOTS had suboptimal accuracy for measuring adherence, partly due to poor patient engagement with 99DOTS. [ABSTRACT FROM AUTHOR]

Objective: To assess the determinants of out-of-pocket (OOP) expenses on diabetes-related treatment incurred in patients attending outpatient clinics in a tertiary care hospital in Delhi, India. Study Design: A cross-sectional analysis of baseline data from a quasi-experimental study was conducted over 8 months in 2016 in a major tertiary care hospital in Delhi. Methods: The study included 375 diabetes patients up to 65 years of age on treatment for at least a year without significant complications. Data were collected through a patient interview schedule. Results: Of the previous six scheduled appointments, at least two missed appointments were seen in 267 (71.2%) patients. The average patient's OOP expenditure on diabetes-related medicines was ₹63.5 a month, a similar amount was spent on traveling to and from health facilities. Sixty-four (17.1%) patients took antidiabetic medication for <85% of the days in the previous 3 months. Conclusion: There exists a high burden of missed clinic appointments among diabetes patients in tertiary care government health settings in India. This appears to be related to the high cost in terms of both time and money involved in attending appointments for the modest benefit of a dispensation of a 15-day drug refill. Health policy measures focused on strengthening medication coverage need to explore the balance of costs and benefits when determining the frequency of clinical appointments in these settings. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in India. CVDs are to a large extent preventable with the availability of wide range of interventions focusing on primary and secondary prevention. However human resource deficit is the biggest challenge for implementing these prevention programs. Task shifting of the cardiovascular risk assessment and communication to nurses can be one of the most viable and sustainable option to run prevention programs.Methods: The study was quasi experimental in nature with 1 year follow up to determine the effect of CVD risk assessment and communication by nurses with the help of risk communication package on primary and secondary prevention of CVDs. The study was done in the outpatient departments of a tertiary health care center of Northern India. All the nurses (n = 16) working in selected OPDs were trained in CVD risk assessment and communication of risk to the patients. A total of 402 patients aged 40 years and above with hypertension (HTN) were recruited for primary prevention of CVDs from medicine and allied OPDs, whereas 500 patients who had undergone CABG/PTCA were recruited from cardiology OPDs for secondary prevention of CVDs and were randomized to intervention (n = 250) and comparison group (n = 250) by using block randomization. CVD risk modification and medication adherence were the outcomes of interest for primary and secondary prevention of CVDs respectively.Results: The results revealed high level of agreement (k = 0.84) between the risk scores generated by nurses with that of investigator. In the primary prevention group, there were significantly higher proportion of participants in the low risk category (70%) as compared to baseline assessment (60.6%) at 1 year follow up. Whereas in secondary prevention group the mean medication adherence score among intervention group participants (7.60) was significantly higher than that of the comparison group (5.96) with a large effect size of 1.1.(p < 0.01).Conclusion: Nurse led intervention was effective in risk modification and improving medication adherence among subjects for primary and secondary prevention of CVDs respectively.Trial Registration: Trial registration no CTRI/2018/01/011372 [Registered on: 16/01/2018] Trial Registered Retrospectively. [ABSTRACT FROM AUTHOR]

Visit compliance and its relation with various parameters of Diabetes are less explored in developing countries like India. Present study aimed to assess visit compliance, its relationship with various predictors of diabetes. 180 patients with confirmed diagnosis of type 2 diabetes mellitus were considered for this study from four town of Gujarat state. Through self-reporting, demographic information, compliance details and visit process was studied. Predictors were identified through assessing distribution pattern using Chi square test and logistic regression using EPI Info. P<0.05 and P<0.0001 were considered to be the criteria for significant and highly significant association. 180 patients consented to be the part of the study. Mean age for the study population was 55.47 ± 12.06 years. It was found that there was no correlation between glycemic goals and visit compliance. Drug intake, exercise and diet modification were found to be predictors for visit compliance. However, comprehensive information about the disease was shared in only 37% patients. The elaborated counselling at the time of visit about diabetes, its self-management and possible co-morbid conditions with investigating information needs from the subjects is strongly recommended. [ABSTRACT FROM AUTHOR]

Cardiovascular (CV) risk factors like diabetes and hypertension are poorly controlled in both rural and urban India. This study was designed to identify the reasons for suboptimal control in a semiurban population in India. A total of 70 participants from the Study to Expand Heart Associated Treatments (SEHAT) trial, conducted in West Bengal, India. We qualitatively examined perspectives regarding CV risk factor control using focus group discussions based on the theory of reasoned action. Qualitative content analysis was used to analyze prevailing themes. Participants demonstrated a generalized knowledge of healthy lifestyle practices but lacked insight into disease-specific prevention methods. We further noticed significant gaps in the translation of existing knowledge into behavior. While personal and systemic barriers exist, factors like high patient motivation and a deep sense of trust in providers can potentially be harnessed to improve risk factor control in the community. We identified key facilitators and barriers to CV risk factor control in the community using a knowledge attitude behavior approach. Our findings provide direction for the development of community-based CV risk reduction models. [ABSTRACT FROM AUTHOR]

Background: Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India., Methods: This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant., Results: We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82)., Conclusions: Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity., (© 2023. The Author(s).)

Purpose: The aim of this study was to understand patient adherence, satisfaction, and experience with the smaller sized metformin 500 mg prolonged release (PR) tablet that has been manufactured with the help of technological advancement (Gluformin I 500 mg), in comparison with metformin 500 mg extended-release (ER) tablet, in patients with type 2 diabetes mellitus (T2DM). Patients and methods: In this postmarketing observational study, T2DM patients who were on a stable dose of metformin 500 mg PR tablet for at least 1 month and had previously received metformin 500 mg ER tablet were recruited from 50 sites in India. The medication adherence and patients' experience, satisfaction, and perception with metformin 500 mg PR tablets were compared with metformin 500 mg ER tablets. The patients' experience was determined based on the external appearance of tablet, ease of swallowing, the presence of gastrointestinal discomfort, and ghost pill effect. Results: A total of 1,000 patients were enrolled. The majority had medium adherence to metformin 500 mg PR tablet (54%) and did not report swallowing difficulties (66.2%) due to its small size (64.4%) and oval shape (64.3%). The PR formulation of metformin was more acceptable than ER formulation due to no aftertaste (63%). The ghost pill effect was reported in 0.7% of patients with metformin 500 mg PR tablet against 8.5% with ER tablet. More than 60% of patients were "comfortable" (67.9%), had "much effect on their well-being" (61.8%), and were "satisfied" (69%) with metformin 500 mg PR tablet compared with ER tablet. Patient's dissatisfaction (42.7%) and taste (24.9%) were the common reasons cited by physicians and patients, respectively, for changing the treatment from metformin 500 mg ER to metformin 500 mg PR formulation. A total of 10 adverse events (nonserious) were reported, and all of them were resolved. Conclusion: The technologically advanced formulation of metformin 500 mg PR tablets is more effective than that of metformin 500 mg ER tablets in improving adherence, compliance, satisfaction, and perception to medication in Indian patients with T2DM. [ABSTRACT FROM AUTHOR]

Background: Trends in morbidity and mortality due to noncommunicable diseases (NCDs) are rising because of poor control status. Medication nonadherence is one of the most common and modifiable causes of inadequate control status. Objectives: To determine the prevalence of drug adherence among patients with NCD in rural Puducherry. Methods: A facility-based cross-sectional study was done among 260 patients with NCD receiving treatment from rural primary health center in Puducherry during February and March 2018. Information regarding sociodemographic profile and household was collected using pretested semi-structured questionnaire. Morisky Medication Adherence Scale was done to assess the adherence. We calculated adjusted prevalence ratios (aPRs) to identify the factors associated with medication adherence. Results: Among the 260 participants, 42.7% belonged to elderly age group; 66.2% were females; 44% did not have any formal education; 70% were unemployed. The majority were suffering from hypertension (71.2%) followed by diabetes (56.2%). This study found that almost one-third (32.7%) of the study participants were not properly adherent to medications. Elderly [aPR 2.51 95% confidence interval (CI): 1.70–3.70] and female participants (aPR 1.64 95% CI: 1.04–2.58) were found to have more chance being nonadherent to medications after adjusting for possible confounding variables. Conclusion: This study reported that almost one-third of the study participants were nonadherent to medications. Elderly age group and female gender were found to be the determinants of nonadherence. Corrective measures need to be started at patient level first by motivating and educating them regarding the importance of drug intake. [ABSTRACT FROM AUTHOR]

Genetic, environmental, and metabolic risk factors are interrelated and contributed to the development of type 2 diabetes mellitus (T2DM). The American Association of Clinical Endocrinologists (AACE) guidelines are gold standard for the management of T2DM. The objective of the study was to assess the prescription adherence to AACE treatment guidelines and risk factors for T2DM in a South Indian tertiary care hospital. A cross-sectional study was carried out in 950 subjects (with or without T2DM), and prescription adherence was assessed by comparing with the AACE guidelines. Odds ratios were calculated in univariate logistic regression analysis for risk factors. T2DM was significantly higher in the subjects of age above 40 years, females, married, BMI, urban residence, higher socioeconomic class, hypertension as comorbidity, physical inactivity, smokers, alcoholics, and stress. Metformin was the most widely prescribed drug followed by α-glucosidase inhibitors in monotherapy. The overall rate of prescription adherence was 88.0 % (when HbA1c <7.5 %, P < 0.01); 86.63 % (when HbA1c 7.5-9 %, P < 0.001), and 80 % (when HbA1c >9 %, P < 0.001). Univariate regression analysis showed that the age (above 40 years), female gender, married, BMI (>25 kg/m2), urban residence, body weight (above 50 kg), high economic class, hypertension, past alcoholic, physical inactivity, and stress are the significantly risk factors for T2DM. The present study results suggested that prescription adherence to AACE guidelines was optimal. Female gender, age (above 50 years), hypertension, stress, physical inactivity, urban residence, body weight, BMI, and high socioeconomic status are the major risk factors for T2DM. [ABSTRACT FROM AUTHOR]

Background: The concept of generic prescription is widely accepted in various parts of the world. Nevertheless, it has failed to gain popularity in India due to factors such as nonavailability and distrust on the product quality. However, since 2012, the Government of West Bengal, India, has initiated exclusive generic drug outlets called "fair price medicine shop" (FPMS) inside the government hospital premises in a "public-private-partnership" model. This study was undertaken to evaluate the experience and attitude of patients who were consuming generic drugs purchased from these FPMS. Materials and Methods: It was a questionnaire-based cross-sectional study where we have interviewed 100 patients each consuming generic and branded drugs, respectively. The perceived effectiveness, reported safety, medication adherence, cost of therapy, and availability of drugs was compared between two mentioned groups. Medication adherence was estimated through Drug Attitude Inventory-10. Results: 93% of generic and 87% branded drug users believed that their drugs were effective (P = 0.238) in controlling their ailments. No significant difference (9% generic, 10% branded drug users, P = 1.000) was observed in reported adverse effects between generic and branded drug users. 82% and 77% of patients were adherent generic and branded drugs, respectively (P = 0.289). As expected, a significantly lower cost of generic drugs was observed compared to its branded counterpart. Conclusion: The policy of FPMS implemented by the Government of West Bengal, India appeared to be promising in terms of perceived effectiveness, safety, and adherence of generic drugs from FPMS compared to drugs purchased from open market retailers. Therefore, this study might act as an impetus for the policy-makers to initiate similar models across the country. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to assess the feasibility and acceptability of video-based anti-tuberculosis (TB) treatment adherence support in patients with TB (PwTB) in South India., Design: An exploratory cohort., Setting: Participants were recruited at the TB treatment centre (direct observed treatment short centre) of a tertiary-level teaching facility in Bangalore, Karnataka, South India., Participants: The study enrolled 25 PwTB, with replacement. Adult PwTB who were on drug-sensitive treatment regimens were included, while those who had drug resistant TB were excluded from the study., Intervention: Participants received scheduled adherence reminders and were trained to videorecord themselves swallowing their medication via a mobile application. The application was automated to submit these videos for evaluation. Participants were followed up monthly till treatment completion or withdrawal., Outcome Measures: Adherence rate and acceptability of video-based directly observed treatment (vDOT)., Results: The mean±SD age of the participants was 33±14 years, majority were females (16, 64%), residing in urban areas (24,96%), married (17, 68%) and had access to smart phones (23,92%). A total of 3193 person days of follow-up was completed; of the videos submitted within the first 6 months of enrollment (2501), 94% (2354/2501) were considered 'acceptable' and 16 (64%) participants were optimally adherent (ie, ≥80%). Participant videos improved in quality and a higher proportion met acceptability criteria over time. Twenty-one (84%) participants stated that they found the application easy to learn; 13 (52%) preferred vDOT over DOT. Mixed model logistic regression showed that those who are married are more likely have daily adherence to anti-TB treatment., Conclusion: Video-based mobile phone interventions are acceptable to PwTB and the ease of using the application increases with time. To provide patient-centred care, vDOT is a promising option that can be offered to patients for treatment support and adherence monitoring., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: Covert administration of medication (CoAdM) by caregivers to persons with severe mental illness (SMI) is a commonly observed medication delivery practice in India., Aims: This study aims to examine different medication delivery practices adopted by caregivers to provide care to SMI at times of medication refusal., Method: This study was conducted at the outpatient department between April 2019 and November 2019. A semi-structured questionnaire was used to interview the caregivers of persons with SMI to assess medication delivery practices., Results: A total of 300 caregivers were interviewed. CoAdM was practiced in 96 (32.0%) persons with SMI at least once during their lifetime, and other strategies used were pleading ( n  = 105, 35.0%), lying ( n  = 10, 3.3%), and threatening ( n  = 154, 51.4%). Logistic regression showed that male gender (OR 4.75; CI 1.37-16.46), absent insight (OR 10.0; CI 2.01-47.56), and poor adherence to medication (OR 4.75; CI 1.31-16.92) were significantly associated with CoAdM in the last 1 year. Caregivers perceived significant improvement in self-care ( Z  = -4.37, p  < .01), interpersonal ( Z  = -7.61, p  < .01), work ( Z  = -5.9, p  < .01), family functioning ( Z  = -7.82, p  < .01) difficult behavior ( Z  = -8.27, p  < .01), and dependency ( Z  = -6.34, p  < .01) in persons with SMI with use of CoAdM., Conclusions: CoAdM was given to one in three persons with SMI at some point in their lives. Male gender, absent insight and poor adherence were predictive of CoAdM in the last 1 year. Caregiver perceived improvements in self-care, work, interpersonal, family functioning, problem behaviors, and dependency after CoAdM. Policies need to be evolved to serve all stakeholders while keeping these practices in mind.

Introduction: Adherence to tuberculosis (TB) medication is one of the critical challenges to tuberculosis elimination in India. Digital adherence technologies (DAT) have the potential to facilitate medication adherence and monitor it remotely. Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD) is one such DAT piloted in Nasik, Maharashtra, from April 2020 to December 2021. The study aims to assess the adherence and cost-effectiveness of TMEAD compared to the standard of care among patients with drug-sensitive tuberculosis (DSTB) residing in the urban areas of Nasik, Maharashtra, India., Methods: A quasi-experimental study was conducted among new cases of TB as per the National TB Elimination Programme (NTEP) residing in the urban geography of Nasik. The intervention and control arms were purposively selected from non-contaminating TB units (TUs). A total of 400 DSTB patients (200 in the intervention group and 200 in the control group) were enrolled. After enrolment, patients in the intervention arm were provided with the TMEAD device and followed for 24 weeks to assess treatment outcomes. Adherence was measured as those patients who have completed 80% of prescribed doses, as reported during patient follow-up, and further validated by analyzing the trace of rifampicin in urine among 20% of patients from both arms. A budget impact analysis was done to assess the impact of the TMEAD program on the overall state health budget., Results: Out of 400 enrolled DSTB patients, 261 patients completed treatment, 108 patients were on treatment, 15 patients died, and 16 patients were defaulters over the study period. The study reported overall treatment adherence of 94% among those who completed treatment. Patient reports indicated high levels of treatment adherence in the intervention group (99%) as compared to the control group (90%). Adherence assessed through analyzing trace of rifampicin in the urine sample for the intervention arm was 84% compared to the control arm (80%). Per beneficiary (discounted) cost for TMEAD was Indian rupees (INR) 6,573 (USD 83). The incremental cost-effectiveness ratio of the intervention is INR 11,599 (USD 146), which shows that the intervention is highly cost-effective., Conclusion: This study revealed that patient-reported treatment adherence was high in TMEAD when compared to standard therapy of care for DSTB patients and the intervention is cost-effective. TMEAD could complement the national strategy to end TB by improving adherence to the treatment regimen in India., Competing Interests: NH and RD were employed by SenseDose Technologies. MJ, MS, and JC were employed by India Health Fund. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Saha, Saxena, Raval, Halkarni, Doshi, Joshi, Sridharan, Sathwara, Yasobant, Shah, Quazi, Rajsekar and Chowdhury.)

Background: Visual analogue scale (VAS) is one of the simplest to measure medication adherence. It has neither been widely used for Non communicable diseases (NCD) nor validated for in the Indian setting. We examined the validity of self-reported medication adherence measures in relation to HbA1C in a rural population with diabetes mellitus (DM)., Methods: Participants with DM was administered VAS, Diabetes Self-Management Questionnaire (DMSQ) and assessed for missed pills. Descriptive statistics and logistic regression analysis were done., Results: We recruited 1347 participants and 84% of them reported being 100% adherent as per VAS and 83.8% stated that they did not miss any pills. However, 58.2% of participants who reported having 100% adherence had poor glycaemic control, as did 58.1% of those who did not miss any pills. None of the diabetic self-care measures was significantly associated with glycaemic control., Conclusion: We found a lack of association between self-reported adherence measures and glycaemic control in participants with DM suggesting that self-reported adherence scales may not be valid in this population., Competing Interests: Conflict of Interests None of the authors declare any conflict of interest., (Copyright © 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background & objectives: National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. Methods: Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. Results: Suboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR-1.341, CI-1.080-1.665), on ART for less than 6 months (OR-1.540, CI- 1.280-1.853), male gender (OR for females -0.807, CI- 0.662-0.982), tribals (OR-2.246, CI-1.134-4.447), on efavirenz (EFA) regimen (OR- 1.479, CI - 1.190 - 1.837), presence of anxiety (OR- 1.375, CI - 1.117 - 1.692), non- disclosure of HIV status to family (OR- 1.549, CI - 1.176 - 2.039), not motivated for treatment (OR- 1.389, CI - 1.093 - 1.756), neglect from friends (OR-1.368, CI-1.069-1.751), frequent change of residence (OR- 3.373, CI - 2.659 - 4.278), travel expenses (OR- 1.364, CI - 1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR-1.639, CI-1.330-2.019). Interpretation & conclusions: To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement. [ABSTRACT FROM AUTHOR]

Background: The alarming rise in prevalence of hypertension warrants psychosocial methods supplementing pharmacotherapy for better management and prevention of cardiac emergencies. The objective of the study was to assess the differential impact of the form and frequency of knowledge intervention on management of primary hypertension., Materials and Method: The study was conducted on 256 hypertensive patients recruited through purposive sampling at health centers in Hyderabad, India. Pretest post-test control group quasi-experimental design was adopted for the study. There were two forms of the knowledge intervention, namely 'Direct Interaction' and 'Audio-Visual'. Each form was presented in two frequencies namely 'single exposure' and 'double exposure'. The four groups were labelled as Direct Intervention Single (DIS), Direct Intervention Double (DID), Audio-Visual Single (AVS) and Audio-Visual Double (AVD). Adherence and management of hypertension were assessed at baseline and six weeks post experiment. Analysis of Covariance (ANCOVA) was applied using IBM SPSS Statistics version 20., Results: ANCOVA followed by Bonferroni Multiple Group Comparison Test revealed significant differences between the four intervention groups and control group on adherence (p< .001). In case of hypertension management significant differences were observed between Control group and DIS, DID (p < .001), Control and AVS (p < .01). Control group did not differ from AVD., Conclusion: There was a positive impact of Knowledge Intervention on adherence and management of hypertension. Double exposure in audio visual form was counterproductive in hypertension management., Competing Interests: Declaration of competing interest The Authors declare that there is no conflict of interest., (Copyright © 2022 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

In India, interruptions to highly active antiretroviral therapy (HAART) are due to adverse drug reactions. This study was aimed to assess the association between HAART adherence and adverse drug reactions (ADRs) in human immunodeficiency virus (HIV) patients. This prospective study was conducted at a Medicine department in a South Indian tertiary care teaching hospital. HIV-positive patients were interviewed for adherence using ACTG adherence questionnaire and intensively monitored for ADRs to HAART. The percentage of adherence was calculated based on missed doses, and graded as less than 80%, 80-95%, and >95%. The World Health Organization (WHO) probability scale was used for causality assessment. Logistic regression analysis as well as univariate analysis was used to assess the association (P value < 0.05). A total of 105 HIV-positive patients had been taking HAART out of whom 50 (47.6%) patients agreed for adherence assessment, and 23 (21.9%) refused due to social stigma. Upon evaluation of the patient characteristics in the reported adherence, 78% were in males (53.8%) and 22% were in females (46.2%) with the level of adherence greater than 95%. Six (12%) patients had a regular alcoholic intake with adherence less than 80% compared to 31 (62%) patients who never had any alcoholic intake (P < 0.05). A significant association between ADRs and adherence was found (P < 0.05). Causality found by the WHO scale was "probable." Clinicians must focus on education regarding the need for adherence, possible adverse effects, and early detection and prevention of ADRs to HAART. [ABSTRACT FROM AUTHOR]

Summary: Hypertension is inadequately controlled in most patients due to poor adherence to treatment. Not much is known about the underlying reasons for poor adherence. The main objective of this study was to assess medication adherence in hypertensive patients and to identify the main barriers associated with medication adherence. A questionnaire-based survey was conducted in the medicine outpatient department of Kempe Gowda Institute of Medical Sciences and Research Centre, Bangalore, India. Self reported adherence was measured by using a short validated questionnaire and detailed patient interviews. Of the 608 patients participated, non-adherence was found in 49.67% of patients. Belief barrier was reported in 39.14% patients. Access barrier and recall barrier were reported by 82.57% and 62.17%, respectively. 78.62% of patients reported that it is difficult to pay for the medication and 54.93% indicated that it is difficult to get a refill on time. It was concluded that about half of the Indian patients studied were not adherent to their antihypertensive regimen and this might result in poor blood pressure control. Non-adherence to hypertension management remains a major limiting factor among Indians in the effective control of hypertension and in the prevention of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Abstract: Acceptability and adherence in clinical trials of microbicides may possibly predict their acceptance by the community. In this study, we investigated the acceptability and adherence of Praneem polyherbal tablet, a candidate microbicide, among 100 HIV-uninfected participants of a Phase II randomised, double-blind, placebo-controlled trial in Pune, India, conducted between June 2004 and February 2006 involving 6 months of coitally-dependent product use. The relationship between five acceptability domains and adherence to product use during the study period was explored. Acceptability and adherence were assessed among 95 study participants completing all study follow-ups. One hundred percent adherence (product use during each sex act for the study period) was reported by 67 participants (70.5%). The majority of participants reported acceptability towards all product characteristics. Product odour was reported to be a concern both in the placebo and Praneem arms. Participants from the Praneem arm [adjusted odds ratio (AOR)=3.8; 95% CI 1.4–10.8] and participants reporting lower acceptability for experience of product use during the sex act (AOR=4.2; 95% CI 1.0–17.3) were more likely to have partial adherence. In conclusion, the study product was acceptable to the majority of participants. However, barriers to adherence attributable to undesirable sexual experiences need to be addressed. [Copyright &y& Elsevier]

Objective: To explore the various stakeholders' perspectives on barriers and facilitators for medication adherence among patients with cardiovascular diseases (CVDs) and diabetes mellitus (DM)in India., Design: Systematic review of qualitative studies., Data Sources: A comprehensive systematic search was conducted in Medline, Cochrane Library, Science Direct and Google Scholar from January 2010 to July 2020. We included all qualitative peer-reviewed studies, reporting barriers and facilitators of medication adherence, from India, for our current review., Data Extraction and Synthesis: Data extraction was performed by two independent authors who also assessed the quality of included studies using the Critical Appraisal Skills Programme criteria. This qualitative evidence synthesis adhered to the enhancing transparency in reporting the synthesis of qualitative research checklist RESULTS: In total, 18 studies were included. Major barriers reported were lack of understanding about the disease, complications related to non-adherence, followed by forgetfulness, lack of family support and risk communication. Health system-related barriers such as accessibility, affordability and acceptability were also reported by majority of the studies. Creation of peer support groups, digital reminder systems, integration of native Indian systems of India, physiotherapy and geriatric clinics at the primary healthcare level and innovations in patient care were suggested to counter these barriers in medication adherence., Conclusion: Such patient-specific targeted interventions need to be developed to achieve better control among patients with CVD and DM.PROSPERO registration numberCRD42020199529., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Setting: Five select districts of Karnataka, India, providing anti-tubercular and antiretroviral therapy (ATT and ART) to people with Human Immunodeficiency Virus (HIV) - associated Tuberculosis (TB) through a single window care approach at the ART centres (seven ART centres and 16 link ART centres)., Objectives: To determine the factors associated with non-adherence to concurrent therapy., Design: We conducted a case-control study involving primary and secondary data collection. Starting January 2019, we consecutively enrolled people on at least three months of ATT until we enrolled 125 cases (non-adherent to concurrent therapy) and 375 controls (adherent to concurrent therapy). Adherence was defined as taking >95% ART doses and >90% ATT doses, every month over the last three months. We performed multivariable logistic regression to identify factors associated with non-adherence., Results: The mean age of the cases and control was similar: 39.8 (standard deviation: 8.8) years. The risk factors for non-adherence were status non-disclosure (aOR = 2.06), zidovudine-based ART (aOR = 4.87), >3 side effects (aOR = 6.45), not receiving counselling before ATT initiation (aOR = 5.25) and non-receipt of co-trimoxazole prophylaxis (aOR = 9.90)., Conclusion: Major determinants for non-adherence were clinical and treatment related factors., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)