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The Rethabile positive parenting activity is being run by 4Children Lesotho with caregivers and teens ages 9 to 24 for the purpose of reducing harsh parenting practices (i.e., violence) and improving positive parenting practices. By promoting adul
...
t–child communication around topics such as HIV and AIDS prevention, and exploring models of family-focused violence prevention and support, the program facilitates disclosure of HIV status, promotes greater treatment seeking and adherence, and helps to reduce HIV stigma.lesoth
more
TB heroes
Hello, my name is Nurse X
My job is to promote integrated HIV and TB prevention, care, treatment and support. This ensures that we, and my team of health care service providers treat eve
...
ryone who is living with HIV and TB to have all the antiretroviral therapy (ART) and HIV care services are provided with TB diagnosis and treatment at one facility. Services that we provide include * Infection control education * TB screening and diagnosis * HIV testing * Treatment for those who require it * Adherence support
Accessed November 2017
more
Transition to new antiretrovirals in HIV programmes
World Health Organization
(2017)
C_WHO
HIV Treatment
Policy Brief
July 2017
Policy Brief to Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy
World Health Organization
(2017)
C_WHO
HIV treatment
Policy brief
July 2017
WHO/HIV/2017.18
Bain LE, et al. BMJ Glob Health 2017;2:e000227. doi:10.1136/bmjgh-2016-000227
The Global Breast Cancer Initiative aims to address disparities in access to care to reduce mortality rates globally. Patient navigation is an evid
...
ence-based personalized intervention designed to guide patients through often complex cancer care systems to receive timely access, particularly in low-income and minority populations. It is useful in settings with limited availability, fragmented healthcare systems and socioeconomic barriers that hinder early detection and treatment. It is proven to significantly reduce delays, improve patient adherence to care and enhance survival rates. The model involves helping individuals and their families to tackle barriers such as cultural stigma, misinformation, and psychosocial, among others, that can delay or prevent access to timely care. It can also reduce financial strain, streamline care coordination and improve the overall quality of life by connecting patients with affordable treatment options and support systems to address their needs in the course of treatment.
more
Over 90% of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) and asthma occurs in low-income and middle-income countries (LMICs) due to well documented factors inc
...
luding decreased access to screening, trained health professionals, and therapies for disease management. Inhaler therapy (eg, aerosolised medications by inhalation, nebulisation, or propellant) is the mainstay of treatment for COPD and asthma. Adherence to maintenance medications for COPD and asthma results in improved lung function and quality of life, as well as decreased hospitalisation and mortality. WHO have included short-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids on the essential medications list, with a target goal of achieving 80% availability of these medications in public and private facilities. However, despite these efforts, accessibility, and affordability of medications for COPD and asthma remains scarce.
more
Adherence to post-exposure prophylaxis: Where do losses Occur?
World Health Organization; Imperial College London
(2019)
C_WHO
Accessed: 27.11.2019
Policy and service delivery guidelines for linkage to care, adherence to treatment and retention
...
in care
more
Severe and difficult asthma in a low- and middle-income country (LMIC) can relate to lack of availability of basic medications; potentially reversible factors such as poor adherence or comorbidities
...
such as obesity inhibiting a good response to treatment; and (rarely) true severe, therapy-resistant asthma. However, definitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The first assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-effects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.
more
Technical information note. Digital Adherence Technologies (DATs) such as the smart medication container
kit can help to support people affected by TB with their
...
treatment in a modern
and ef-fective way. These technologies are able to deliver reminders and may
help em-power TB affected individuals and their families to take their daily
medication at a time and place that suits them best. They also generate a
digital record of medication intake.
more
In the European Union, over 20 million people suffer from asthma. During the 1990s there was a rapid decrease in asthma mortality, probably related to the increased use of inhaled corticosteroids (ICS). However, during the last decade, asthma mortal
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ity rates have plateaued, and a consistently high proportion of patients have uncontrolled asthma. As a result, many patients with asthma still have impaired quality of life and suffer from chronic respiratory symptoms, often including night-time symptoms, causing sleep disturbance, excessive daytime sleepiness and decreased work productivity.
more
Background
Access to medicines is important for long‐term care of cardiovascular diseases and hypertension. This study provides a cross‐country assessment of availability, prices, and affordability of cardiovascular disease and hypertension med
...
icines to identify areas for improvement in access to medication treatment.
Methods and Results
We used the World Health Organization online repository of national essential medicines lists (EMLs) for 53 countries to transcribe the information on the inclusion of 12 cardiovascular disease/hypertension medications within each country's essential medicines list. Data on availability, price, and affordability were obtained from 84 surveys in 59 countries that used the World Health Organization's Health Action International survey methodology. We summarized and compared the indicators across lowest‐price generic and originator brand medicines in the public and private sectors and by country income groups. The average availability of the select medications was 54% in low‐ and lower‐middle‐income countries and 60% in high‐ and upper‐middle‐income countries, and was higher for generic (61%) than brand medicines (41%). The average patient median price ratio was 80.3 for brand and 16.7 for generic medicines and was higher for patients in low‐ and lower‐middle‐income countries compared with high‐ and upper‐middle‐income countries across all medicine categories. The costs of 1 month's antihypertensive medications were, on average, 6.0 days’ wage for brand medicine and 1.8 days’ wage for generics. Affordability was lower in low‐ and lower‐middle‐income countries than high‐ and upper‐middle‐income countries for both brand and generic medications.
Conclusions
The availability and accessibility of pharmaceuticals is an ongoing challenge for health systems. Low availability and high costs are major barriers to the use of and adherence to essential cardiovascular disease and antihypertensive medications worldwide, particularly in low‐ and lower‐middle‐income countries.
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Adherence Guidelines for HIV, TB and NCDs
M. Phokojoe; H. Duvivier; Dr. Y. Pillay; et al.
Department: Health Republic of South Africa
(2016)
C2
Policy and service delivery guidelines for linkage to care, adherence to treatment and retention
...
in care
February 2016
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. The aim of this journal is
...
to provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. This article emphasizes the importance to make a correct diagnosis based, most import
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antly, on the clinical history and supported by investigations. Further, the appropriate drug and device must be chosen to achieve good asthma control. It explains that patients must be followed up regularly and their asthma control must be assessed so that the treatment can then be adjusted according to the level of control. Additionally, Asthma education and adherence are important components of management of the condition.
more
The document provides practical guidance for individuals with COPD, covering topics such as medication management, oxygen therapy, mucus control, physical exercise, smoking cessation, nutrition, associated conditions, and how to prevent and manage e
...
xacerbations. It emphasizes the importance of patient education, adherence to treatment plans, and collaboration with healthcare providers to improve quality of life and disease outcomes.
more
The article investigates the effectiveness and challenges of remote monitoring systems for chronic respiratory diseases, focusing on COPD and asthma. It reviews various technologies and their potential to improve patient outcomes through better symp
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tom tracking, medication adherence, and early detection of exacerbations. The study highlights that while remote monitoring has significant potential, challenges such as data accuracy, patient compliance, and integration with existing healthcare systems remain. The authors call for further research to standardize and validate remote monitoring tools and emphasize the need for patient-centric approaches to enhance engagement and adherence.
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Impact of COVID-19 on Pediatric Asthma: Practice Adjustments and Disease Burden
Papadopoulos, N.G.; Custovic, A.; Deschildre, A. et al.
The Journal of Allergy and Clinical Immunology: In Practice
(2020)
CC
Coronavirus disease 2019 has a mild disease course in children and adolescents. Chronic respiratory conditions, including asthma, have been suggested as risk factors; however, asthma in children is highly variable in both triggers and severity.
During the pandemic, pediatric asthma services limite
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d consultations and established virtual clinics. However, respondents perceived their patients’ asthma control to be retained or even improved, while treatment adherence was considered increased. Children with asthma were not disproportionately affected by coronavirus disease 2019.
Trigger avoidance and treatment adherence can rapidly improve asthma control in children, even under lockdown pressure. Children/adolescents with asthma do not appear to need additional prophylactic measures from coronavirus disease 2019 when asthma is well-treated. This article analyses the effect of COVID-19 on Asthma in children, providing information for management guidelines.
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