Background. Generally defined as taking >= 5 non-antiretroviral therapy (ART) medications, polypharmacy has a disproportionate impact on people living with HIV (PWH), who experience a 2 – 3 times greater prevalence of polypharmacy than aged-matched individuals from the general population. Up to 40% of PWH have one or more potential drug-drug interactions, including interactions with over-the-counter (OTC) medications that are essential but often unreported in medical records. These drug-drug interactions can result in increased morbidity and mortality.

Data and Methods. We conducted a preliminary study of OTC use in a large HIV Clinic in South Carolina. Pharmacy students interviewed 50 randomly selected patients after their office visits with providers. We recorded all consistent use of OTC medications, defined as having taken at least two consecutive doses in the past 30 days. The results were compared against the list of medications captured in patient electronic health records to assess concordance. Finally, we reviewed the medical literature to identify potential adverse events from specific OTC-ART combinations.

Results. Of the 50 patients, 32 took an OTC medication consistently in the previous 30 days. Only 12% (4/32) of OTC use was captured in the medical records; 22% (7/32) of patients had potentially clinically significant ART-OTC interactions. The most taken OTC medications were pain medication (47%), antihistamines (31%), vitamins (25%), acid suppressants (19%), cough, cold, and allergy medications (19%), herbal supplements (9%), and gastrointestinal medications (3%). The OTC medication involved in potential interactions were antihistamines (diphenhydramine, pseudoephedrine), corticosteroids (fluticasone), and acid reducers (famotidine lansoprazole). The ART involved included protease inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside reverse transcriptase inhibitors. All 7 of the ART-OTC drug interactions found were clinically significant, including QT prolonging (irregular heart rhythm), increased blood pressure, adrenal suppression, and decreased absorption of ART.

Conclusion. We identified high rates of undocumented use of OTC and clinically relevant drug interactions between OTC and ART. Our findings suggest a great need to devise and implement strategies to better document and flag OTC medication use in health records, in order to reduce potential serious adverse reactions among PWH.

Introduction:

Adolescent girls engaged in transactional sex and drug use in Uganda are at increased risk of HIV transmission. Although PrEP has the potential to mitigate this risk, its scale-up and evidence on effective implementation strategies are still limited.

Methods:

Between April 2018 and May 2019, we conducted cross-sectional semi-structured interviews to explore effective implementation strategies and recommendations for enhancing PrEP delivery with 18 Ugandan adolescent girls aged 15-24 years engaged in transactional sex/used drugs and 10 PrEP implementers (healthcare leaders and healthcare providers, policymakers, Peer leaders, community-based organization). We analyzed data using a directed content analysis approach guided by CFIR.

Results:

Stakeholders recommended a variety of implementation strategies to enhance PrEP delivery among adolescent girls engaged in transactional sex. These strategies included training key gatekeepers such as PrEP focal persons at PrEP clinics and peer leaders, providing technical assistance through support supervision and hands-on mentorship, and integrating PrEP with other services like harm reduction, HIV testing, cancer screening, etc. They also emphasized providing culturally sensitive and adolescent-centered services by involving peers in the PrEP care processes, developing community engagement by equipping adolescents, peer leaders, and parents with PrEP information, and making changes within health facilities to create adolescent-friendly spaces for PrEP provision. These strategies influenced three domains of the CFIR: the inner setting by improving infrastructure and workflow; the implementation climate by enhancing stakeholder engagement, reducing PrEP stigma, and improving attitudes; and readiness for PrEP implementation by facilitating timely problem-solving. Some barriers reported include inadequate government funding to support sustained PrEP implementation and a restrictive legal environment against adolescents engaged in transactional sex.

Conclusion:

Our study underscores the need for context-specific implementation strategies to enhance PrEP uptake and effectiveness among adolescent girls engaged in transactional sex and drug use in Uganda. The stakeholder recommendations provide valuable insights for policymakers and practitioners striving to improve HIV prevention efforts in this vulnerable population.

Background: The growing burden of non-communicable diseases (NCDs) among people living with HIV (PWH), especially in low- and middle-income countries (LMICs), is threatening gains in life expectancy. Calls to integrate HIV and NCD-related care by global organizations have not been supported by clear guidance for achieving this goal. We conducted a content analysis of national documents to assess the extent to which LMICs are integrating NCD and HIV care. Here we present preliminary results.

Methods: We included national-level strategic plans, technical guidelines, and PEPFAR operational plans that described the management and care of PWH and were published in English between 2010 and 2023, sourced from websites of country governments and the US State Department. We extracted documentation related to screening and/or treatment of four NCDs (hypertension, diabetes, cervical cancer, and depression), and/or two NCD risk factors (alcohol and tobacco use), and barriers and/or facilitators to NCD-HIV integration. We calculated the frequency of mentions of these categories to assess the level of priority LMICs placed on NCD-HIV integration.

Results: We analyzed documents from Kenya, India, Jamaica and Nigeria. The majority of documents acknowledged the importance of NCD-HIV integration; 91.7% mentioned cervical cancer screening and treatment, 66.7% mentioned depression, and 59% mentioned hypertension and diabetes. Only 16.7% mentioned tobacco use. Barriers to integration were infrequently reported; however, half the documents (50%) mentioned facilitators such as making improvements in service delivery (e.g., outlined clear protocols) and health workforce (e.g., increased staff). One-third (33.3%) mentioned improving leadership and governance by adopting global integration policies and public-private partnerships. Three documents each (25%) mentioned improving information systems, medical products, and financing.

Conclusion: The emphasis on cervical cancer likely represents recent efforts to address the higher risk among women living with HIV. Strategies to incorporate NCD care into existing HIV services focus on service delivery and workforce development. Integrating NCDs and HIV care will require country-specific guidance on strategies that facilitate NCD treatment for PWH in LMICs.