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Biosensing enhancement of dengue virus using microballoon mixers on centrifugal microfluidic platforms

Aeinehvand MM, Ibrahim F, Harun SW, Djordjevic I, Hosseini S, Rothan HA, et al.

Biosens Bioelectron, 2015 May 15;67:424-30.
PMID: 25220800 DOI: 10.1016/j.bios.2014.08.076

Dengue is the current leading cause of death among children in several Latin American and Asian countries. Due to poverty in areas where the disease is prevalent and the high cost of conventional diagnostic systems, low cost devices are needed to reduce the burden caused by dengue infection. Centrifugal microfluidic platforms are an alternative solution to reduce costs and increase the availability of a rapid diagnostic system. The rate of chemical reactions in such devices often depends on the efficiency of the mixing techniques employed in their microfluidic networks. This paper introduces a micromixer that operates by the expansion and contraction of a microballoon to produce a consistent periodical 3D reciprocating flow. We established that microballoons reduced mixing time of 12 μl liquids from 170 min, for diffusional mixing, to less than 23 s. We have also tested the effect of the microballoon mixers on the detection of the dengue virus. The results indicate that employing a microballoon mixer enhances the detection sensitivity of the dengue virus by nearly one order of magnitude compared to the conventional ELISA method.
Partner's engagement in community-based health promotion programs: a case study of professional partner's experiences and perspectives in Iran

Bahraminejad N, Ibrahim F, Riji HM, Majdzadeh R, Hamzah A, Keshavarz Mohammadi N

Health Promot Int, 2015 Dec;30(4):963-75.
PMID: 24934454 DOI: 10.1093/heapro/dau043

Community-based health promotion requires effective participation and partnership of diverse and numerous stakeholders from community as well as external professional organizations. Although effective partnership of stakeholders is often the key for success of health promotion practice and research, but this has proved to be a complex and challenging task. This study is an exploratory study to identify professional stakeholder's perspectives and experiences toward the partner's engagement challenges in community-based participatory research conducted in Population Research Centers in Iran. A qualitative study design with in-depth semi-structured interviews as data collection method was chosen. Using purposeful sampling technique, policy-makers and managers (mainly academics) involved in community-based participatory research in these centers were invited to be interviewed. Data were collected to the point where no new information was forthcoming. All interviews were taped and transcribed. To provide answers for research questions, qualitative content analysis was employed to extract emerging main themes from numerous cods. Findings were categorized in three main themes as Partnership's relationship and trust issues, Partnership's individual issues and Partnership's system issues. Although community-based participatory research in Iran benefits from more than a decade history and some physical infrastructures, but it seems that public health experts and researchers and other partner organizations are lagging behind in terms of capacities and competencies required to effectively utilize the available structure and opportunities. Hence, capacity development, both among professional partners and community may be the main way forward to tackling the future challenges for strengthening community actions but should include both levels of individuals and systems.
Fulltext Three-dimensional culture environment increases the efficacy of platelet rich plasma releasate in prompting skin fibroblast differentiation and extracellular matrix formation

Rothan HA, Djordjevic I, Bahrani H, Paydar M, Ibrahim F, Abd Rahmanh N, et al.

Int J Med Sci, 2014;11(10):1029-38.
PMID: 25136258 DOI: 10.7150/ijms.8895

Platelet rich plasma clot- releasate (PRCR) shows significant influence on tissue regeneration in clinical trials. Although, the mechanism of PRCR effect on fibroblast differentiation has been studied on 2D culture system, a detailed investigation is needed to establish the role of PRCR in cell seeded in 3D scaffolds. Therefore, a study was conducted to evaluate the influence of PRCR in fibroblasts (DFB) differentiation and extracellular matrix formation on both 3D and 2D culture systems. Cell viability was measured using MTT assay and DFB differentiation was evaluated by determining the expression levels of nucleostamin and alpha smooth muscle actin (α-SMA), using indirect immunostaining and Western blotting. The expression levels of extracellular matrix genes (collagen-I, collagen-III, fibronectin and laminin) and focal adhesion formation gene (integrin beta-1) were measured using Real-time PCR. The PRCR at 10% showed significant effect on cells viability compared with 5% and 20% in both culture environments. The decrease in the expression levels of nucleostamin and the increase in α-SMA signify the DFB differentiation to myofibroblast-like cells that was prominently greater in 3D compared to 2D culture. In 3D culture systems, the total collage production, expression levels of the extracellular matrix gene and the focal adhesion gene were increased significantly compared to 2D culture. In conclusion, 3D culture environments enhances the proliferative and differentiation effects of PRCR on DFB, thereby potentially increases the efficacy of DFB for future tissue engineering clinical application.
Fulltext Classification of reflected signals from cavitated tooth surfaces using an artificial intelligence technique incorporating a fiber optic displacement sensor

Rahman HA, Harun SW, Arof H, Irawati N, Musirin I, Ibrahim F, et al.

J Biomed Opt, 2014 May;19(5):057009.
PMID: 24839996 DOI: 10.1117/1.JBO.19.5.057009

An enhanced dental cavity diameter measurement mechanism using an intensity-modulated fiber optic displacement sensor (FODS) scanning and imaging system, fuzzy logic as well as a single-layer perceptron (SLP) neural network, is presented. The SLP network was employed for the classification of the reflected signals, which were obtained from the surfaces of teeth samples and captured using FODS. Two features were used for the classification of the reflected signals with one of them being the output of a fuzzy logic. The test results showed that the combined fuzzy logic and SLP network methodology contributed to a 100% classification accuracy of the network. The high-classification accuracy significantly demonstrates the suitability of the proposed features and classification using SLP networks for classifying the reflected signals from teeth surfaces, enabling the sensor to accurately measure small diameters of tooth cavity of up to 0.6 mm. The method remains simple enough to allow its easy integration in existing dental restoration support systems.
Fulltext Vacuum/compression valving (VCV) using parrafin-wax on a centrifugal microfluidic CD platform

Al-Faqheri W, Ibrahim F, Thio TH, Moebius J, Joseph K, Arof H, et al.

PLoS One, 2013;8(3):e58523.
PMID: 23505528 DOI: 10.1371/journal.pone.0058523

This paper introduces novel vacuum/compression valves (VCVs) utilizing paraffin wax. A VCV is implemented by sealing the venting channel/hole with wax plugs (for normally-closed valve), or to be sealed by wax (for normally-open valve), and is activated by localized heating on the CD surface. We demonstrate that the VCV provides the advantages of avoiding unnecessary heating of the sample/reagents in the diagnostic process, allowing for vacuum sealing of the CD, and clear separation of the paraffin wax from the sample/reagents in the microfluidic process. As a proof of concept, the microfluidic processes of liquid flow switching and liquid metering is demonstrated with the VCV. Results show that the VCV lowers the required spinning frequency to perform the microfluidic processes with high accuracy and ease of control.
Analysis of water compartment in dengue patients

Ibrahim F, Ooi KF, Ismail NA, Taib MN, Wan Abas WA

Conf Proc IEEE Eng Med Biol Soc, 2007 2 7;2005:4130-3.
PMID: 17281142

This paper describes the water compartments in healthy subjects and dengue patients on the day of defervescence of fever using bioelectrical impedance analysis. A total of 223 healthy subjects (65 males and 158 females) and 210 dengue patients (119 males and 91 females) in Hospital Universiti Kebangsaan Malaysia (HUKM), were studied. The ages for healthy subjects vary between 14 and 60 years old with mean age of 26.05 years while the ages for the dengue patients vary between 12 and 83 years old with mean age of 30.14 years. The parameters of water compartments investigated were total body water (TBW), extracellular water (ECW) and intracellular water (ICW). There were significant difference between healthy subjects and dengue patients for both male (p<0.05) and female (p<0.001) beginning on fever day 0 till fever day 4. The mean TBW and ECW values of dengue patients obtained were found to be higher than the normal healthy subjects while the mean ICW was lower. The mean TBW and ICW for male were higher than female while the mean ECW for male was lower than female for healthy subjects and dengue patients.
Fulltext Theoretical development and critical analysis of burst frequency equations for passive valves on centrifugal microfluidic platforms

Thio TH, Soroori S, Ibrahim F, Al-Faqheri W, Soin N, Kulinsky L, et al.

Med Biol Eng Comput, 2013 May;51(5):525-35.
PMID: 23292292 DOI: 10.1007/s11517-012-1020-7

This paper presents a theoretical development and critical analysis of the burst frequency equations for capillary valves on a microfluidic compact disc (CD) platform. This analysis includes background on passive capillary valves and the governing models/equations that have been developed to date. The implicit assumptions and limitations of these models are discussed. The fluid meniscus dynamics before bursting is broken up into a multi-stage model and a more accurate version of the burst frequency equation for the capillary valves is proposed. The modified equations are used to evaluate the effects of various CD design parameters such as the hydraulic diameter, the height to width aspect ratio, and the opening wedge angle of the channel on the burst pressure.
A novel dengue fever (DF) and dengue haemorrhagic fever (DHF) analysis using artificial neural network (ANN)

Ibrahim F, Taib MN, Abas WA, Guan CC, Sulaiman S

Comput Methods Programs Biomed, 2005 Sep;79(3):273-81.
PMID: 15925426

Dengue fever (DF) is an acute febrile viral disease frequently presented with headache, bone or joint and muscular pains, and rash. A significant percentage of DF patients develop a more severe form of disease, known as dengue haemorrhagic fever (DHF). DHF is the complication of DF. The main pathophysiology of DHF is the development of plasma leakage from the capillary, resulting in haemoconcentration, ascites, and pleural effusion that may lead to shock following defervescence of fever. Therefore, accurate prediction of the day of defervescence of fever is critical for clinician to decide on patient management strategy. To date, no known literature describes of any attempt to predict the day of defervescence of fever in DF patients. This paper describes a non-invasive prediction system for predicting the day of defervescence of fever in dengue patients using artificial neural network. The developed system bases its prediction solely on the clinical symptoms and signs and uses the multilayer feed-forward neural networks (MFNN). The results show that the proposed system is able to predict the day of defervescence in dengue patients with 90% prediction accuracy.
Ictal EEG Source Imaging for Presurgical Evaluation of Refractory Focal Epilepsy

Habib MA, Ibrahim F, Mohktar MS, Kamaruzzaman SB, Rahmat K, Lim KS

World Neurosurg, 2016 Apr;88:576-585.
PMID: 26548833 DOI: 10.1016/j.wneu.2015.10.096

BACKGROUND: Electroencephalography source imaging (ESI) is a promising tool for localizing the cortical sources of both ictal and interictal epileptic activities. Many studies have shown the clinical usefulness of interictal ESI, but very few have investigated the utility of ictal ESI. The aim of this article is to examine the clinical usefulness of ictal ESI for epileptic focus localization in patients with refractory focal epilepsy, especially extratemporal lobe epilepsy.
METHODS: Both ictal and interictal ESI were performed by the use of patient-specific realistic forward models and 3 different linear distributed inverse models. Lateralization as well as concordance between ESI-estimated focuses and single-photon emission computed tomography (SPECT) focuses were assessed.
RESULTS: All the ESI focuses (both ictal and interictal) were found lateralized to the same hemisphere as ictal SPECT focuses. Lateralization results also were in agreement with the lesion sides as visualized on magnetic resonance imaging. Ictal ESI results, obtained from the best-performing inverse model, were fully concordant with the same cortical lobe as SPECT focuses, whereas the corresponding concordance rate is 87.50% in case of interictal ESI.
CONCLUSIONS: Our findings show that ictal ESI gives fully lateralized and highly concordant results with ictal SPECT and may provide a cost-effective substitute for ictal SPECT.
Fulltext Design and Development of Micro-Power Generating Device for Biomedical Applications of Lab-on-a-Disc

Joseph K, Ibrahim F, Cho J, Thio TH, Al-Faqheri W, Madou M

PLoS One, 2015;10(9):e0136519.
PMID: 26422249 DOI: 10.1371/journal.pone.0136519

The development of micro-power generators for centrifugal microfluidic discs enhances the platform as a green point-of-care diagnostic system and eliminates the need for attaching external peripherals to the disc. In this work, we present micro-power generators that harvest energy from the disc's rotational movement to power biomedical applications on the disc. To implement these ideas, we developed two types of micro-power generators using piezoelectric films and an electromagnetic induction system. The piezoelectric-based generator takes advantage of the film's vibration during the disc's rotational motion, whereas the electromagnetic induction-based generator operates on the principle of current generation in stacks of coil exposed to varying magnetic flux. We have successfully demonstrated that at the spinning speed of 800 revolutions per minute (RPM) the piezoelectric film-based generator is able to produce up to 24 microwatts using 6 sets of films and the magnetic induction-based generator is capable of producing up to 125 milliwatts using 6 stacks of coil. As a proof of concept, a custom made localized heating system was constructed to test the capability of the magnetic induction-based generator. The heating system was able to achieve a temperature of 58.62 °C at 2200 RPM. This development of lab-on-a-disc micro power generators preserves the portability standards and enhances the future biomedical applications of centrifugal microfluidic platforms.
Reversible thermo-pneumatic valves on centrifugal microfluidic platforms

Aeinehvand MM, Ibrahim F, Harun SW, Kazemzadeh A, Rothan HA, Yusof R, et al.

Lab Chip, 2015 Aug 21;15(16):3358-69.
PMID: 26158597 DOI: 10.1039/c5lc00634a

Centrifugal microfluidic systems utilize a conventional spindle motor to automate parallel biochemical assays on a single microfluidic disk. The integration of complex, sequential microfluidic procedures on these platforms relies on robust valving techniques that allow for the precise control and manipulation of fluid flow. The ability of valves to consistently return to their former conditions after each actuation plays a significant role in the real-time manipulation of fluidic operations. In this paper, we introduce an active valving technique that operates based on the deflection of a latex film with the potential for real-time flow manipulation in a wide range of operational spinning speeds. The reversible thermo-pneumatic valve (RTPV) seals or reopens an inlet when a trapped air volume is heated or cooled, respectively. The RTPV is a gas-impermeable valve composed of an air chamber enclosed by a latex membrane and a specially designed liquid transition chamber that enables the efficient usage of the applied thermal energy. Inputting thermo-pneumatic (TP) energy into the air chamber deflects the membrane into the liquid transition chamber against an inlet, sealing it and thus preventing fluid flow. From this point, a centrifugal pressure higher than the induced TP pressure in the air chamber reopens the fluid pathway. The behaviour of this newly introduced reversible valving system on a microfluidic disk is studied experimentally and theoretically over a range of rotational frequencies from 700 RPM to 2500 RPM. Furthermore, adding a physical component (e.g., a hemispherical rubber element) to induce initial flow resistance shifts the operational range of rotational frequencies of the RTPV to more than 6000 RPM. An analytical solution for the cooling of a heated RTPV on a spinning disk is also presented, which highlights the need for the future development of time-programmable RTPVs. Moreover, the reversibility and gas impermeability of the RTPV in the microfluidic networks are validated on a microfluidic disk designed for performing liquid circulation. Finally, an array of RTPVs is integrated into a microfluidic cartridge to enable sequential aliquoting for the conversion of dengue virus RNA to cDNA and the preparation of PCR reaction mixtures.
Fulltext Sequential push-pull pumping mechanism for washing and evacuation of an immunoassay reaction chamber on a microfluidic CD platform

Thio TH, Ibrahim F, Al-Faqheri W, Soin N, Kahar Bador M, Madou M

PLoS One, 2015;10(4):e0121836.
PMID: 25853411 DOI: 10.1371/journal.pone.0121836

A centrifugal compact disc (CD) microfluidic platform with reservoirs, micro-channels, and valves can be employed for implementing a complete immunoassay. Detection or biosensor chambers are either coated for immuno-interaction or a biosensor chip is inserted in them. On microfluidic CDs featuring such multi-step chemical/biological processes, the biosensor chamber must be repeatedly filled with fluids such as enzymes solutions, buffers, and washing solutions. After each filling step, the biosensor chamber needs to be evacuated by a passive siphoning process to prepare it for the next step in the assay. However, rotational speed dependency and limited space on a CD are two big obstacles to performing such repetitive filling and siphoning steps. In this work, a unique thermo-pneumatic (TP) Push-Pull pumping method is employed to provide a superior alternative biosensor chamber filling and evacuation technique. The proposed technique is demonstrated on two CD designs. The first design features a simple two-step microfluidic process to demonstrate the evacuation technique, while the second design shows the filling and evacuation technique with an example sequence for an actual immunoassay. In addition, the performance of the filling and evacuation technique as a washing step is also evaluated quantitatively and compared to the conventional manual bench top washing method. The two designs and the performance evaluation demonstrate that the technique is simple to implement, reliable, easy to control, and allows for repeated push-pulls and thus filling and emptying of the biosensor chamber. Furthermore, by addressing the issue of rotational speed dependency and limited space concerns in implementing repetitive filling and evacuation steps, this newly introduced technique increases the flexibility of the microfluidic CD platform to perform multi-step biological and chemical processes.
A reduced graphene oxide-titanium dioxide nanocomposite based electrochemical aptasensor for rapid and sensitive detection of Salmonella enterica

Muniandy S, Teh SJ, Appaturi JN, Thong KL, Lai CW, Ibrahim F, et al.

Bioelectrochemistry, 2019 Jun;127:136-144.
PMID: 30825657 DOI: 10.1016/j.bioelechem.2019.02.005

Recent foodborne outbreaks in multiple locations necessitate the continuous development of highly sensitive and specific biosensors that offer rapid detection of foodborne biological hazards. This work focuses on the development of a reduced graphene oxide‑titanium dioxide (rGO-TiO2) nanocomposite based aptasensor to detect Salmonella enterica serovar Typhimurium. A label-free aptamer was immobilized on a rGO-TiO2 nanocomposite matrix through electrostatic interactions. The changes in electrical conductivity on the electrode surface were evaluated using electroanalytical methods. DNA aptamer adsorbed on the rGO-TiO2 surface bound to the bacterial cells at the electrode interface causing a physical barrier inhibiting the electron transfer. This interaction decreased the DPV signal of the electrode proportional to decreasing concentrations of the bacterial cells. The optimized aptasensor exhibited high sensitivity with a wide detection range (108 to 101 cfu mL-1), a low detection limit of 101 cfu mL-1 and good selectivity for Salmonella bacteria. This rGO-TiO2 aptasensor is an excellent biosensing platform that offers a reliable, rapid and sensitive alternative for foodborne pathogen detection.
Safety profiling of pioglitazone and telmisartan combination by sub-chronic toxicity study in rat

Sengupta P, Das A, Ibrahim F, Mandal UK, Chatterjee B, Mahmood S, et al.

Regul Toxicol Pharmacol, 2016 Aug 26;81:155-161.
PMID: 27569202 DOI: 10.1016/j.yrtph.2016.08.009

It has been reported that the major cause of mortality in diabetes is cardiovascular diseases and contribution of hypertension is significant in this context. Pioglitazone, a thiazolidinedione class of therapeutic agent is used to treat type 2 diabetes mellitus. Telmisartan, an angiotensin receptor blocker antihypertensive has been reported to have beneficial effect if co-administered with pioglitazone for the management of diabetes complications. The present research work aims to evaluate the safety/toxicity profile of this combination in rat model. The investigation was carried out after co-administering the drugs to the rats for 28 days at three dose levels of 50, 100 and 150 mg/kg covering low to high dose ranges. Various hematological and biochemical parameters were studied in addition to the histopathology of the major organs in order to evaluate the toxicity profile of the combination. Absence of mortality and histopathological changes as well as unaltered hematological and biochemical parameters was observed. This preliminary investigation concludes that the combination of pioglitazone and telmisartan can primarily be stated as safe in animals, even at the dose level which is several folds higher than the intended human dose. Thus, this combination can be explored in future to develop a rational therapy regimen to treat hypertensive diabetic patients.
Neuroelectrophysiological approaches in heroin addiction research: A review of literatures

Motlagh F, Ibrahim F, Menke JM, Rashid R, Seghatoleslam T, Habil H

J Neurosci Res, 2016 Apr;94(4):297-309.
PMID: 26748947 DOI: 10.1002/jnr.23703

Neuroelectrophysiological properties have been used in human heroin addiction studies. These studies vary in their approach, experimental conditions, paradigms, and outcomes. However, it is essential to integrate previous findings and experimental methods for a better demonstration of current issues and challenges in designing such studies. This Review examines methodologies and experimental conditions of neuroelectrophysiological research among heroin addicts during withdrawal, abstinence, and methadone maintenance treatment and presents the findings. The results show decrements in attentional processing and dysfunctions in brain response inhibition as well as brain activity abnormalities induced by chronic heroin abuse. Chronic heroin addiction causes increased β and α2 power activity, latency of P300 and P600, and diminished P300 and P600 amplitude. Findings confirm that electroencephalography (EEG) band power and coherence are associated with craving indices and heroin abuse history. First symptoms of withdrawal can be seen in high-frequency EEG bands, and the severity of these symptoms is associated with brain functional connectivity. EEG spectral changes and event-related potential (ERP) properties have been shown to be associated with abstinence length and tend to normalize within 3-6 months of abstinence. From the conflicting criteria and confounding effects in neuroelectrophysiological studies, the authors suggest a comprehensive longitudinal study with a multimethod approach for monitoring EEG and ERP attributes of heroin addicts from early stages of withdrawal until long-term abstinence to control the confounding effects, such as nicotine abuse and other comorbid and premorbid conditions.
Acute effects of methadone on EEG power spectrum and event-related potentials among heroin dependents

Motlagh F, Ibrahim F, Rashid R, Shafiabady N, Seghatoleslam T, Habil H

Psychopharmacology (Berl), 2018 Nov;235(11):3273-3288.
PMID: 30310960 DOI: 10.1007/s00213-018-5035-0

Methadone as the most prevalent opioid substitution medication has been shown to influence the neurophysiological functions among heroin addicts. However, there is no firm conclusion on acute neuroelectrophysiological changes among methadone-treated subjects as well as the effectiveness of methadone in restoring brain electrical abnormalities among heroin addicts. This study aims to investigate the acute and short-term effects of methadone administration on the brain's electrophysiological properties before and after daily methadone intake over 10 weeks of treatment among heroin addicts. EEG spectral analysis and single-trial event-related potential (ERP) measurements were used to investigate possible alterations in the brain's electrical activities, as well as the cognitive attributes associated with MMN and P3. The results confirmed abnormal brain activities predominantly in the beta band and diminished information processing ability including lower amplitude and prolonged latency of cognitive responses among heroin addicts compared to healthy controls. In addition, the alteration of EEG activities in the frontal and central regions was found to be associated with the withdrawal symptoms of drug users. Certain brain regions were found to be influenced significantly by methadone intake; acute effects of methadone induction appeared to be associative to its dosage. The findings suggest that methadone administration affects cognitive performance and activates the cortical neuronal networks, resulting in cognitive responses enhancement which may be influential in reorganizing cognitive dysfunctions among heroin addicts. This study also supports the notion that the brain's oscillation powers and ERPs can be utilized as neurophysiological indices for assessing the addiction treatment traits.
Fulltext Smartphone Addiction and Sleep Quality on Academic Performance of University Students: An Exploratory Research

Rathakrishnan B, Bikar Singh SS, Kamaluddin MR, Yahaya A, Mohd Nasir MA, Ibrahim F, et al.

Int J Environ Res Public Health, 2021 08 05;18(16).
PMID: 34444042 DOI: 10.3390/ijerph18168291

This study was conducted to examine the relationship between smartphone addiction, sleep quality, and academic performance. The study presented quantitative research on 323 students in a public university in Sabah to explore the relationship between smartphone addiction, sleep quality, and academic performance. A simple random sampling was used in the study. The Smartphone Addiction Scale Short Version (SAS-SV) and the Pittsburgh Sleep Quality Index (PSQI) were used in this study. SPSS was used as a tool of analysis for descriptive and inferential analysis. Pearson correlation was involved to test the hypothesis of the study. The result indicated that the greater the smartphone addiction, the lower the academic performance of university students. The finding also proved that students with poor sleep quality might exhibit low academic performance. Smartphone addiction was found to be associated with sleep quality where overusing smartphones was related to poor sleep quality in university students. On this basis, the problem of smartphone addiction and sleep quality should be tackled in order to improve the academic performance of university students and their overall health.
Fulltext The Effectiveness of a Wireless Modular Bed Absence Sensor Device for Fall Prevention among Older Inpatients

Subermaniam K, Welfred R, Subramanian P, Chinna K, Ibrahim F, Mohktar MS, et al.

Front Public Health, 2016;4:292.
PMID: 28119908 DOI: 10.3389/fpubh.2016.00292

Falls and fall-related injuries are increasingly serious issues among elderly inpatients due to population aging. The bed-exit alarm has only previously been evaluated in a handful of studies with mixed results. Therefore, we evaluated the effectiveness of a modular bed absence sensor device (M-BAS) in detecting bed exits among older inpatients in a middle income nation in East Asia.
Socioeconomic Predictors of Adherence Behavior Among HIV-Positive Patients Receiving Antiretroviral Therapy in Selangor, Malaysia

Abdulrahman SA, Rampal L, Othman N, Ibrahim F, Kadir Shahar H, Radhakrishnan AP

Asia Pac J Public Health, 2017 May;29(4):304-314.
PMID: 28397533 DOI: 10.1177/1010539517700471

Medication adherence remains a critical link between the prescribed ART regimen and treatment outcome. Several factors may influence adherence behavior. This cross-sectional study aimed to highlight socioeconomic predictors of adherence behavior among a cohort of 242 adult Malaysian patients receiving antiretroviral therapy in Hospital Sungai Buloh, Malaysia, where they were enrolled in a parent study (single-blinded randomized controlled trial) between January and December 2014. Statistical analysis of secondary data on adherence behavior and sociodemographic characteristics of the patients revealed mean age of 33.4 years and ranged from 18 to 64 years; 88.8% were males. A total of 224 (93%) patients who completed 6 months' adherence assessment were included in the model. Of these, 135 (60.3%) achieved optimal adherence. Multivariate binary logistic regression analysis revealed that patient's income and ethnicity were significant predictors of adherence behavior. This may be valuable for targeted programmatic interventions to further enhance successful treatment outcomes among the target population.
Fulltext Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial

Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Kadir Shahar H, Othman N

PLoS One, 2017;12(5):e0177698.
PMID: 28520768 DOI: 10.1371/journal.pone.0177698

BACKGROUND: Adherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART).
OBJECTIVE(S): Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia.
METHODS: A single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman's ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention.
RESULTS: The response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39-96.97) as compared to the control group (87.5; 95% CI: 86.14-88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group.
CONCLUSION: Mobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.

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