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Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia
BACKGROUND: Non-adherence to tuberculosis treatment increases the risk of poor treatment outcomes. Digital adherence technologies (DATs), including the smart pillbox (EvriMED), aim to improve treatment adherence and are being widely evaluated. As part of the Adherence Support Coalition to End TB (AS...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576388/ https://www.ncbi.nlm.nih.gov/pubmed/37838677 http://dx.doi.org/10.1186/s12889-023-16905-z |
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author | Tadesse, Amare Worku Cusinato, Martina Weldemichael, Gedion Teferra Abdurhman, Tofik Assefa, Demelash Yazew, Hiwot Gadissa, Demekech Shiferaw, Amanuel Belachew, Mahilet Sahile, Mamush van Rest, Job Bedru, Ahmed Foster, Nicola Jerene, Degu Fielding, Katherine Linda |
author_facet | Tadesse, Amare Worku Cusinato, Martina Weldemichael, Gedion Teferra Abdurhman, Tofik Assefa, Demelash Yazew, Hiwot Gadissa, Demekech Shiferaw, Amanuel Belachew, Mahilet Sahile, Mamush van Rest, Job Bedru, Ahmed Foster, Nicola Jerene, Degu Fielding, Katherine Linda |
author_sort | Tadesse, Amare Worku |
collection | PubMed |
description | BACKGROUND: Non-adherence to tuberculosis treatment increases the risk of poor treatment outcomes. Digital adherence technologies (DATs), including the smart pillbox (EvriMED), aim to improve treatment adherence and are being widely evaluated. As part of the Adherence Support Coalition to End TB (ASCENT) project we analysed data from a cluster-randomised trial of DATs and differentiated care in Ethiopia to examine individual-factors for poor engagement with the smart pillbox. METHODS: Data were obtained from a cohort of trial participants with drug-sensitive tuberculosis (DS-TB) whose treatment started between 1 December 2020 and 1 May 2022, and who were using the smart pillbox. Poor engagement with the pillbox was defined as (i) > 20% days with no digital confirmation and (ii) the count of days with no digital confirmation, and calculated over a two evaluation periods (56-days and 168-days). Logistic random effects regression was used to model > 20% days with no digital confirmation and negative binomial random effects regression to model counts of days with no digital confirmation, both accounting for clustering of individuals at the facility-level. RESULTS: Among 1262 participants, 10.8% (133/1262) over 56-days and 15.8% (200/1262) over 168-days had > 20% days with no digital confirmation. The odds of poor engagement was less among participants in the higher stratum of socio-economic position (SEP) over 56-days. Overall, 4,689/67,315 expected doses over 56-days and 18,042/199,133 expected doses over 168-days were not digitally confirmed. Compared to participants in the poorest SEP stratum, participants in the wealthiest stratum had lower rates of days not digitally confirmed over 168-days (adjusted rate ratio [RR(a)]:0.79; 95% confidence interval [CI]: 0.65, 0.96). In both evaluation periods (56-days and 168-days), HIV-positive status (RR(a):1.29; 95%CI: 1.02, 1.63 and RR(a):1.28; 95%CI: 1.07, 1.53), single/living independent (RR(a):1.31; 95%CI: 1.03, 1.67 and RR(a):1.38; 95%CI: 1.16, 1.64) and separated/widowed (RR(a):1.40; 95%CI: 1.04, 1.90 and RR(a):1.26; 95%CI: 1.00, 1.58) had higher rates of counts of days with no digital confirmation. CONCLUSION: Poorest SEP stratum, HIV-positive status, single/living independent and separated/ widowed were associated with poor engagement with smart pillbox among people with DS-TB in Ethiopia. Differentiated care for these sub-groups may reduce risk of non-adherence to TB treatment. |
format | Online Article Text |
id | pubmed-10576388 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-105763882023-10-15 Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia Tadesse, Amare Worku Cusinato, Martina Weldemichael, Gedion Teferra Abdurhman, Tofik Assefa, Demelash Yazew, Hiwot Gadissa, Demekech Shiferaw, Amanuel Belachew, Mahilet Sahile, Mamush van Rest, Job Bedru, Ahmed Foster, Nicola Jerene, Degu Fielding, Katherine Linda BMC Public Health Research BACKGROUND: Non-adherence to tuberculosis treatment increases the risk of poor treatment outcomes. Digital adherence technologies (DATs), including the smart pillbox (EvriMED), aim to improve treatment adherence and are being widely evaluated. As part of the Adherence Support Coalition to End TB (ASCENT) project we analysed data from a cluster-randomised trial of DATs and differentiated care in Ethiopia to examine individual-factors for poor engagement with the smart pillbox. METHODS: Data were obtained from a cohort of trial participants with drug-sensitive tuberculosis (DS-TB) whose treatment started between 1 December 2020 and 1 May 2022, and who were using the smart pillbox. Poor engagement with the pillbox was defined as (i) > 20% days with no digital confirmation and (ii) the count of days with no digital confirmation, and calculated over a two evaluation periods (56-days and 168-days). Logistic random effects regression was used to model > 20% days with no digital confirmation and negative binomial random effects regression to model counts of days with no digital confirmation, both accounting for clustering of individuals at the facility-level. RESULTS: Among 1262 participants, 10.8% (133/1262) over 56-days and 15.8% (200/1262) over 168-days had > 20% days with no digital confirmation. The odds of poor engagement was less among participants in the higher stratum of socio-economic position (SEP) over 56-days. Overall, 4,689/67,315 expected doses over 56-days and 18,042/199,133 expected doses over 168-days were not digitally confirmed. Compared to participants in the poorest SEP stratum, participants in the wealthiest stratum had lower rates of days not digitally confirmed over 168-days (adjusted rate ratio [RR(a)]:0.79; 95% confidence interval [CI]: 0.65, 0.96). In both evaluation periods (56-days and 168-days), HIV-positive status (RR(a):1.29; 95%CI: 1.02, 1.63 and RR(a):1.28; 95%CI: 1.07, 1.53), single/living independent (RR(a):1.31; 95%CI: 1.03, 1.67 and RR(a):1.38; 95%CI: 1.16, 1.64) and separated/widowed (RR(a):1.40; 95%CI: 1.04, 1.90 and RR(a):1.26; 95%CI: 1.00, 1.58) had higher rates of counts of days with no digital confirmation. CONCLUSION: Poorest SEP stratum, HIV-positive status, single/living independent and separated/ widowed were associated with poor engagement with smart pillbox among people with DS-TB in Ethiopia. Differentiated care for these sub-groups may reduce risk of non-adherence to TB treatment. BioMed Central 2023-10-14 /pmc/articles/PMC10576388/ /pubmed/37838677 http://dx.doi.org/10.1186/s12889-023-16905-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Tadesse, Amare Worku Cusinato, Martina Weldemichael, Gedion Teferra Abdurhman, Tofik Assefa, Demelash Yazew, Hiwot Gadissa, Demekech Shiferaw, Amanuel Belachew, Mahilet Sahile, Mamush van Rest, Job Bedru, Ahmed Foster, Nicola Jerene, Degu Fielding, Katherine Linda Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia |
title | Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia |
title_full | Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia |
title_fullStr | Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia |
title_full_unstemmed | Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia |
title_short | Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia |
title_sort | risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in ethiopia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576388/ https://www.ncbi.nlm.nih.gov/pubmed/37838677 http://dx.doi.org/10.1186/s12889-023-16905-z |
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