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Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania

BACKGROUND: Non-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice betw...

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Autores principales: Mkopi, Abdallah, Range, Nyagosya, Lwilla, Fred, Egwaga, Saidi, Schulze, Alexander, Geubbels, Eveline, van Leth, Frank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526644/
https://www.ncbi.nlm.nih.gov/pubmed/23284782
http://dx.doi.org/10.1371/journal.pone.0051828
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author Mkopi, Abdallah
Range, Nyagosya
Lwilla, Fred
Egwaga, Saidi
Schulze, Alexander
Geubbels, Eveline
van Leth, Frank
author_facet Mkopi, Abdallah
Range, Nyagosya
Lwilla, Fred
Egwaga, Saidi
Schulze, Alexander
Geubbels, Eveline
van Leth, Frank
author_sort Mkopi, Abdallah
collection PubMed
description BACKGROUND: Non-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice between home-based treatment supervised by a treatment supporter of their own choice, and health facility–based treatment observed by a medical professional. The aim of this study was to assess the extent and determinants of adherence to anti-TB therapy in patients opting for home-based treatment under the novel PCT approach. METHODS: In this cross-sectional study, the primary outcome was the percentage of patients adherent to TB therapy as detected by the presence of isoniazid in urine (IsoScreen assay). The primary analysis followed a non-inferiority approach in which adherence could not be lower than 75%. Logistic regression was used to examine the influence of potentially predictive factors. RESULTS: A total of 651 new TB patients were included. Of these, 645 (99.1%) provided urine for testing and 617 patients (95.7%; 90%CI 94.3–96.9) showed a positive result. This result was statistically non-inferior to the postulated adherence level of 75% (p<0.001). CONCLUSIONS: Adherence to TB therapy under home-based Directly Observed Treatment can be ensured in programmatic settings. A reliable supply of medication and the careful selection of treatment supporters, who preferably live very close to the patient, are crucial success factors. Finally, we recommend a cohort study to assess the rate of adherence throughout the full course of TB treatment.
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spelling pubmed-35266442013-01-02 Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania Mkopi, Abdallah Range, Nyagosya Lwilla, Fred Egwaga, Saidi Schulze, Alexander Geubbels, Eveline van Leth, Frank PLoS One Research Article BACKGROUND: Non-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice between home-based treatment supervised by a treatment supporter of their own choice, and health facility–based treatment observed by a medical professional. The aim of this study was to assess the extent and determinants of adherence to anti-TB therapy in patients opting for home-based treatment under the novel PCT approach. METHODS: In this cross-sectional study, the primary outcome was the percentage of patients adherent to TB therapy as detected by the presence of isoniazid in urine (IsoScreen assay). The primary analysis followed a non-inferiority approach in which adherence could not be lower than 75%. Logistic regression was used to examine the influence of potentially predictive factors. RESULTS: A total of 651 new TB patients were included. Of these, 645 (99.1%) provided urine for testing and 617 patients (95.7%; 90%CI 94.3–96.9) showed a positive result. This result was statistically non-inferior to the postulated adherence level of 75% (p<0.001). CONCLUSIONS: Adherence to TB therapy under home-based Directly Observed Treatment can be ensured in programmatic settings. A reliable supply of medication and the careful selection of treatment supporters, who preferably live very close to the patient, are crucial success factors. Finally, we recommend a cohort study to assess the rate of adherence throughout the full course of TB treatment. Public Library of Science 2012-12-19 /pmc/articles/PMC3526644/ /pubmed/23284782 http://dx.doi.org/10.1371/journal.pone.0051828 Text en © 2012 Mkopi et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Mkopi, Abdallah
Range, Nyagosya
Lwilla, Fred
Egwaga, Saidi
Schulze, Alexander
Geubbels, Eveline
van Leth, Frank
Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania
title Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania
title_full Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania
title_fullStr Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania
title_full_unstemmed Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania
title_short Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania
title_sort adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the united republic of tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526644/
https://www.ncbi.nlm.nih.gov/pubmed/23284782
http://dx.doi.org/10.1371/journal.pone.0051828
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