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Adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the United Republic of Tanzania
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-bas...
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Published in: | PloS one 2012-12, Vol.7 (12), p.e51828-e51828 |
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description | 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.
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.
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 |
doi_str_mv | 10.1371/journal.pone.0051828 |
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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.
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).
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0051828</identifier><identifier>PMID: 23284782</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adhesion ; Adolescent ; Adult ; AIDS ; Analysis ; Antiretroviral drugs ; Antitubercular agents ; Antitubercular Agents - therapeutic use ; Care and treatment ; Cross-Sectional Studies ; Directly Observed Therapy ; Drug resistance ; Drugs ; Female ; Health care facilities ; Health centres ; Health facilities ; HIV ; Human immunodeficiency virus ; Humans ; Isoniazid ; Leprosy ; Male ; Medical research ; Medication Adherence - statistics & numerical data ; Medicine ; Middle Aged ; Mycobacterium tuberculosis - drug effects ; Patient compliance ; Patient Compliance - statistics & numerical data ; Patients ; Regression analysis ; Self Administration - statistics & numerical data ; Tanzania ; Therapy ; Treatment Outcome ; Tuberculosis ; Tuberculosis - drug therapy ; Urine ; Young Adult</subject><ispartof>PloS one, 2012-12, Vol.7 (12), p.e51828-e51828</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Mkopi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2012 Mkopi et al 2012 Mkopi et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-41dd7eb1deb7d771a86524716b2c2d900e7653ce0270e72f8df8400302311f1c3</citedby><cites>FETCH-LOGICAL-c692t-41dd7eb1deb7d771a86524716b2c2d900e7653ce0270e72f8df8400302311f1c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1327188997/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1327188997?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,315,733,786,790,891,25783,27957,27958,37047,37048,44625,53827,53829,75483</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23284782$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Munayco, Cesar V.</contributor><creatorcontrib>Mkopi, Abdallah</creatorcontrib><creatorcontrib>Range, Nyagosya</creatorcontrib><creatorcontrib>Lwilla, Fred</creatorcontrib><creatorcontrib>Egwaga, Saidi</creatorcontrib><creatorcontrib>Schulze, Alexander</creatorcontrib><creatorcontrib>Geubbels, Eveline</creatorcontrib><creatorcontrib>van Leth, Frank</creatorcontrib><title>Adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the United Republic of Tanzania</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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.
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).
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.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adhesion</subject><subject>Adolescent</subject><subject>Adult</subject><subject>AIDS</subject><subject>Analysis</subject><subject>Antiretroviral drugs</subject><subject>Antitubercular agents</subject><subject>Antitubercular Agents - therapeutic use</subject><subject>Care and treatment</subject><subject>Cross-Sectional Studies</subject><subject>Directly Observed Therapy</subject><subject>Drug resistance</subject><subject>Drugs</subject><subject>Female</subject><subject>Health care facilities</subject><subject>Health centres</subject><subject>Health facilities</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Isoniazid</subject><subject>Leprosy</subject><subject>Male</subject><subject>Medical research</subject><subject>Medication Adherence - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mkopi, Abdallah</au><au>Range, Nyagosya</au><au>Lwilla, Fred</au><au>Egwaga, Saidi</au><au>Schulze, Alexander</au><au>Geubbels, Eveline</au><au>van Leth, Frank</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the United Republic of Tanzania</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2012-12-19</date><risdate>2012</risdate><volume>7</volume><issue>12</issue><spage>e51828</spage><epage>e51828</epage><pages>e51828-e51828</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><notes>Conceived and designed the experiments: AM NR EG FvL. Performed the experiments: AM NR EG FvL. Analyzed the data: AM EG FvL. Contributed reagents/materials/analysis tools: AM EG FvL. Wrote the paper: AM. Commented on the manuscript: FL SE AS.</notes><notes>Competing Interests: The authors have declared that no competing interests exist.</notes><abstract>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.
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.
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).
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23284782</pmid><doi>10.1371/journal.pone.0051828</doi><tpages>e51828</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Acquired immune deficiency syndrome Adhesion Adolescent Adult AIDS Analysis Antiretroviral drugs Antitubercular agents Antitubercular Agents - therapeutic use Care and treatment Cross-Sectional Studies Directly Observed Therapy Drug resistance Drugs Female Health care facilities Health centres Health facilities HIV Human immunodeficiency virus Humans Isoniazid Leprosy Male Medical research Medication Adherence - statistics & numerical data Medicine Middle Aged Mycobacterium tuberculosis - drug effects Patient compliance Patient Compliance - statistics & numerical data Patients Regression analysis Self Administration - statistics & numerical data Tanzania Therapy Treatment Outcome Tuberculosis Tuberculosis - drug therapy Urine Young Adult |
title | Adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the United Republic of Tanzania |
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