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Devaleenal DB, Jeyabal L, Nair D, Mahalingam V, R R, Rebecca BP, Suresh C, Murugesan PR, Thomas B. Improving treatment adherence among tuberculosis patients through evening DOTS in Chennai, India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:219-223. [PMID: 38692635 DOI: 10.25259/nmji_819_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background Fixed days and timings of service are challenges in the care of patients with tuberculosis (TB). We assessed whether provision of evening DOTS (directly observed treatment, short course) improves treatment outcomes in a city with a working population. Methods We enrolled new adult patients with TB from seven tuberculous units (TUs) in this prospective cohort study. Participants were offered the option of DOTS during the day (8 a.m. to 3:30 p.m.) or evening (4 p.m. to 8 p.m.) and assigned accordingly. Results Of 127 patients enrolled between April and July 2017, 19 (15%) opted for evening DOTS. The number varied between the seven TUs (p=0.002). On an average, antitubercular therapy (ATT) was taken at 9:41 a.m. in the routine and 5:14 p.m. in the evening DOTS centres. Patients who were employed, left residence and returned back at 9:05 a.m. and 6:40 p.m., respectively. Around 96% (104/108) opted for day-time DOTS due to closeness of the centre to their residence. Around 74% (14/19) chose evening DOTS because of time convenience. Around 15% of patients on routine DOTS (16) had unfavourable treatment outcomes. All had favourable outcomes in the evening DOTS. Men were less likely and those withut alcohol disorders were more likely to have treatment success. Conclusion Provision of time convenient services might improve adherence and treatment outcome.
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Affiliation(s)
| | - Lavanya Jeyabal
- District Tuberculosis Office, National Tuberculosis Elimination Programme, Greater Chennai Corporation, Chennai, Tamil Nadu, India
| | - Dina Nair
- National Institute for Research in Tuberculosis, ICMR, Chennai 600031, Tamil Nadu, India
| | - Vasantha Mahalingam
- National Institute for Research in Tuberculosis, ICMR, Chennai 600031, Tamil Nadu, India
| | - Radhakrishnan R
- National Institute for Research in Tuberculosis, ICMR, Chennai 600031, Tamil Nadu, India
| | | | - Chandra Suresh
- National Institute for Research in Tuberculosis, ICMR, Chennai 600031, Tamil Nadu, India
| | | | - Beena Thomas
- National Institute for Research in Tuberculosis, ICMR, Chennai 600031, Tamil Nadu, India
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Suliman Q, Lim PY, Md Said S, Tan KA, Mohd Zulkefli NA. Risk factors for early TB treatment interruption among newly diagnosed patients in Malaysia. Sci Rep 2022; 12:745. [PMID: 35031658 PMCID: PMC8760252 DOI: 10.1038/s41598-021-04742-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/29/2021] [Indexed: 12/01/2022] Open
Abstract
TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018–2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.
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Affiliation(s)
- Qudsiah Suliman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.,Ministry of Health, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
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Al-Shahrani MS, Hakami MI, Younis MA, Fan HA, Jeraiby MA, Alraey Y. Prevalence of primary anti-tuberculosis drug resistance at the tertiary center in Saudi Arabia and associated risk factors. Saudi Med J 2021; 42:728-734. [PMID: 34187916 PMCID: PMC9195529 DOI: 10.15537/smj.2021.42.7.20200797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate the prevalence mono-resistant tuberculosis (MR-TB) and multidrug resistant TB (MDR-TB), and evaluate the risk factors associated with the drug-resistant tuberculosis (DR-TB). METHODS A descriptive, retrospective study was applied, utilizing the TB patients' medical records at King Fahd Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia. The records of patients notified between 2000 and 2018 were reviewed and culture positive cases for Mycobacterium tuberculosis species were included. Moreover, the risk factors included were age, gender, smoking history, renal disease, liver disease, hyperbilirubinemia, diabetes mellitus, and human immunodeficiency virus (HIV). RESULTS Nine hundred and one cases in entirety were involved in the research, out of which 193 had drug-resistant tuberculosis (DR-TB) (21.4%). Out of the 21.4% DR-TB, 91.7% were MR-TB and 8.3% were MDR-TB. The highest MR prevalence was for pyrazinamide at 33.4%, while the lowest resistance was for ethambutol at 7.1%. For the risk factors of drug-resistant TB, only age depicted a statistically significant (p<0.01) but weak negative (r= -0.145) correlation with anti-TB drug resistance. CONCLUSION Rates of DR-TB reported in the study are considered higher compared to the recently reported national and international rates. According to the results, only younger people are at risk of developing DR-TB. Moreover, genetic mutation may play a role in drug resistance among our cases specifically for pyrazinamide monoresistance.
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Affiliation(s)
- Mohammed S. Al-Shahrani
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Majed I. Hakami
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Mahmoud A. Younis
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hanan A. Fan
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Mohammed A. Jeraiby
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Yasser Alraey
- From the Department of Medical Laboratory (Al-Shahrani), Department of Pulmonary Medicine (Younis, Fan), King Fahd Armed Forces Hospital, Jeddah; Saudi Ministry of Health (Hakami), King Fahd Central Hospital; from the Biochemistry Department (Jeraiby), Faculty of Medicine, Jazan University, Jazan; and from Department of Clinical Laboratory Sciences (Alraey), College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
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Kwon BS, Kim Y, Lee SH, Lim SY, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee CT, Lee JH. The high incidence of severe adverse events due to pyrazinamide in elderly patients with tuberculosis. PLoS One 2020; 15:e0236109. [PMID: 32692774 PMCID: PMC7373258 DOI: 10.1371/journal.pone.0236109] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background Pyrazinamide (PZA) is a common drug that causes serious adverse events (SAEs). The aim of this study was to determine the incidence of and risk factors for SAEs due to PZA during first-line anti-tuberculosis treatment. Methods The medical records of patients with tuberculosis (TB) treated with PZA-containing regimens including first-line drugs—ethambutol, rifampicin, and isoniazid—from January 2003 to June 2016 were reviewed. SAEs were defined as side effects that led to drug discontinuation. The causative drug was determined based on the disappearance of the SAEs upon drug withdrawal and/or the recurrence of the same SAEs with re-challenge. Results Of 2,478 patients with TB, 16.4% experienced SAEs. The incidence of SAEs increased significantly as age increased, except with rifampin. PZA accounted for most SAEs (55.8%). Hepatotoxicity was the most common SAE due to PZA (44.5%), followed by gastrointestinal (GI) intolerance (23.8%). The risk of SAEs due to PZA increased significantly as age increased, when sex and comorbidities were adjusted (odds ratio, 1.013; 95% confidence interval, 1.004–1.023; P = 0.007). In the subgroup analysis, older age was an independent risk factor for GI intolerance but not for hepatotoxicity. Conclusion PZA was the most common drug associated with SAEs among the first-line anti-TB drugs, and old age was an independent factor for SAE occurrence. This study suggests that the early recognition of whether the causative agent is PZA may improve effective treatment compliance, particularly in elderly patients.
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Affiliation(s)
- Byoung Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, South Korea
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
- * E-mail:
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Tola HH, Karimi M, Yekaninejad MS. Effects of sociodemographic characteristics and patients' health beliefs on tuberculosis treatment adherence in Ethiopia: a structural equation modelling approach. Infect Dis Poverty 2017; 6:167. [PMID: 29241454 PMCID: PMC5731079 DOI: 10.1186/s40249-017-0380-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/30/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients' beliefs are a major factor affecting tuberculosis (TB) treatment adherence. However, there has been little use of Health Belief Model (HBM) in determining the pathway effect of patients' sociodemographic characteristics and beliefs on TB treatment adherence. Therefore, this study was aimed at determining the effect of sociodemographic characteristics and patients' health beliefs on TB treatment adherence based on the HBM concept in Ethiopia. METHODS A cross-sectional study was conducted in Addis Ababa, Ethiopia among TB patients undertaking treatment. Thirty health centres were randomly selected and one hospital was purposely chosen. Six hundred and ninety-eight TB patients who had been on treatment for 1-2 month, were aged 18 years or above, and had the mental capability to provide consent were enrolled consecutively with non-probability sampling technique from the TB registration book until required sample size achieved. Structured questionnaires were used to collect data. Structural equation modelling was employed to assess the pathway relationship between sociodemographic characteristics, patients' beliefs, and treatment adherence. RESULTS Of the 698 enrolled participants, 401 (57.4%) were male and 490 (70.2%) were aged 35 years and below. The mean age of participants was 32 (± 11.7) and the age range was 18-90 years. Perceived barrier/benefit was shown to be a significant direct negative effect on TB treatment adherence (ß = -0.124, P = 0.032). In addition, cue to action (ß = -0.68, P ≤ 0.001) and psychological distress (ß = 0.08, P < 0.001) were shown significant indirect effects on TB treatment adherence through perceived barrier/benefit. CONCLUSIONS Interventions intended to decrease perceived barriers and maximize perceived benefits should be implemented to enhance TB treatment adherence. In addition, it is crucial that counselling is incorporated with the regular directly observed therapy program. Motivators (cue to actions) such as friends, family, healthcare workers, and the media could be used to promote TB treatment adherence.
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Affiliation(s)
- Habteyes Hailu Tola
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
- Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, P.O. Box 1242, /5654 Addis Ababa, Ethiopia
| | - Mehrdad Karimi
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
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Tola HH, Garmaroudi G, Shojaeizadeh D, Tol A, Yekaninejad MS, Ejeta LT, Kebede A, Kassa D. The Effect of Psychosocial Factors and Patients' Perception of Tuberculosis Treatment Non-Adherence in Addis Ababa, Ethiopia. Ethiop J Health Sci 2017; 27:447-458. [PMID: 29217949 PMCID: PMC5615005 DOI: 10.4314/ejhs.v27i5.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Although there are several studies reported on factors affecting tuberculosis (TB) treatment non-adherence, there is information gap on psychosocial and patients' perceptions aspects. Therefore, this study was aimed to investigate the effect of psychosocial factors and patients' perceptions on TB treatment non-adherence in Ethiopia. METHODS A cross sectional study was conducted in Addis Ababa from May to December, 2014. Thirty one health facilities were randomly selected and 698 TB patients, who had been on treatment, were enrolled consecutively using patient registration number. Structured questionnaire was used to collect data on demographics, knowledge, psychological distress, alcohol use, tobacco smoking and six HBM domains. Treatment adherence level was the main outcome variable, and it measured using visual analog scale. Statistical Package for Social Sciences version 20 was used for data analysis. RESULTS Non-adherence level within last one month prior to the study was 19.5%. After controlling for all potential confounding variables, Antiretroviral Therapy (ART) status (Adjusted Odds Ratio (AOR) = 1.79, 95% Confidence interval (CI) (1.09 -2.95)), alcohol use (AOR = 2.11, 95% CI (1.33-3.37)), economic status (AOR = 0.53, 95% CI (0.33-0.82)), perceived barriers (AOR = 1.21, 95% CI (1.10-1.47)) and psychological distress (AOR = 1.83, 95% CI (1.47-2.29)) were independently associated with TB treatment non-adherence. CONCLUSION ART status, economic status, alcohol use, perceived barrier and psychological distress are the major areas that need to be targeted with health promotion intervention to enhance TB treatment adherence.
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Affiliation(s)
- Habteyes Hailu Tola
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gholamreza Garmaroudi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
| | - Davoud Shojaeizadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
| | - Azar Tol
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Luche Tadesse Ejeta
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences-International Campus, Tehran, Iran
| | - Abebaw Kebede
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Desta Kassa
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Valencia S, León M, Losada I, Sequera VG, Fernández Quevedo M, García-Basteiro AL. How do we measure adherence to anti-tuberculosis treatment? Expert Rev Anti Infect Ther 2016; 15:157-165. [DOI: 10.1080/14787210.2017.1264270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Salome Valencia
- Preventive Medicine and Epidemiology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Montserrat León
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Victor G Sequera
- Preventive Medicine and Epidemiology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Alberto L García-Basteiro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Tuberculosis Research Area, Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
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Tola HH, Shojaeizadeh D, Tol A, Garmaroudi G, Yekaninejad MS, Kebede A, Ejeta LT, Kassa D, Klinkenberg E. Psychological and Educational Intervention to Improve Tuberculosis Treatment Adherence in Ethiopia Based on Health Belief Model: A Cluster Randomized Control Trial. PLoS One 2016; 11:e0155147. [PMID: 27167378 PMCID: PMC4864292 DOI: 10.1371/journal.pone.0155147] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Treatment non-adherence results in treatment failure, prolonged transmission of disease and emergence of drug resistance. Although the problem widely investigated, there remains an information gap on the effectiveness of different methods to improve treatment adherence and the predictors of non-adherence in resource limited countries based on theoretical models. This study aimed to evaluate the impact of psychological counseling and educational intervention on tuberculosis (TB) treatment adherence based on Health Belief Model (HBM). METHODOLOGY A cluster randomized control trial was conducted in Addis Ababa from May to December, 2014. Patients were enrolled into study consecutively from 30 randomly selected Health Centers (HCs) (14 HCs intervention and 16 HCs control groups). A total of 698 TB patients, who were on treatment for one month to two months were enrolled. A structured questionnaire was administered to both groups of patients at baseline and endpoint of study. Control participants received routine directly-observed anti-TB therapy and the intervention group additionally received combined psychological counseling and adherence education. Treatment non-adherence level was the main outcome of the study, and multilevel logistic regression was employed to assess the impact of intervention on treatment adherence. RESULTS At enrollment, the level of non-adherence among intervention (19.4%) and control (19.6%) groups was almost the same. However, after intervention, non-adherence level decreased among intervention group from 19.4 (at baseline) to 9.5% (at endpoint), while it increased among control group from 19.4% (baseline) to 25.4% (endpoint). Psychological counseling and educational interventions resulted in significant difference with regard to non-adherence level between intervention and control groups (Adjusted OR = 0.31, 95% Confidence Interval (CI) (0.18-0.53), p < 0.001)). CONCLUSION Psychological counseling and educational interventions, which were guided by HBM, significantly decreased treatment non-adherence level among intervention group. Provision of psychological counseling and health education to TB patients who are on regular treatment is recommended. This could be best achieved if these interventions are guided by behavioral theories and incorporated into the routine TB treatment strategy. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR201506001175423.
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Affiliation(s)
- Habteyes Hailu Tola
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Health Education and Promotion, Tehran, Iran
- Ethiopian Public Health Institute, TB/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Davoud Shojaeizadeh
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Health Education and Promotion, Tehran, Iran
| | - Azar Tol
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Health Education and Promotion, Tehran, Iran
| | - Gholamreza Garmaroudi
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Health Education and Promotion, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Tehran University of Medical Sciences International Campus, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Abebaw Kebede
- Ethiopian Public Health Institute, TB/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Luche Tadesse Ejeta
- Tehran University of Medical Sciences-International Campus, School of Public Health, Department of Health Education and Promotion, Tehran, Iran
| | - Desta Kassa
- Ethiopian Public Health Institute, TB/HIV Research Directorate, Addis Ababa, Ethiopia
| | - Eveline Klinkenberg
- KNCV Tuberculosis Foundation, The Hague, The Netherlands
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Makharia GK, Ghoshal UC, Ramakrishna BS, Agnihotri A, Ahuja V, Chowdhury SD, Gupta SD, Mechenro J, Mishra A, Mishra A, Pathak MK, Pandey RM, Sharma R, Sharma SK. Intermittent Directly Observed Therapy for Abdominal Tuberculosis: A Multicenter Randomized Controlled Trial Comparing 6 Months Versus 9 Months of Therapy. Clin Infect Dis 2015; 61:750-757. [PMID: 25969531 DOI: 10.1093/cid/civ376] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/29/2015] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The duration of treatment of gastrointestinal tuberculosis continues to be a matter of debate. The World Health Organization advocates intermittent directly observed short-course therapy (DOTs), but there is a lack of data of its efficacy in abdominal tuberculosis. We therefore conducted a multicenter randomized controlled trial to compare 6 months and 9 months of antituberculosis therapy using DOTs. METHODS One hundred ninety-seven patients with abdominal tuberculosis (gastrointestinal, 154; peritoneal, 40; mixed, 3) were randomized to receive 6 months (n = 104) or 9 months (n = 93) of antituberculosis therapy using intermittent directly observed therapy. Patients were followed up 1 year after completion of treatment to assess recurrence. Patients were evaluated for primary endpoint (complete clinical response, partial response, and no response) and secondary endpoint (recurrence of the disease at the end of 1 year of follow-up). RESULTS Baseline characteristics were similar between the 2 randomized groups. There was no difference between the 6-month group and 9-month group in the complete clinical response rate on per-protocol analysis (91.5% vs 90.8%; P = .88) or intent-to-treat analysis (75% vs 75.8%; P = .89). Only 1 patient in the 9-month group and no patients in the 6-month group had recurrence of disease. Side effects occurred in 21 (21.3%) and 16 (18.2%) patients in the 6-month and 9-month groups, respectively. CONCLUSIONS There was no difference in efficacy of antituberculosis therapy delivered for either 6 months or 9 months in either gastrointestinal or peritoneal tuberculosis, confirming the efficacy of intermittent directly observed therapy. CLINICAL TRIALS REGISTRATION NCT01124929.
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Affiliation(s)
- Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
| | - Balakrishnan S Ramakrishna
- Department of Gastroenterology, SRM Institute of Medical Sciences, Chennai Department of Gastroenterology, Christian Medical College, Vellore
| | - Abhishek Agnihotri
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi
| | | | | | - John Mechenro
- Department of Gastroenterology, SRM Institute of Medical Sciences, Chennai Department of Gastroenterology, Christian Medical College, Vellore
| | - Asha Mishra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi
| | - Asha Mishra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
| | - Manish K Pathak
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi
| | | | | | - Surendra K Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Treatment Outcomes of Patients with Tuberculosis in New York City. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2015; 21:E11-8. [PMID: 25551205 DOI: 10.1097/phh.0000000000000193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Treatment completion for tuberculosis (TB) is one of the essential components of TB prevention and control. Delays in treatment completion and incomplete treatment can result in increased transmission, development of drug resistance, and increased morbidity and mortality. Understanding the reasons for poor treatment outcomes may help improve TB control efforts. OBJECTIVE To identify those at highest risk and determine the reasons for poor treatment outcomes among TB cases (January 2009-June 2010). DESIGN Retrospective analysis. SETTING/PARTICIPANTS New York City TB patients eligible to complete treatment within 12 months. MAIN OUTCOME MEASURES Poisson regression models were used to identify risk factors associated with delayed completion and incomplete treatment compared with completion within 12 months of initiating treatment (timely completion). Reasons for delayed completion and incomplete treatment were summarized. RESULTS Of 1008 cases eligible to complete treatment within 12 months, 921 (91%) had timely completion, 48 (5%) had delayed completion, and 39 (4%) had incomplete treatment. Cases with delayed completion and incomplete treatment were more likely to have extrapulmonary TB (adjusted risk ratio = 3.31; 95% confidence interval, 1.79-6.14; and adjusted risk ratio = 3.34; 95% confidence interval, 1.73-6.44, respectively). Primary reasons for delayed completion were a physician's decision to extend treatment (35%) and interrupted treatment (31%), whereas those for incomplete treatment included lost to care (38%), moved (28%), and refusal to continue treatment (26%). CONCLUSION Overall, treatment completion in New York City was high. Patients with delayed completion and incomplete treatment had extrapulmonary disease in common. However, specific reasons suggest that delayed completion may be clinically motivated whereas incomplete treatment may result from social conditions.
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