Abstract
Background: Adherence to tuberculosis (TB) drugs is one of the key aspects of global TB control, yet there is a lack of epidemiological evidence on the factors influencing adherence to TB drugs. Thus, this study aimed to explore the adherence and factors associated with adherence among TB patients in South Korea. Methods: We conducted a cohort study using a sampled national healthcare database from 2017 to 2018. Our study population included incident TB patients initiating quadruple or triple regimen who were available for follow-up for 180-days. Adherence was evaluated using the proportion of days covered (PDC): 1) adherent group: patients with PDC ≥80%; 2) non-adherent group: patients with PDC <80%. Kaplan-Meier analysis was conducted to calculate the median time-to-discontinuation in the study population. We calculated the adjusted odds ratios (aOR) with 95% confidence intervals (CI) to assess factors associated with adherence to TB drugs using logistic regression. Results: Of 987 patients, 558 (56.5%) were adherent and 429 (43.5%) were non-adherent, with the overall mean PDC of 68.87% (standard deviation, 33.37%). The median time-to-discontinuation was 113 days (interquartile range 96–136) in the study population. Patients initiating quadruple regimen were more likely to adhere in comparison to the triple regimen (aOR 4.14; 95% CI 2.78–6.17), while those aged ≥65 years (aOR 0.53; 95% CI 0.35–0.81), with a history of dementia (aOR 0.53; 95% CI 0.34–0.85), and with history of diabetes mellitus (aOR 0.70; 95% CI 0.52–0.96) were less likely to adhere to the drug. Conclusion: Approximately 45% of TB patients were non-adherent to the drug, which is a major concern for the treatment outcome. We call for intensified attention from the authorities and healthcare providers to reinforce patients’ adherence to the prescribed TB drugs.
Highlights
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, accounting for more than 10 million cases and 1.3 million deaths annually (WHO, 2018; Furin et al, 2019)
Adherence to TB drugs is critical in achieving successful treatment outcomes, controlling the spread, and preventing the development of drug resistance in TB
Completion of 2months intensive followed by 4-to 7-months continuation phases of therapy has shown to cure most of the drug-susceptible TB cases with only less than 5–8% chances of relapse (Horsburgh et al, 2015), whereas non-adherence to TB drugs likely led to a multidrug-resistant TB (MDR-TB) or post-TB sequelae (Cox et al, 2006; Fløe et al, 2018)
Summary
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, accounting for more than 10 million cases and 1.3 million deaths annually (WHO, 2018; Furin et al, 2019). Less than 10 incident cases per 100,000 population were reported in most high-income countries, the disease burden from TB has been high in South Korea, with average annual incidence rate of 70 cases per 100,000 population (KCDC, Division of TB & HIV/ AIDS Control, 2018). The Korean government launched “Public-Private Mix” in 2007 to provide supervision and patient support to improve adherence to the standardized TB treatment (Kim and Yim, 2015) Despite these efforts, burden of TB in South Korea is the highest among the OECD member countries.
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