Abstract
BackgroundGood adherence to treatment is crucial to control tuberculosis (TB). Efficiency and feasibility of directly observed therapy (DOT) under routine program conditions have been questioned. As an alternative, Médecins sans Frontières introduced self-administered therapy (SAT) in several TB programs. We aimed to measure adherence to TB treatment among patients receiving TB chemotherapy with fixed dose combination (FDC) under SAT at the Homa Bay district hospital (Kenya). A second objective was to compare the adherence agreement between different assessment tools.MethodsWe conducted a cross-sectional survey amongst a series of new TB patients receiving 6 months of standard TB chemotherapy with FDC under SAT. Adherence was assessed at home with urine testing for Isoniazid (INH), pill count, interviewer-administered questionnaire and visual analogue scale (VAS).ResultsIn November 2008 and in June 2009, 212 of 279 eligible patients were assessed for adherence. Overall, 95.2% [95%CI: 91.3–97.7] of the patients reported not having missed a tablet in the last 4 days. On the VAS, complete adherence was estimated at 92.5% [95%CI: 88.0–95.6]. INH urine test was positive for 97.6% [95%CI: 94.6–99.2] of the patients. Pill count could be assessed among only 70% of the interviewed patients. Among them, it was complete for 82.3% [95%CI: 75.1–88.1]. Among the 212 surveyed patients, 193 (91.0%) were successfully treated (cured or treatment completed). The data suggest a fair agreement between the questionnaire and the INH urine test (k = 0.43) and between the questionnaire and the VAS (k = 0.40). Agreement was poor between the other adherence tools.ConclusionThese results suggest that SAT, together with the FDC, allows achieving appropriate adherence to antituberculosis treatment in a high TB and HIV burden area. The use of a combination of a VAS and a questionnaire can be an adequate approach to monitor adherence to TB treatment in routine program conditions.
Highlights
Good adherence to tuberculosis (TB) treatment is crucial to cure patients, to limit the development of drug resistance and to reduce TB transmission in the community
The efficiency and feasibility of directly observed therapy (DOT) in routine health care programs have been questioned for several reasons: i) DOT requires well functioning and well staffed health services which may not be available in some high burden and limited resource countries [2,3]; ii) DOT is expensive, and time-consuming for patients [4]; iii) the appropriateness of using DOT for TB treatment in regions of high HIV prevalence where antiretroviral treatments (ART) are self-administered may be questioned; iv) DOT has not consistently been shown to be superior to other approaches such as self-administered treatment (SAT) when comparing cure or treatment completion rates [5]; v) DOT may raise ethical issues regarding privacy and stigmatisation [6,7]
To ensure good adherence to TB treatment in these self-administered therapy (SAT) based programs, MSF promotes the use of fixed dose combinations (FDC)
Summary
Good adherence to tuberculosis (TB) treatment is crucial to cure patients, to limit the development of drug resistance and to reduce TB transmission in the community. The efficiency and feasibility of DOT in routine health care programs have been questioned for several reasons: i) DOT requires well functioning and well staffed health services which may not be available in some high burden and limited resource countries [2,3]; ii) DOT is expensive, and time-consuming for patients [4]; iii) the appropriateness of using DOT for TB treatment in regions of high HIV prevalence where antiretroviral treatments (ART) are self-administered may be questioned; iv) DOT has not consistently been shown to be superior to other approaches such as self-administered treatment (SAT) when comparing cure or treatment completion rates [5]; v) DOT may raise ethical issues regarding privacy and stigmatisation [6,7]. To ensure good adherence to TB treatment in these SAT based programs, MSF promotes the use of fixed dose combinations (FDC). Medecins sans Frontieres introduced self-administered therapy (SAT) in several TB programs. A second objective was to compare the adherence agreement between different assessment tools
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