Treatment Default Research Articles

Changing the default for tobacco-cessation treatment in an inpatient setting: study protocol of a randomized controlled trial

BackgroundMost health care providers do not treat tobacco dependence routinely. This may in part be due to the treatment “default.” Current treatment guidelines recommend that providers (1) ask patients if they are willing to quit and (2) provide cessation-focused medications and counseling only to smokers who state that they are willing to quit. The default is that patients have to “opt in” to receive cessation assistance: providers ask smokers if they are willing to quit, and only offer medications and cessation support to those who say “yes.” This drastically limits the reach of cessation services because, at any given encounter, only one in three smokers say that they are ready to quit. The objective of this study is to determine the impact of providing all smokers with tobacco-cessation treatment unless they refuse it (OPT OUT) versus current practice—screening for readiness and only offering treatment to smokers who say they are ready to quit (OPT IN).MethodsThis individually randomized clinical trial is conducted in a tertiary-care hospital. We will conduct the trial among up to 1000 randomly selected hospitalized smokers to determine the population impact of changing the treatment default, identify mediators of outcome, and determine the cost-effectiveness of this new, highly proactive approach. This is a population-based study that targets an endpoint of vital interest; applies minimal eligibility criteria to broaden generalizability; and utilizes hospital staff for interventions to ensure long-term sustainability. The study employs delayed consent and an innovative Bayesian adaptive design to evaluate a major shift in our approach to care. If effective, this change would expand the reach of tobacco-cessation treatment from 30% to 100% of smokers.DiscussionRegardless of outcome, the trial will provide a model of how to alter and evaluate the impact of health care defaults. If OPT OUT proves to be more effective, it will expand the population eligible for cessation treatment by over 300%. It will also simplify the tobacco-cessation treatment algorithm, and relieve busy health care providers of the burden of evaluating readiness to quit.Trial registrationClinical Trials Registration, ID: NCT02721082. Registered on 22 March 2016.

Evaluation of outpatient therapeutic programme (OTP) for treatment of severe acute malnutrition in Yemen: a focus on treatment default and its risk factors.

This study aimed to measure the treatment default rate among children with severe acute malnutrition (SAM) who were admitted to the outpatient therapeutic programme (OTP) in Yemen and determine its risk factors. A prospective study was conducted among children with SAM who were newly admitted to the 11 OTPs in primary health centres of Sana'a city. A pretested semistructured questionnaire was used for data collection at admission and at after 2 months of admission to the OTP. Univariate and multivariate analysis using binary logistic regression were used to analyse the risk factors of treatment default. This study included 339 SAM children. Of those, 186 (55%) children discharged as defaulters, 141 (42%) were cured, and 12 (3%) were transferred to other treatment sites. Many factors related to poor accessibility, poor satisfaction with staff and system, and treatment and acceptability of OTP services factors were significantly associated with treatment default. Having difficulty to attend OTP every week (OR 8.4), unavailability of medication during follow-up visits (OR 5.0), not liking to eat Plumpy'Nut (OR 5.8), and not gaining weight since the start of treatment (OR 9.3) were the strongest predictors of treatment default. This study showed a high default rate among SAM children in Sana'a city. Factors related to poor accessibility, poor satisfaction with staff and system, and factors related to treatment and acceptability of OTP services were significantly associated with high default rate. Expansion of OTP services and training OTPs staff on SAM treatment protocols are highly recommended.

English

Tuberculosis is a chronic infections disease caused by Mycobacterium tuberculosis attributable to nearly 9.3 million new cases and 2 million deaths a year, most of which occurring in developing countries. Besides its public health impact, tuberculosis continues to be a challenge for holistic development. Lack of proper knowledge regarding treatment of tuberculosis and consequences of defaulting lead to poor adherence in turn resulting to unsuccessful control program. To assess treatment defaulter rate and associated factors among tuberculosis patients on follow up attending Jimma University Specialized Hospital tuberculosis clinic. An institution based cross sectional study was conducted in JUSH, Southwest Ethiopia from March 1st to 30th March, 2016. The study population were tuberculosis patients on treatment during study period. Data was collected using face to face interview and record review using semi-structured questionnaires and checklists. Data was edited and entered to a statistical software, SPSS version 20.0 and then analyzed using of the same software. Chi-square test and p-value were done to show statistical significance of findings and in addition, association among different variables was determined. A total of 138 respondents were participated with a response rate of 95 of whom 83 (60%) were females and 40 (29%) were in 15 to 24 years age group. TB patients under new treatment regimen constitute for 128 (92.8%) and the rest 10 (7.2%) cases were under re-treatment regimen. About 85% (118/138) participants replied that they have heard about TB, and nearly 37% (51/138) stated that direct coughing or sneezing as a means of transmitting TB and 51 (37%) respondents tried at least 2 TB specific symptoms. However, based on assessment of the overall knowledge of TB, only 21(22.3%) of them were knowledgeable about tuberculosis in the context of knowing cause, transmission, prevention and treatment of tuberculosis while 73(77.7%) of were not knowledgeable. The high defaulting rate and the factors associated with defaulting in this study show high prevalence of defaulting rate and also the challenges faced by patients in the course of TB treatment. Key words: Defaulter, TB and default.

Treatment outcomes of multidrug-resistant tuberculosis patients in Zhejiang, China, 2009–2013

ObjectivesTo examine treatment outcomes and factors associated with poor outcome of multidrug-resistant (MDR) tuberculosis (TB) in China. MethodsWe conducted a prospective observational cohort study including consecutive patients with MDR-TB between 2009 and 2013 in six regions of Zhejiang province. Patients were prescribed treatments by infectious disease specialists, and treatment outcomes were recorded. Sociodemographic characteristics were obtained through a structured questionnaire. The primary endpoint was poor treatment outcomes, defined as treatment failure based on microbiologic persistence, default (lost to follow-up) or death at 24 months. We assessed risk factors for poor treatment outcomes using a Cox proportional hazards model. ResultsA total of 820 MDR-TB patients were observed, and 537 with known treatment outcomes were included in our study. Overall, the treatment success rate was 40.2 per 100 years (374/537 participants, 69.6%), while treatment failure, death and default rates were 10.0 per 100 years (101 participants, 18.8%), 3.4 per 100 years (36 participants, 6.7%) and 2.7 per 100 years (26 participants, 4.8%) respectively. Independent predictors of poor treatment outcomes included age >60 years (hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.2–4.2), patients registered as experiencing relapse (HR 2.2, 95% CI 1.1–4.4), patients registered as receiving treatment after failure (HR 2.4, 95% CI 1.2–4.9), use of standardized MDR-TB regimens (HR 0.6, 95% CI 0.4–1.0), cavitary disease (HR 4.9, 95% CI 2.8–8.6) and adverse events (HR 2.5, 95% CI 1.2–5.5). ConclusionsUnder well-designed treatment and management scheme, high treatment success rates were achieved in a high-MDR-TB-burden country. Antimicrobial susceptibility testing for all second-line drugs should be conducted to further assist in the treatment of MDR-TB.

Treatment Outcomes of Mycobacterium avium Complex Lung Disease: A Systematic Review and Meta-analysis.

The advent of macrolides has led to therapeutic advances in the treatment of Mycobacterium avium complex lung disease (MAC-LD). The aim of this study was to elucidate the treatment outcomes of macrolide-containing regimens. We performed a systematic review and meta-analysis of published studies reporting treatment outcomes of macrolide-containing regimens for MAC-LD using the Medline, Embase, and Cochrane Library databases through 31 July 2016. The rates of treatment success, default from treatment, and adverse events of macrolide-containing regimens were assessed. Treatment success was defined as either 12 months of sustained culture negativity while on therapy or achievement of culture conversion and completion of the planned treatment without relapse. In total, 16 studies involving 1462 patients were included. The rate of treatment success was 60.0% (95% confidence interval [CI], 55.1%-64.8%). The proportion of patients who defaulted from the treatment was 16.0% (95% CI, 12.3%-19.7%). When a thrice-weekly dosing schedule was available, the default rate was 12.0% (95% CI, 8.9%-15.0%). Adverse events necessitating treatment discontinuation or dosage modification of macrolides were observed in 6.4% of patients (95% CI, 3.2%-9.5%), and decreased auditory acuity was the most common adverse event. Treatment outcomes of macrolide-containing regimens are relatively poor in terms of both the treatment success and default rates. The default rate could be reduced if a thrice-weekly dosing schedule is available. Clinicians should be aware of decreased auditory function as the most common adverse event associated with macrolide-containing regimens.

Disease and treatment-related factors associated with tuberculosis treatment default in Khartoum State, Sudan: a case-control study.

Defaulting on tuberculosis (TB) treatment remains a challenge to controlling TB. This case-control study aimed to identify determinants of treatment default among TB patients attending treatment clinics in Khartoum State from May to July 2011. Cases were TB patients who defaulted on treatment and controls were those who completed treatment. Of the 2727 TB patients attending the clinics, 328 (14%) had defaulted. Of these, 185 had resumed treatment before data collection and 143 had not and were eligible as cases. Of the 143, 27 could not be traced and 11 declined to participate. Thus, 105 cases and 210 controls were included and interviewed. The variables significantly associated with treatment default were: rural residence (OR: 2.68; 95% CI: 1.51-4.73), not being on a DOTS programme (OR: 2.53; 95% CI: 1.49-4.30), having side-effects from treatment (OR: 1.94; 95% CI: 1.14-3.29), and having a history of TB (relapse, multidrug-resistant TB or treatment failure) (OR: 5.11; 95% CI: 2.69-9.69). Attention should be paid to these groups at risk of defaulting to encourage treatment adherence and continuation.

Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study.

In 2011, Malawi launched Option B+, a program of universal antiretroviral therapy (ART) treatment for pregnant and lactating women to optimize maternal health and prevent pediatric HIV infection. For optimal outcomes, women need to achieve HIVRNA suppression. We report 6-month HIVRNA suppression and HIV drug resistance in the PURE study. PURE study was a cluster-randomized controlled trial evaluating 3 strategies for promoting uptake and retention; arm 1: Standard of Care, arm 2: Facility Peer Support, and arm 3: Community Peer support. Pregnant and breastfeeding mothers were enrolled and followed according to Malawi ART guidelines. Dried blood spots for HIVRNA testing were collected at 6 months. Samples with ART failure (HIVRNA ≥1000 copies/ml) had resistance testing. We calculated odds ratios for ART failure using generalized estimating equations with a logit link and binomial distribution. We enrolled 1269 women across 21 sites in Southern and Central Malawi. Most enrolled while pregnant (86%) and were WHO stage 1 (95%). At 6 months, 950/1269 (75%) were retained; 833/950 (88%) had HIVRNA testing conducted, and 699/833 (84%) were suppressed. Among those with HIVRNA ≥1000 copies/ml with successful amplification (N = 55, 41% of all viral loads > 1000 copies/ml), confirmed HIV resistance was found in 35% (19/55), primarily to the nonnucleoside reverse transcriptase inhibitor class of drugs. ART failure was associated with treatment default but not study arm, age, WHO stage, or breastfeeding status. Virologic suppression at 6 months was <90% target, but the observed confirmed resistance rates suggest that adherence support should be the primary approach for early failure in option B+.

Retrospective assessment of the status and determinants of tuberculosis treatment outcome among patients treated in government hospitals in North Shoa Administrative Zone, Amhara Regional State, Ethiopia.

BackgroundOne of the specific targets of Directly Observed Treatment, Short-course detailed in the updated Global Plan (2011–2015) was to achieve a treatment success rate of 87% by 2015. This strategy was introduced to Ethiopia in 1995 to reach full coverage in 2005; however, by 2009, treatment had not been as successful as expected.ObjectiveThis study was conducted to determine treatment success rate and identify risk factors for tuberculosis (TB) treatment outcomes in North Shoa Administrative Zone, Amhara Regional State, Ethiopia.MethodsA retrospective cohort study was conducted on all TB patients (739) who registered for TB treatment from September 1, 2012 to August 31, 2014 at public hospitals in North Shoa Administrative Zone, Ethiopia. Data were gathered by using a pretested structured medical record checklist. Four data collectors and two supervisors were involved in gathering the data. The data were analyzed using descriptive statistics and logistic regression and were entered into Epi Info and analyzed by using the SPSS software package version 20.ResultsThis study revealed that the TB treatment success rate was 86.1% (169 [22.9%] cured and 467 [63.2%] completed). In addition, 22 (3%) of the study participants defaulted their treatment of which 19 (86.4%) withdrew during the intensive phase. The multiple logistic regression model revealed that the study year of treatment, sputum smear positivity at the second-month follow-up, history of treatment default, and subsequent hospitalization were significantly associated with the TB treatment outcome.ConclusionThe TB treatment success rate in the study area was low compared to that estimated by World Health Organization to achieve by 2015. Therefore, Federal Ministry of Health and Regional and Zonal Health Office have to strengthen the interventions on minimizing anti-TB treatment default rate through well-organized documentation, follow-up on TB patients, and awareness-creation programs.

Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa

Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa

Risk factors for readmission to hospital in patients with tuberculosis in Tehran, Iran: three-year surveillance.

Tuberculosis (TB) is still a major health problem and TB hospital readmission could increase health system costs. In a retrospective study in a tertiary referral hospital for TB in Tehran, Iran, TB patients with readmission were evaluated. These TB patients in the index year who were then readmitted were compared with TB patients in the same year who were not readmitted during the follow-up period. One hundred and forty-six patients had hospital readmission within three-year follow-up with mean age of 51.6 years old of whom 78 patients (53.5%) were men. Univariate analysis revealed married status, smoking, opium smoking, and medical comorbidities (chronic obstructive pulmonary disease [COPD], hypertension, and human immunodeficiency virus [HIV] infection) as risk factors. Final logistic regression model revealed married status and smoking values of (0.478 odds ratio [OR], 0.310-0.737; 95% confidence interval [CI], P = 0.001) and (1.932 OR, 1.269-2.941; 95% CI, P = 0.002), respectively. Readmission predicted probability was 37% for married patients and 31% for active smokers. The most common medical comorbidities in the first readmission were COPD and HIV infection. Dyspnea and anti-TB drug-induced hepatitis were a common cause of early readmission, while failure and default of treatment were more frequent causes of late readmission. Admission and discharge guidelines, outpatient follow-up, and smoking cessation intervention were proposed as important factors in decreasing the readmission rate.

Outcomes, infectiousness, and transmission dynamics of patients with extensively drug-resistant tuberculosis and home-discharged patients with programmatically incurable tuberculosis: a prospective cohort study

The emergence of programmatically incurable tuberculosis threatens to destabilise control efforts. The aim of this study was to collect prospective patient-level data to inform treatment and containment strategies. In a prospective cohort study, 273 South African patients with extensively drug-resistant tuberculosis, or resistance beyond extensively drug-resistant tuberculosis, were followed up over a period of 6 years. Transmission dynamics, infectiousness, and drug susceptibility were analysed in a subset of patients from the Western Cape using whole-genome sequencing (WGS; n=149), a cough aerosol sampling system (CASS; n=26), and phenotypic testing for 18 drugs (n=179). Between Oct 1, 2008, and Oct 31, 2012, we enrolled and followed up 273 patients for a median of 20·3 months (IQR 9·6-27·8). 203 (74%) had programmatically incurable tuberculosis and unfavourable outcomes (treatment failure, relapse, default, or death despite treatment with a regimen based on capreomycin, aminosalicylic acid, or both). 172 (63%) patients were discharged home, of whom 104 (60%) had an unfavourable outcome. 54 (31%) home-discharged patients had failed treatment, with a median time to death after discharge of 9·9 months (IQR 4·2-17·4). 35 (20%) home-discharged cases were smear-positive at discharge. Using CASS, six (23%) of 26 home-discharged cases with data available expectorated infectious culture-positive cough aerosols in the respirable range (<5 μm), and most reported inter-person contact with suboptimal protective mask usage. WGS identified 17 (19%) of the 90 patients (with available sequence data) that were discharged home before the diagnosis of 20 downstream cases of extensively drug-resistant tuberculosis with almost identical sequencing profiles suggestive of community-based transmission (five or fewer single nucleotide polymorphisms different and with identical resistance-encoding mutations for 14 drugs). 11 (55%) of these downstream cases had HIV co-infection and ten (50%) had died by the end of the study. 22 (56%) of 39 isolates in patients discharged home after treatment failure were resistant to eight or more drugs. However, five (16%) of 31 isolates were susceptible to rifabutin and more than 90% were likely to be sensitive to linezolid, bedaquiline, and delamanid. More than half of the patients with programmatically incurable tuberculosis were discharged into the community where they remained for an average of 16 months, were at risk of expectorating infectious cough aerosols, and posed a threat of transmission of extensively drug-resistant tuberculosis. Urgent action, including appropriate containment strategies, is needed to address this situation. Access to delamanid, bedaquiline, linezolid, and rifabutin, when appropriate, must be accelerated along with comprehensive drug susceptibility testing. UK Medical Research Council, South African Medical Research Council, South African National Research Foundation, European & Developing Countries Clinical Trials Partnership, Oppenheimer Foundation, Newton Fund, Biotechnology and Biological Sciences Research Council, King Abdullah University of Science & Technology.

Relationship between Patients Perception of Recovery, Distance to Health Facility and Tuberculosis Treatment Default in Ebonyi State, Nigeria

With the current launch of End TB Strategy by World Health Organization, this is a global call to reduce Tuberculosis death by 95percent and tuberculosis incidence by 90 percent by the year 2035. It becomes imperative to investigate some factors that may hinder the achievement of this goal and find solution to these limiting factors. The aim of this study was to determine the influence of distance to Direct Observation Treatment (DOT) centre on one hand and patients’ perception of improved prognostic outcome on tuberculosis treatment default. A random sample of 150 tuberculosis patients on treatment between May – August 2016 attending different health centers in Ebonyi State, Nigeria were interviewed. Data were collected using self-administered questionnaires from consenting TB patients. Chi-square statistical technique at 5 percent level of significance was used to test the null hypothesis of no relationship. Results indicated that 83 of the 150 TB patients defaulted in their treatment regimen, giving a default rate of 55.3 percent. Residential distance to health /DOT center was statistically associated with Tuberculosis (TB) treatment default, default increased with travel distance between patients’ residence and treatment center (X2 = 16.7003; df = 2; p < 0.001). Also, patients’ experience of disappearance of signs and symptoms as evidence of improved prognosis (perception of recovery) of TB illness was statistically associated with TB treatment default (X2 = 12.5468, df = 4, P = 0.014 ). This study emphasized the need for suitable specific measures for reducing treatment non-compliance as well as proper and repeated motivation of patients during treatment e.g. referring patients to nearby DOT centers, improving contact and default tracing, DOTS expansion and consolidation etc.

Previous Treatment Failure or Default Increased the Risk of Massive Hemoptysis in PTB Patients

Background: Hemotysis is one of the hallmark symptoms in pulmonary tuberculosis (PTB), which always causes great anxiety and rarely ignored by the patient. Massive hemoptysis is one of the major causes of death in PTB patients. Objectives: To evaluate the independent association of risk factors with the occurrence of massive hemoptysis in PTB patients. Methods: Observational retrospective study of PTB patients with hemoptysis hospitalized in the fifth affiliated hospital of Sun Yat-sen University. Patients were categorized into subjects with massive hemoptysis and with mildmoderate hemoptysis. Independent associations of variables with massive hemoptysis were estimated using univariate analysis. Results: Of 168 subjects with PTB with hemoptysis, 76 (45.23%) reported the presence of massive hemoptysis. In univariate analysis, retreatment cases were more likely to present massive hemoptysis (P=0.020), especially those who had failed or defaulted treatment (P=0.029). Between the two groups, no significant differences were found in the distribution of demographic characteristics and poor radiographic presentations. There were no significant differences in co-morbid diabetes mellitus (DM), lung infection, or bronchiectasis. Conclusions: Previous treatment failure or default is an independent risk factor for massive hemoptysis in PTB. Poor radiographic presentations could not predict the occurrence of massive hemoptysis.

Family perspectives in the care and support of tuberculosis patients: An Indian context

Tuberculosis (TB) has been a major public health crisis throughout the globe, so also in India. Around one-fourth of TB cases are found in India. Currently, the Government of India implements TB control program through a centrally sponsored program known as the Revised National Tuberculosis Control Program (RNTCP). The program is being implemented at community level through Directly Observed Treatment Short-course (DOTS) strategy and is provided though DOTS providers. Despite all these efforts in the country, failures, relapses, and treatment defaulters are common throughout the nation. Families play a greater role in TB control, as the treatment duration of TB is protracted compared to other clinical conditions. Furthermore, TB patients require a great degree of support in terms of care, nutritional and livelihood support. Sometimes, long-term treatment and more pills on a daily or intermittent basis make the patient uncomfortable to continue with the treatment, and the patient discontinues the therapy in the middle of the course. Thus, to increase treatment adherence, a great degree of family support is necessary. In this study, the role of families in TB care has been narrated, in which both the positive and negative aspects of families have been delineated in an Indian perspective.

Treatment Outcome of Pulmonary Tuberculosis Patients at Tehsil Head Quarter Hospital Dargai

Even in this modern era Tuberculosis (TB) poses a serious challenge for the world. Due to emerging of resistance strain and coinfection with Human Immuno Deficiency Virus (HIV)/Acquired Immuno Deficiency Syndrome (AIDS) it is difficult to control the disease. Among the 22 high TB burden countries Pakistan ranks 5th, in case of multi drug resistant its position is 27th [1]. In the year 2013, approximately 12997 incident cases of drug resistant TB in which only 1570 (13%) were registered for treatment [2]. Aim of this study was to find out treatment success rate of pulmonary tuberculosis (PTB) at Tehsil Head Quarter Dargai, Khyber Pakhtunkhwa, Pakistan from 1st January 2011 to 31st December 2014. A total of 410 PTB patients were enrolled. Of the total cases, 373 (90.98%) were diagnosed as new cases, 17 (4.15%) were relapse cases, 13 (3.17%) were transfer in cases, 7 (1.7%) were others cases while no case of treatment failure and treatment default were recorded. The treatment success rate (cured and treatment completed) was reported 333 (81.22%), 8 (1.95%) cases were died from PTB, only 1 (0.24%) case was failure, 2 (0.49%) cases were default while 4 (0.98%) were transfer out and 62 (15.12%) cases were no record of treatment outcome.

Tuberculosis Treatment Outcomes and Factors Associated with Each of Them in a Cohort Followed Up between 2010 and 2014

Tuberculosis treatment has undergone recent changes in Brazil. Objective. To assess whether favorable outcomes on tuberculosis therapy improved in recent years. Methods. Retrospective observational study, based on primary data of tuberculosis patients, followed at INI-FIOCRUZ, from January 2012 to December 2014. Results. The outcomes observed were as follows: cure (80%), default (14%), treatment failure (5%), and death (1%). HIV infection without antiretroviral therapy [OR 0.34 (0.15–0.79)], tuberculosis diagnosis based on sputum smear [OR 0.22 (0.07–0.74)], drug use [OR 0.22 (0.11–0.46)], and/or treatment interruption due to adverse reactions [OR 0.23 (0.08–0.67)] decreased the chance of cure. Predictors of default, that is, use of noninjecting drugs [OR 3.00 (95% CL 1.31–6.88)], treatment interruption due to adverse reactions [OR 6.30 (1.81–21.95)], low schooling [OR 2.59 (2.15–5.82)], higher age [OR 0.44 (0.23–0.82)], and female gender [OR 0.28 (0.11–0.71)], reduced the chance of treatment default. Tuberculosis diagnosis based on sputum smear [OR 7.77 (1.94–31.09)] and/or arterial hypertension [OR 4.07 (1.25–13.18)] was associated with treatment failure. Conclusion. Mortality and default were low considering the prevalence of HIV infection; however cure was not significantly increased.

Patient attitudes towards community-based tuberculosis DOT and adherence to treatment in an urban setting; Kampala, Uganda.

IntroductionHigh Tuberculosis treatment default rate (17%) and sub-optimal treatment completion rates (45%) has burdened Kampala. Nevertheless, there are observable increase in the number of patients on TB DOT; from 6% to 29% in two consecutive annual reports. The main objective was to determine the association of TB patient attitudes towards community-based observers on the TB drug adherence on directly observed treatment for TB in Kampala.MethodsA cross-sectional study was carried out in Lubaga division, Kampala. A total of 201 patients in continuation phase of treatment for Pulmonary TB (i.e. 8 to 20 weeks of TB treatment) were included in the study. Patient attitudes were measured using a 4-point Likert scale aggregated into a binary outcome with ''agree'' and ''disagree'' responses. Poisson regression model using a forward fitting approach in STATA v12 was used to determine the association between patient attitude towards CB-DOTs observers and adherence to TB treatment.ResultsAmong the 201 patients, 66% reported their treatment was being observed by someone. Relatives were the commonest (82%) treatment observers, 26% were non adherent to their TB treatment. Perceiving ''no need for a treatment observer'' and ''people rejecting TB patients'' were predictors of non-adherence to TB treatment (IRR=1.6,95%CI 1.00-2.57;p=0.048) and (IRR=0.6, 95%CI 0.35-0.95; p=0.019) respectively.ConclusionPatient's perceived attitude and stigma towards treatment observers contribute to non-adherence on TB treatment. For improved local TB control, more emphasis is needed to build a friendly environment between treatment supporters and patients during the course of TB treatment.

Medication Non-adherence and Use of Traditional Treatment Among Adult Psychiatric Patients in Jimma Town Treated at Jimma University Teaching Hospital Psychiatric Clinic. Community Based Cross-sectional Study, 2016

Background: Medication non-adherence is common problem across all branches of medicine including psychiatry especially in severe mental illness. Many people with mental illness are known to use both modern and traditional treatment for their illness. However, the level of medication non-adherence among this group of patients is not yet explored. This study was conducted to assess the magnitude of non-adherence and traditional treatment as well as associated factors with non-adherence. Methods: Community based cross sectional study was conducted from April June, 2016 in Jimma town. Data was collected using interviewer administered questionnaire and from patients’ medical record. The four-item Morisky medication adherence scale was used to assess degree of medication non adherence. Pre-test was done on patients who had follow-up at Jimma University teaching Hospital psychiatric clinic and outside the study area. Data was analyzed using SPSS version 20 for windows and descriptive statistics and binary logistic regression statistical methods were applied. P-Value of less than 0.05 was considered statistically significant association in the final model. Results: Out of 300 patients, 61.7% males and 38.3% were females. The prevalence rate of medication nonadherence was 39.3% and 198 (66%) of the participants were traditional treatment users. Using religious types of traditional treatment [AOR=3.763, 95% C.I (1.459, 9.707)], longer duration of treatment (>10 years) [AOR=0.375, 95% C.I (0.155, 0.908)], no history of treatment default [AOR=0.375, 95% C.I (0.155, 0.908)] and no relapse history [AOR=0.365, 95% C.I (0.190, 0.702)] were independently associated variables with medication non-adherence. Conclusion: This study showed that high magnitude of non-adherence and majority of the participants were users of traditional treatments which significantly affects medication adherence. Therefore, mental health professionals should focus on methods how to work cooperatively with traditional treatment giver to decrease non adherence and improve counseling service for patients about being non adherent and its effect on clinical outcome.

Patient knowledge and behavioral factors leading to non-adherence to tuberculosis treatment in Khartoum State, Sudan

Although tuberculosis is a curable and preventable disease, defaulting from treatment can prolong infectiousness leading to increased transmission, an increased risk of drug resistance, relapse and death. Our objective was to identify patient related determinants (including knowledge and awareness, opinion about TB services and behavioral factors) of treatment defaulting among TB patients in Khartoum State, Sudan. Between May 2010 to May 2011., we conducted a case control study where the patients defaulting from treatment were considered as ‘cases’ and those completing treatment as ‘controls’. There were 2727 TB patients who attended TB treatment clinics during study period. Out of these 2399 patients (86%) had continued their treatment while 328 patients (14%) had interrupted it. 105 cases were traced and interviewed. In addition 210 patients who had continued their treatment were included as controls. In the multivariate analysis the variables that remained in the model were: rural residence (OR= 2.16; 95% CI= 1.19-3.90), “had never heard about TB before had it (OR= 1.81; 95%CI=1.02-3.20 ), lack of knowledge on when to stop TB medication (OR= 2.00; 95% CI= 1.10 -3.64), less support by families, friends and colleagues (OR= 3.23; 95% CI= 1.62- 6-46), too many patients when visiting the TB center (OR= 2.24; 95% CI =1.29 - 3.88), and lack of counseling about TB and its treatment (OR= 4.79; 95% CI= 2.57 -8.95). The results of this study show that patient’s knowledge about TB, its treatment and the experienced professional and peer support are associated with TB treatment continuation. Hence, adequate counseling of patients, including counseling of their peers for social support, and adequate training of the health care providers who have enough time to attend to their patient’s need are potential measures to reduce TB treatment default. Key words: Tuberculosis, non-adherence, adherence, defaulter.

Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa

To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p<0.001), <25 years old (9.1% vs. 25-34 years: 8.7%; 35-44 years: 7.0%; 45-54 years: 5.2%; 55-64 years: 4.4%; >64 years: 3.9%; p<0.001), undergoing TB retreatment (11.0% vs. new cases: 6.3%; p<0.001), had a negative pre-treatment sputum smear result (7.8% vs. positive smear results: 7.1%; p<0.001), were in the first 2 months of treatment (95.5% vs. >2 months: 4.8%; p<0.001), and had unknown HIV status (7.8% vs. HIV-positive: 7.0% and HIV-negative: 5.7%; p<0.001). After controlling for potential confounders, multivariate analysis revealed a two-fold increased risk of defaulting treatment when being retreated compared to being treated for the first time for TB (adjusted OR (AOR) 2.0, 95% CI 1.85-2.25). Female cases were 40% less likely to default treatment compared to their male counterparts (AOR 0.6, 95% CI 0.51-0.71). Treatment default was less likely among cases >24 years old compared to younger cases (25-34 years: AOR 0.8, 95% CI 0.77-0.87; 35-44 years: AOR 0.6, 95% CI 0.50-0.64; 45-54 years: AOR 0.4, 95% CI 0.32-0.49; 55-64 years: AOR 0.3, 95% CI 0.21-0.43; >64 years: AOR 0.3, 95% CI 0.19-0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46-0.57). Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.