BACKGROUND: Scaling up treatment for multidrug-resistant tuberculosis is a global health priority. However, current treatment regimens are long and associated with side effects, and default rates are consequently high. This systematic review aimed to identify strategies for reducing treatment default. METHODS: We conducted a systematic search up to May 2012 to identify studies describing interventions to support patients receiving treatment for multidrug-resistant tuberculosis (MDR-TB). The potential influence of study interventions were explored through subgroup analyses. RESULTS: A total of 75 studies provided outcomes for 18,294 patients across 31 countries. Default rates ranged from 0.5% to 56%, with a pooled proportion of 14.8% (95%CI 12.4-17.4). Strategies identified to be associated with lower default rates included the engagement of community health workers as directly observed treatment (DOT) providers, the provision of DOT throughout treatment, smaller cohort sizes and the provision of patient education. CONCLUSION: Current interventions to support adherence and retention are poorly described and based on weak evidence. This review was able to identify a number of promising, inexpensive interventions feasible for implementation and scale-up in MDR-TB programmes. The high default rates reported from many programmes underscore the pressing need to further refine and evaluate simple intervention packages to support patients.
BACKGROUND: Scaling up treatment for multidrug-resistant tuberculosis is a global health priority. However, current treatment regimens are long and associated with side effects, and default rates are consequently high. This systematic review aimed to identify strategies for reducing treatment default. METHODS: We conducted a systematic search up to May 2012 to identify studies describing interventions to support patients receiving treatment for multidrug-resistant tuberculosis (MDR-TB). The potential influence of study interventions were explored through subgroup analyses. RESULTS: A total of 75 studies provided outcomes for 18,294 patients across 31 countries. Default rates ranged from 0.5% to 56%, with a pooled proportion of 14.8% (95%CI 12.4-17.4). Strategies identified to be associated with lower default rates included the engagement of community health workers as directly observed treatment (DOT) providers, the provision of DOT throughout treatment, smaller cohort sizes and the provision of patient education. CONCLUSION: Current interventions to support adherence and retention are poorly described and based on weak evidence. This review was able to identify a number of promising, inexpensive interventions feasible for implementation and scale-up in MDR-TB programmes. The high default rates reported from many programmes underscore the pressing need to further refine and evaluate simple intervention packages to support patients.
Authors: M Loveday; K Wallengren; J Brust; J Roberts; A Voce; B Margot; J Ngozo; I Master; G Cassell; N Padayatchi Journal: Int J Tuberc Lung Dis Date: 2015-02 Impact factor: 2.373
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Authors: A Khaliaukin; A M V Kumar; A Skrahina; H Hurevich; V Rusovich; J Gadoev; D Falzon; M Khogali; P de Colombani Journal: Public Health Action Date: 2014-10-21
Authors: T Tupasi; A M C G Garfin; J M Mangan; R Orillaza-Chi; L C Naval; G I Balane; R Basilio; A Golubkov; E S Joson; W-J Lew; V Lofranco; M Mantala; S Pancho; J N Sarol; A Blumberg; D Burt; E V Kurbatova Journal: Int J Tuberc Lung Dis Date: 2017-01-01 Impact factor: 2.373
Authors: Christoph Lange; Ibrahim Abubakar; Jan-Willem C Alffenaar; Graham Bothamley; Jose A Caminero; Anna Cristina C Carvalho; Kwok-Chiu Chang; Luigi Codecasa; Ana Correia; Valeriu Crudu; Peter Davies; Martin Dedicoat; Francis Drobniewski; Raquel Duarte; Cordula Ehlers; Connie Erkens; Delia Goletti; Gunar Günther; Elmira Ibraim; Beate Kampmann; Liga Kuksa; Wiel de Lange; Frank van Leth; Jan van Lunzen; Alberto Matteelli; Dick Menzies; Ignacio Monedero; Elvira Richter; Sabine Rüsch-Gerdes; Andreas Sandgren; Anna Scardigli; Alena Skrahina; Enrico Tortoli; Grigory Volchenkov; Dirk Wagner; Marieke J van der Werf; Bhanu Williams; Wing-Wai Yew; Jean-Pierre Zellweger; Daniela Maria Cirillo Journal: Eur Respir J Date: 2014-03-23 Impact factor: 16.671
Authors: Carole D Mitnick; Molly F Franke; Michael L Rich; Felix A Alcantara Viru; Sasha C Appleton; Sidney S Atwood; Jaime N Bayona; Cesar A Bonilla; Katiuska Chalco; Hamish S F Fraser; Jennifer J Furin; Dalia Guerra; Rocio M Hurtado; Keith Joseph; Karim Llaro; Lorena Mestanza; Joia S Mukherjee; Maribel Muñoz; Eda Palacios; Epifanio Sanchez; Kwonjune J Seung; Sonya S Shin; Alexander Sloutsky; Arielle W Tolman; Mercedes C Becerra Journal: PLoS One Date: 2013-03-13 Impact factor: 3.240