Fay Stephens1, Neel R Gandhi1, James C M Brust2, Koleka Mlisana3, Pravi Moodley4, Salim Allana1, Angie Campbell1, Sarita Shah1,5. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. 2. Divisions of General Internal Medicine & Infectious Diseases, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY. 3. Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal and National Health Laboratory Service, Durban, South Africa. 4. Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal and National Health Laboratory Service, Durban, South Africa. 5. Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Atlanta, GA.
Abstract
BACKGROUND: Success in multidrug-resistant tuberculosis (MDR-TB) and HIV treatment requires high medication adherence despite high pill burdens, frequent adverse events, and long treatment duration, which may jeopardize adherence. We prospectively compared MDR-TB/HIV-coinfected persons to those with MDR-TB alone to determine the impact of concurrent treatment on adherence and outcomes. METHODS: We assessed medication adherence monthly using 3-day recall, 30-day recall, and visual analog scale and examined adherence to monthly study visits (months 0-12). We determined the proportion of participants fully adherent (no reported missed doses) to MDR-TB vs. HIV treatment by each measure. We assessed the association of medication and clinic visit adherence with MDR-TB treatment success (cure or completion, 18-24 months) and HIV virologic suppression. RESULTS: Among 200 patients with MDR-TB, 63% were women, median age was 33 years, 144 (72%) were HIV-infected, and 81% were receiving antiretroviral therapy (ART) at baseline. Adherence to medications (81%-98% fully adherent across all measures) and clinic visits (80% missed ≤1 visit) was high, irrespective of HIV status. Adherence to ART was significantly higher than to MDR-TB treatment by all self-reported measures (3-day recall: 92% vs. 84%, respectively; P = 0.003). In multivariable analysis, the adjusted risk ratio of unsuccessful MDR-TB treatment increased with every missed visit: 1.50, 2.25, and 3.37 for unsuccessful treatment, for 1, 2, and ≥3 missed visits. CONCLUSIONS: Adherence to ART was higher than to MDR-TB treatment among persons with MDR-TB/HIV coinfection. Missed clinic visits may be a simple measure for identifying patients at risk of unsuccessful MDR-TB treatment outcome.
BACKGROUND: Success in multidrug-resistant tuberculosis (MDR-TB) and HIV treatment requires high medication adherence despite high pill burdens, frequent adverse events, and long treatment duration, which may jeopardize adherence. We prospectively compared MDR-TB/HIV-coinfectedpersons to those with MDR-TB alone to determine the impact of concurrent treatment on adherence and outcomes. METHODS: We assessed medication adherence monthly using 3-day recall, 30-day recall, and visual analog scale and examined adherence to monthly study visits (months 0-12). We determined the proportion of participants fully adherent (no reported missed doses) to MDR-TB vs. HIV treatment by each measure. We assessed the association of medication and clinic visit adherence with MDR-TB treatment success (cure or completion, 18-24 months) and HIV virologic suppression. RESULTS: Among 200 patients with MDR-TB, 63% were women, median age was 33 years, 144 (72%) were HIV-infected, and 81% were receiving antiretroviral therapy (ART) at baseline. Adherence to medications (81%-98% fully adherent across all measures) and clinic visits (80% missed ≤1 visit) was high, irrespective of HIV status. Adherence to ART was significantly higher than to MDR-TB treatment by all self-reported measures (3-day recall: 92% vs. 84%, respectively; P = 0.003). In multivariable analysis, the adjusted risk ratio of unsuccessful MDR-TB treatment increased with every missed visit: 1.50, 2.25, and 3.37 for unsuccessful treatment, for 1, 2, and ≥3 missed visits. CONCLUSIONS: Adherence to ART was higher than to MDR-TB treatment among persons with MDR-TB/HIV coinfection. Missed clinic visits may be a simple measure for identifying patients at risk of unsuccessful MDR-TB treatment outcome.
Authors: E Nathanson; R Gupta; P Huamani; V Leimane; A D Pasechnikov; T E Tupasi; K Vink; E Jaramillo; M A Espinal Journal: Int J Tuberc Lung Dis Date: 2004-11 Impact factor: 2.373
Authors: K F Laserson; L E Thorpe; V Leimane; K Weyer; C D Mitnick; V Riekstina; E Zarovska; M L Rich; H S F Fraser; E Alarcón; J P Cegielski; M Grzemska; R Gupta; M Espinal Journal: Int J Tuberc Lung Dis Date: 2005-06 Impact factor: 2.373
Authors: D L Paterson; S Swindells; J Mohr; M Brester; E N Vergis; C Squier; M M Wagener; N Singh Journal: Ann Intern Med Date: 2000-07-04 Impact factor: 25.391
Authors: Jessica H Oyugi; Jayne Byakika-Tusiime; Edwin D Charlebois; Cissy Kityo; Roy Mugerwa; Peter Mugyenyi; David R Bangsberg Journal: J Acquir Immune Defic Syndr Date: 2004-08-15 Impact factor: 3.731
Authors: Charles D Wells; J Peter Cegielski; Lisa J Nelson; Kayla F Laserson; Timothy H Holtz; Alyssa Finlay; Kenneth G Castro; Karin Weyer Journal: J Infect Dis Date: 2007-08-15 Impact factor: 5.226
Authors: R Ruslami; R van Crevel; E van de Berge; B Alisjahbana; R E Aarnoutse Journal: Southeast Asian J Trop Med Public Health Date: 2008-11 Impact factor: 0.267
Authors: Kevin Wong; James Nguyen; Lillie Blair; Marina Banjanin; Bunraj Grewal; Shane Bowman; Hailey Boyd; Grant Gerstner; Hyun Jun Cho; David Panfilov; Cho Ki Tam; Delaney Aguilar; Vishwanath Venketaraman Journal: J Clin Med Date: 2020-11-06 Impact factor: 4.241