K C McNabb1, A Bergman1, J E Farley1,2. 1. Johns Hopkins University School of Nursing, Baltimore, MD, USA. 2. REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
Abstract
BACKGROUND: Metrics of poor patient engagement, including missed appointments, treatment interruption, sub-optimal medication adherence, and loss to follow-up, have been linked to poor clinical multidrug-resistant TB (MDR-TB) outcomes. Understanding the risk factors for poor patient engagement is necessary to improve outcomes and control TB. This review synthesizes the risk factors for poor patient engagement in MDR-TB treatment across South Africa. DESIGN: A systematic review of five databases (PubMed, Embase, CINAHL, Cochrane, and Web of Science) was conducted, covering articles published between 2010 and 2020. Articles were included if they provided information about risk factors associated with poor engagement among adults (⩾15 years) in treatment for MDR-TB in South Africa. Reviews, editorials, abstracts, and case studies were excluded. RESULTS: Six studies met the inclusion criteria. Male sex and younger age were the most consistently identified risk factors for poor engagement; however, there was a lack of consistency in the choice of covariates, measurement of the variables, analytic methods, and significant factors associated with poor engagement between studies. Alcohol use, substance use, living with HIV, pulmonary TB site, and ethnicity were all identified as risk factors in at least one included study, while formal housing and steady employment were found to be protective. CONCLUSION: The available literature offers little cohesive data to address poor patient engagement in this population. Further research needs to focus on identifying and addressing risk factors for poor patient engagement. This is particularly salient within the context of newer all-oral and short-course MDR-TB treatment regimens.
BACKGROUND: Metrics of poor patient engagement, including missed appointments, treatment interruption, sub-optimal medication adherence, and loss to follow-up, have been linked to poor clinical multidrug-resistant TB (MDR-TB) outcomes. Understanding the risk factors for poor patient engagement is necessary to improve outcomes and control TB. This review synthesizes the risk factors for poor patient engagement in MDR-TB treatment across South Africa. DESIGN: A systematic review of five databases (PubMed, Embase, CINAHL, Cochrane, and Web of Science) was conducted, covering articles published between 2010 and 2020. Articles were included if they provided information about risk factors associated with poor engagement among adults (⩾15 years) in treatment for MDR-TB in South Africa. Reviews, editorials, abstracts, and case studies were excluded. RESULTS: Six studies met the inclusion criteria. Male sex and younger age were the most consistently identified risk factors for poor engagement; however, there was a lack of consistency in the choice of covariates, measurement of the variables, analytic methods, and significant factors associated with poor engagement between studies. Alcohol use, substance use, living with HIV, pulmonary TB site, and ethnicity were all identified as risk factors in at least one included study, while formal housing and steady employment were found to be protective. CONCLUSION: The available literature offers little cohesive data to address poor patient engagement in this population. Further research needs to focus on identifying and addressing risk factors for poor patient engagement. This is particularly salient within the context of newer all-oral and short-course MDR-TB treatment regimens.
Authors: Jason E Farley; Norbert Ndjeka; Ana M Kelly; Erin Whitehouse; Simmi Lachman; Chakra Budhathoki; Kelly Lowensen; Ellie Bergren; Hloniphile Mabuza; Ntombasekhaya Mlandu; Martie van der Walt Journal: PLoS One Date: 2017-08-04 Impact factor: 3.240
Authors: Thelma E Tupasi; Anna Marie Celina G Garfin; Ekaterina V Kurbatova; Joan M Mangan; Ruth Orillaza-Chi; Leilani C Naval; Glenn I Balane; Ramon Basilio; Alexander Golubkov; Evelyn S Joson; Woo-Jin Lew; Vivian Lofranco; Mariquita Mantala; Stuart Pancho; Jesus N Sarol Journal: Emerg Infect Dis Date: 2016-03 Impact factor: 6.883