Patterns of individual non-treatment during multiple rounds of mass drug administration for control of soil-transmitted helminths in the TUMIKIA trial, Kenya: a secondary longitudinal analysis.
Patterns of individual non-treatment during multiple rounds of mass drug administration for control of soil-transmitted helminths in the TUMIKIA trial, Kenya: a secondary longitudinal analysis.
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DOI：
10.1016/s2214-109x(20)30344-2
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Pullan RL
中科院分区：
文献类型：
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作者：
Oswald WE;Kepha S;Halliday KE;Mcharo C;Safari T;Witek-McManus S;Hardwick RJ;Allen E;Matendechero SH;Brooker SJ;Njenga SM;Mwandawiro CS;Anderson RM;Pullan RL
关于大规模药物管理（MDA）期间控制被忽视的热带病的治疗模式的研究很少。我们使用常规收集的个人治疗记录，这些记录是为 2015 年至 2017 年在肯尼亚沿海进行的 Tuangamize Minyoo Kenya Imarisha Afya（斯瓦希里语，即根除肯尼亚蠕虫以改善健康[TUMIKIA]）试验进行整理的。在这项分析中，我们估计了同一个人在多轮 MDA 中未接受治疗的程度和相关因素，我们将其称为系统性不治疗。我们将 TUMIKIA 试验中随机分配接受一年两次全社区 MDA 治疗土源性蠕虫病的基线人群与该研究的四轮治疗中任何一轮接受治疗的纵向记录联系起来。我们拟合了逻辑回归模型来估计给定回合中未治疗与上一轮中未治疗的关联，并控制已确定的未治疗预测因素。我们还使用多项逻辑回归来确定与部分治疗或不治疗与完全治疗相关的因素。我们的分析包括 36 327 名参与者：16 236 名 2-14 岁儿童和 20 091 名 15 岁或以上成人。如果参与者在上一轮 MDA 期间未接受治疗，则未记录治疗的几率会更高（调整后比值比 [OR] 3·60，儿童 95% CI 3·08–4·20，成人 5·58、5·01–6·21）。对于儿童来说，上学和居住在农村会降低接受部分治疗或不接受治疗的几率，而社会经济地位最低和生活在城市或城郊家庭的几率会增加。女性接受部分治疗或不接受治疗的几率高于男性。然而，当排除过去两周内怀孕或分娩的女性后，女性接受完整治疗的可能性就更大。 20-25岁的成年人是接受部分治疗（OR 1·41，95% CI 1·22–1·63）或不接受治疗（OR 1·81，95% CI 1·53–2·14）的几率最高的年龄组。不治疗与特定的社会人口群体和特征相关，并且不是随机发生的。这一发现对 MDA 计划的有效性具有重要意义，随着疾病流行率的下降和感染变得越来越聚集，其相关性将会增强。比尔及梅琳达·盖茨基金会、医学研究理事会联合全球健康试验计划、英国国际发展部、惠康信托基金、儿童投资基金基金会和伦敦被忽视的热带病中心。
Few studies have been done of patterns of treatment during mass drug administration (MDA) to control neglected tropical diseases. We used routinely collected individual-level treatment records that had been collated for the Tuangamize Minyoo Kenya Imarisha Afya (Swahili for Eradicate Worms in Kenya for Better Health [TUMIKIA]) trial, done in coastal Kenya from 2015 to 2017. In this analysis we estimate the extent of and factors associated with the same individuals not being treated over multiple rounds of MDA, which we term systematic non-treatment. We linked the baseline population of the TUMIKIA trial randomly assigned to receive biannual community-wide MDA for soil-transmitted helminthiasis to longitudinal records on receipt of treatment in any of the four treatment rounds of the study. We fitted logistic regression models to estimate the association of non-treatment in a given round with non-treatment in the previous round, controlling for identified predictors of non-treatment. We also used multinomial logistic regression to identify factors associated with part or no treatment versus complete treatment. 36 327 participants were included in our analysis: 16 236 children aged 2–14 years and 20 091 adults aged 15 years or older. The odds of having no treatment recorded was higher if a participant was not treated during the previous round of MDA (adjusted odds ratio [OR] 3·60, 95% CI 3·08–4·20 for children and 5·58, 5·01–6·21 for adults). For children, school attendance and rural residence reduced the odds of receiving part or no treatment, whereas odds were increased by least poor socioeconomic status and living in an urban or periurban household. Women had higher odds than men of receiving part or no treatment. However, when those with pregnancy or childbirth in the previous 2 weeks were excluded, women became more likely to receive complete treatment. Adults aged 20–25 years were the age group with the highest odds of receiving part (OR 1·41, 95% CI 1·22–1·63) or no treatment (OR 1·81, 95% CI 1·53–2·14). Non-treatment was associated with specific sociodemographic groups and characteristics and did not occcur at random. This finding has important implications for MDA programme effectiveness, the relevance of which will intensify as disease prevalence decreases and infections become increasingly clustered. Bill & Melinda Gates Foundation, Joint Global Health Trials Scheme of the Medical Research Council, UK Department for International Development, Wellcome Trust, Children's Investment Fund Foundation, and London Centre for Neglected Tropical Diseases.