Understanding Nonadherence to Tuberculosis Medications in India Using Urine Drug Metabolite Testing: A Cohort Study.
Understanding Nonadherence to Tuberculosis Medications in India Using Urine Drug Metabolite Testing: A Cohort Study.
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通过尿液药物代谢物测试了解印度结核病药物不依从性：一项队列研究。
DOI：
10.1093/ofid/ofab190
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发表时间：
2021-06
影响因子：
4.2
通讯作者：
Haberer JE
中科院分区：
文献类型：
--
作者：
Subbaraman R;Thomas BE;Kumar JV;Thiruvengadam K;Khandewale A;Kokila S;Lubeck-Schricker M;Ranjith Kumar M;Gaurkhede GR;Walgude AS;Hephzibah Mercy J;Kumbhar JD;Eliasziw M;Mayer KH;Haberer JE
结核病 (TB) 治疗依从性差与疾病复发和死亡相关。印度很少进行研究来了解结核病药物不依从性。我们在金奈、韦洛尔和孟买招募了成年药物敏感结核病患者，其中大约一半是人类免疫缺陷病毒 (PWH) 感染者。我们进行了一次未经事先通知的家访，以进行一项调查，评估不依从的原因，并收集尿液样本进行异烟肼含量检测。我们描述了患者报告的不依从性的原因，并使用多变量逻辑回归确定了与不依从性（即尿检阴性）相关的因素。我们还评估了不依从性与治疗结果之间的关联。在该队列的 650 名参与者中，77 名（11.8%）的尿检结果呈阴性。不依从性与日薪劳动（调整后的比值比 [aOR]，2.7；置信区间 [CI]，1.1-6.5；P = .03）、后期继续治疗阶段（aOR，2.0；CI，1.1-3.9；P = .03）、涂片阳性肺部疾病（aOR，2.1；CI，1.1-3.9；P = .03）独立相关。 .03)、饮酒(aOR, 2.5; CI, 1.2–5.2; P = .01)，以及花费≥30分钟收集药物补充(aOR, 6.6; CI, 1.5–29.5; P = .01)。艾滋病毒感染者报告说，与非艾滋病毒感染者相比，领取药物面临更大的障碍。在 167 名报告漏服药物的患者中，报告的原因包括外出旅行、忘记、感到沮丧和药物用完。不依从的患者出现不良治疗结果的几率高出 4.0 (CI, 2.1–7.6) 倍 (P < .0001)。解决结构性和社会心理障碍对于提高印度结核病治疗的依从性至关重要。尿液异烟肼检测可能有助于识别不依从的患者，以便于治疗期间的早期干预。我们通过对突击家访期间收集的异烟肼尿液进行检测，评估了 650 名印度患者对结核病药物的依从性。收集药物补充的结构性障碍和社会心理障碍成为导致药物不依从的最重要因素。
Poor adherence to tuberculosis (TB) treatment is associated with disease recurrence and death. Little research has been conducted in India to understand TB medication nonadherence. We enrolled adult drug-susceptible TB patients, approximately half of whom were people with human immunodeficiency virus (PWH), in Chennai, Vellore, and Mumbai. We conducted a single unannounced home visit to administer a survey assessing reasons for nonadherence and collect a urine sample that was tested for isoniazid content. We described patient-reported reasons for nonadherence and identified factors associated with nonadherence (ie, negative urine test) using multivariable logistic regression. We also assessed the association between nonadherence and treatment outcomes. Of 650 participants in the cohort, 77 (11.8%) had a negative urine test. Nonadherence was independently associated with daily wage labor (adjusted odds ratio [aOR], 2.7; confidence interval [CI], 1.1–6.5; P = .03), the late continuation treatment phase (aOR, 2.0; CI, 1.1–3.9; P = .03), smear-positive pulmonary disease (aOR, 2.1; CI, 1.1–3.9; P = .03), alcohol use (aOR, 2.5; CI, 1.2–5.2; P = .01), and spending ≥30 minutes collecting medication refills (aOR, 6.6; CI, 1.5–29.5; P = .01). People with HIV reported greater barriers to collecting medications than non-PWH. Among 167 patients reporting missing doses, reported reasons included traveling from home, forgetting, feeling depressed, and running out of pills. The odds of unfavorable treatment outcomes were 4.0 (CI, 2.1–7.6) times higher among patients with nonadherence (P < .0001). Addressing structural and psychosocial barriers will be critical to improve TB treatment adherence in India. Urine isoniazid testing may help identify nonadherent patients to facilitate early intervention during treatment. We evaluated adherence to tuberculosis medications in 650 Indian patients by conducting urine isoniazid tests collected during unannounced home visits. Structural barriers to collecting medication refills and psychosocial barriers emerged as the most important factors contributing to medication nonadherence.
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DOI：
10.5588/ijtld.19.0472
发表时间：
2020-05-01
影响因子：
4
作者：
Arinaminpathy, N.;Chin, D. P.;Dewan, P.
通讯作者：
Dewan, P.
影响因子：
168.9
作者：
Elizaga, J;Friedland, JS
通讯作者：
Friedland, JS
影响因子：
3.8
作者：
Kendall, Emily A.;Durovni, Betina;Golub, Jonathan E.
通讯作者：
Golub, Jonathan E.
影响因子：
4.4
作者：
Musinguzi, Nicholas;Muwonge, Timothy;Haberer, Jessica E.
通讯作者：
Haberer, Jessica E.
影响因子：
2.7
作者：
Sagbakken M;Frich JC;Bjune GA;Porter JD
通讯作者：
Porter JD