Adherence to tuberculosis preventive therapy measured by urine metabolite testing among people with HIV
Adherence to tuberculosis preventive therapy measured by urine metabolite testing among people with HIV
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DOI：
10.1097/qad.0000000000002380
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发表时间：
2020-01-01
期刊：
影响因子：
3.8
通讯作者：
Golub, Jonathan E.
中科院分区：
文献类型：
--
作者：
Kendall, Emily A.;Durovni, Betina;Golub, Jonathan E.
目的：对艾滋病毒感染者的结核病预防治疗是有效的，被广泛推荐，并越来越多地被规定，但完成率不太理想，并且通常没有监测依从性。我们试图用尿代谢物检测来量化异烟肼预防性治疗的依从性。设计：两个横断面调查。背景：巴西里约热内卢，2008-2009年;南非西北省，2018-2019年。参会人员：203名巴西和93名南非患者在HIV诊所接受异烟肼预防性治疗的有效处方。主要结局指标：自我报告的异烟肼依从性，与尿液异烟肼代谢物的半定量测量配对。结果如下：通过自我报告，90%的患者[95%置信区间（CI）86-93%]报告在入组当天或前一天服用了一剂异烟肼，91%（95% CI 87-94%）报告每周平均缺失一剂或更少。通过尿液检测，仅65%（95% CI 59-70%）的所有患者和69%（95% CI 63-74%）的报告当天或前一天服用异烟肼的患者可检测到尿液代谢产物（预计24 h时95%的患者可检测到）。自开始预防性治疗以来的时间较长与异烟肼代谢物尿液检测阴性独立相关（校正的患病率比为1.11/月异烟肼，95%CI 1.05-1.18）。结论：巴西和南非的艾滋病毒感染者对异烟肼预防性治疗的依从性不足，自我报告高估了这一依从性，并随着治疗时间的推移而下降。较短的结核病预防性治疗方案可能会提高依从性和完成率，但可能需要对所有患者提供依从性支持。
Objectives: Tuberculosis preventive therapy for people living with HIV is effective, widely recommended, and increasingly prescribed, but completion rates are less than ideal, and adherence is not typically monitored. We sought to quantify adherence to isoniazid preventive therapy using a urine metabolite assay. Design: Two cross-sectional surveys. Setting: Rio de Janeiro, Brazil, 2008-2009; and Northwest Province, South Africa, 2018-2019. Participants: Two hundred and three Brazilian and 93 South African patients attending HIV clinics with active prescriptions for isoniazid preventive therapy Main outcome measures: Self-reported isoniazid adherence, paired with semiquantitative measurement of urine isoniazid metabolites. Results: By self-report, 90% of patients [95% confidence interval (CI) 86-93%] reported having taken a dose of isoniazid on the day of enrollment or the preceding day, and 91% (95% CI 87-94%) reported missing an average of one dose or fewer per week. By urine testing, only 65% (95% CI 59-70%) of all patients, and 69% (95% CI 63-74%) of those who reported having taken isoniazid on the current or preceding day, had detectable urine metabolites (expected in 95% of patients at 24 h). Longer time since starting preventive therapy was independently associated with a negative urine test for isoniazid metabolites (adjusted prevalence ratio 1.11 per month of isoniazid, 95% CI 1.05-1.18). Conclusion: Adherence to isoniazid preventive therapy among patients with HIV in Brazil and South Africa is inadequate, is overestimated by self-report, and declines with time on treatment. Shorter regimens for TB preventive therapy may improve adherence and completion, but adherence support for all patients may be necessary.