Adherence to artemether-lumefantrine drug combination: a rural community experience six years after change of malaria treatment policy in Tanzania
Adherence to artemether-lumefantrine drug combination: a rural community experience six years after change of malaria treatment policy in Tanzania
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DOI：
10.1186/1475-2875-13-267
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发表时间：
2014-07-10
期刊：
影响因子：
3
通讯作者：
Ngasala, Billy
中科院分区：
文献类型：
--
作者：
Minzi, Omary;Maige, Sylivester;Ngasala, Billy
背景：在全世界范围内，坚持多次给药都面临着挑战。本研究评估了坦桑尼亚农村社区从单剂量磺胺多辛-乙胺嘧啶政策转换六年后对多剂量蒿甲醚-本芴醇 (ALu) 的依从程度。 方法：本研究是一项前瞻性观察性、开放标签、非随机研究，涉及坦桑尼亚巴加莫约区 Fukayosi 药房招募的 151 名单纯性疟疾患者。第 3 天，接受 ALu 治疗的患者在家接受采访，了解药物摄入量、毛细血管血样采集用于显微镜检查和 ALu 药片计数。第7天收集静脉血样（2ml）用于测定血苯芴醇浓度，并收集血载玻片用于显微镜检查。 Kappa 系数用于评估药丸计数和自我报告之间的一致性。根据剩余药片和患者的报告对依从性进行分类。只有那些拥有空泡罩包装但没有剩余药片并报告以正确剂量和正确时间服用所有六剂 ALu 的患者才被视为明确依从性。其余的患者要么可能坚持服药，要么可能不坚持服药。结果：只有 14.9% 的患者确实坚持服药，其余患者在错误的时间服药或没有吃完药片。在对 90 名患者的血浆样本进行本芴醇血液浓度分析中，13/90 (14.4.0%) 的本芴醇浓度 < 175 ng/ml。那些声称已按要求服用所有剂量的患者 (561.61 ng/ml 95% CI = 419.81-703.41) 与那些声称没有很好地坚持服药的患者 (490.95 ng/ml, 95% CI = 404.18-577.7074 (p = 0.643)) 相比，平均本芴醇浓度没有差异。无论依从性状态和第 7 天血液苯芴醇水平如何，患者在第 3 天和第 7 天都可检测到寄生虫。自我报告的药物摄入量和服药计数反应之间存在很强的一致性（kappa 系数 = 0.955），年龄、性别、教育程度和首次服药地点与依从性相关。结论：疟疾治疗政策改变六年后的总体依从性较低。持续监控治疗的坚持程度，以了解现状并及时采取纠正措施。
Background: Adherence to multidosing is challenging worldwide. This study assessed the extent of adherence to multidosing artemether-lumefantrine (ALu) in a rural community in Tanzania, six years after switching from single dose policy of sulphadoxine-pyrimethamine.Methods: This study was a prospective observational, open label, non-randomized study involving 151 patients with uncomplicated malaria recruited at Fukayosi dispensary in Bagamoyo district in Tanzania. Patients treated with ALu were visited at home on day 3 for interview on drug intake, capillary blood sample collection for microscopy and ALu tablets count. Venous blood samples (2 ml) for determination of blood lumefantrine concentrations and blood slides for microscopy were collected on day-7. Kappa's coefficient was used to assess agreement between pill count and self-report. Adherence was categorized depending on the tablets remaining and what the patient reported. Only those with empty blister pack available but no tablet remaining and reported taking all six doses of ALu at a correct dose and correct time were regarded as definite adherent. The rest were either probable adherent or probable non-adherent.Results: Only 14.9% of the patients were definite adherent the rest took the drug at incorrect time or did not finish the tablets. Out of 90 patients with analysed plasma samples for lumefantrine blood concentrations, 13/90 (14.4.0%) had lumefantrine concentrations < 175 ng/ml. There was no difference in mean lumefantrine concentration in the patients who stated to have taken all doses as required (561.61 ng/ml 95% CI = 419.81-703.41) compared to those who stated to have not adhered well to drug intake (490.95 ng/ml, 95% CI = 404.18-577.7074 (p = 0.643). None of the patients had detectable parasites by microscopy on day-3 and day-7 regardless of adherence status and the level of day-7 blood lumefantrine. There was strong agreement between the self-reported responses on drug intake and pill-counts (kappa coefficient = 0.955). Age, sex, education and place where first dose was taken were associated with adherence.Conclusions: The overall adherence six years after the change of malaria treatment policy was low. It is, therefore, important to continuously monitor the level of adherence to treatment in order to get the current situation and institute corrective measures on time.