Adherence trajectory as an on-treatment risk indicator among drug-resistant TB patients in the Philippines.
Adherence trajectory as an on-treatment risk indicator among drug-resistant TB patients in the Philippines.
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DOI：
10.1371/journal.pone.0277078
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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高水平的治疗依从性对于结核病患者，特别是耐药结核病患者实现最佳治疗结果至关重要。目前用于识别高风险不依从性的工具是不够的。在这里，我们应用轨迹分析来表征耐多药结核病治疗早期的依从性行为，并评估这些模式是否能预测治疗结果。我们对2013年至2016年期间接受治疗的菲律宾耐药结核病患者进行了回顾性分析。为了确定独特的依从性模式，我们对治疗前12周的依从性进行了基于组的轨迹建模。我们使用单变量和多变量logistic回归估计了依从性轨迹组与六个月和最终治疗结果的关联。我们还估计并比较了依从性轨迹组和二元依从性阈值对治疗结果的预测准确性。596例患者中，302例（50.7%）为耐多药结核，11例（1.8%）为极耐药结核，283例（47.5%）为前耐多药结核。在治疗的前12周，我们确定了三个不同的依从性轨迹：高依从性组（n = 483），中等依从性组（n = 93）和低依从性组（n = 20）。在第4周和第8周时发现了类似的模式。处于12周的中等或低依从性组与不利的6个月治疗结果相关（调整or [aOR] 3.42, 95% CI 1.90-6.12）和最终（aOR 2.71, 95% 1.73-4.30）。依从性轨迹组在预测最终治疗结果方面的表现与二元阈值分类相似（65.9%对65.4%正确分类），但在预测六个月治疗结果方面更为准确（79.4%对60.0%正确分类）。坚持模式对耐多药结核病的治疗结果具有很强的预测性。基于轨迹的分析是研究结核病患者依从性行为的一个令人兴奋的途径，旨在为快速识别和支持具有高风险依从性模式的患者的干预措施提供信息。
High levels of treatment adherence are critical for achieving optimal treatment outcomes among patients with tuberculosis (TB), especially for drug-resistant TB (DR TB). Current tools for identifying high-risk non-adherence are insufficient. Here, we apply trajectory analysis to characterize adherence behavior early in DR TB treatment and assess whether these patterns predict treatment outcomes. We conducted a retrospective analysis of Philippines DR TB patients treated between 2013 and 2016. To identify unique patterns of adherence, we performed group-based trajectory modelling on adherence to the first 12 weeks of treatment. We estimated the association of adherence trajectory group with six-month and final treatment outcomes using univariable and multivariable logistic regression. We also estimated and compared the predictive accuracy of adherence trajectory group and a binary adherence threshold for treatment outcomes. Of 596 patients, 302 (50.7%) had multidrug resistant TB, 11 (1.8%) extremely drug-resistant (XDR) TB, and 283 (47.5%) pre-XDR TB. We identified three distinct adherence trajectories during the first 12 weeks of treatment: a high adherence group (n = 483), a moderate adherence group (n = 93) and a low adherence group (n = 20). Similar patterns were identified at 4 and 8 weeks. Being in the 12-week moderate or low adherence group was associated with unfavorable six-month (adjusted OR [aOR] 3.42, 95% CI 1.90–6.12) and final (aOR 2.71, 95% 1.73–4.30) treatment outcomes. Adherence trajectory group performed similarly to a binary threshold classification for the prediction of final treatment outcomes (65.9% vs. 65.4% correctly classified), but was more accurate for prediction of six-month treatment outcomes (79.4% vs. 60.0% correctly classified). Adherence patterns are strongly predictive of DR TB treatment outcomes. Trajectory-based analyses represent an exciting avenue of research into TB patient adherence behavior seeking to inform interventions which rapidly identify and support patients with high-risk adherence patterns.
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影响因子：
39.2
作者：
De Geest S;Zullig LL;Dunbar-Jacob J;Helmy R;Hughes DA;Wilson IB;Vrijens B
通讯作者：
Vrijens B
影响因子：
4.2
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
通讯作者：
Haberer JE
影响因子：
3.5
作者：
Elmer J;Gianakas JJ;Rittenberger JC;Baldwin ME;Faro J;Plummer C;Shutter LA;Wassel CL;Callaway CW;Fabio A;Pittsburgh Post-Cardiac Arrest Service
通讯作者：
Pittsburgh Post-Cardiac Arrest Service
影响因子：
24
作者：
Salmasi, Shahrzad;De Vera, Mary A.;Loewen, Peter
通讯作者：
Loewen, Peter
DOI：
10.1146/annurev.clinpsy.121208.131413
发表时间：
2010-01-01
期刊：
ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, VOL 6
影响因子：
--
作者：
Nagin, Daniel S.;Odgers, Candice L.
通讯作者：
Odgers, Candice L.