Non-adherence to therapy in chronic conditions (initially tuberculosis): a quantitative, methodological approach.

一种传染病的严重程度和蔓延可以看作是三个因素的结果：它的全球流行、它的致命性和根除它的难度。由于存在有效的治疗方法，这种总和的严重性应该得到减轻。然而，在确保坚持治疗方面的困难阻碍了成功减轻许多可预防疾病的负担。该项目将以结核病作为慢性病的一个例子。结核病仍然是传播最广的传染病之一，每年造成150万人死亡。由于SARS-CoV-2造成的药物供应链和卫生保健系统中断，这一估计数字将上升。结核病是十大死亡原因之一，也是人类最致命的单一传染病。引起结核传播的大多数病原体是结核分枝杆菌和密切相关的非洲分枝杆菌。众所周知，分枝杆菌属很难从体内清除，需要很长时间的几种药物治疗，这些药物可能有严重的副作用，而且很难控制。坚持服用这些药物对治愈这种疾病很重要。对治疗的坚持程度需要一个积极的结果是未知的。目的：从作为模型疾病的结核病开始，研究依从性模式如何影响我们的治疗方法，以最大限度地提高有利的结果。目的：1)使用已有和新收集的数据源，描述结核病治疗期间的非依从性模式。2)确定不同的依从性模式如何影响治疗结果？3)确定患者特征是否与最有害依从模式的风险相关。4)与建模同事合作，检查这些模式如何影响最佳剂量。

The severity and spread of an infectious disease can be seen as the culmination of three elements: its global prevalence, its lethality and the difficulty in eradicating it. This severity of this summation should be mitigated by the existence of an effective cure. However, difficulties in ensuring adherence to treatment prevents the success of reducing the burden of many preventable diseases. This project will use tuberculosis (TB) as an example of a chronic disease.TB continues to be one of the most widespread infectious diseases and is responsible for 1.5 million deaths a year. This estimate is set to rise because of the disruption to supply chains of medication and health care systems caused by SARS-CoV-2. TB is one of the top ten causes of death and it the most lethal single infectious agent in humans. The pathogens that cause the majority of TB transmission are Mycobacterium tuberculosis and the closely related Mycobacterium africanum. The Mycobacterium genus is notoriously difficult to eliminate from the body and requires a long course of several drugs which can have serious side-effects that can be difficult to manage. Adherence to these drugs is important for curing the disease. The extent of adherence to therapy required for a positive outcome is unknown. Aims: To investigate how adherence patterns should influence our approach to treatment to maximise favourable outcomes, starting with tuberculosis as a model disease:Objectives1) Describe non-adherence patterns across the duration of treatment in tuberculosis, using pre-existing and newly collected data sources.2) Determine how different adherence patterns impact treatment outcomes?3) Ascertain if patient characteristics are associated with being at risk of the most detrimental adherence patterns.4) Working with modelling colleagues, examine how such patterns could influence optimal dosing.