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

一种传染病的严重性和传播可被视为三个因素的最高点：其全球流行性、致命性和根除的难度，这一总和的严重性应因存在有效的治疗方法而有所减轻。然而，由于难以确保坚持治疗，无法成功减轻许多可预防疾病的负担。该项目将以结核病为例，结核病仍然是最普遍的传染病之一，每年造成150万人死亡。由于SARS-CoV-2造成的药物和医疗保健系统供应链中断，这一估计数将上升。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。导致大多数结核病传播的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消除，需要长时间服用几种药物，这些药物可能会产生难以控制的严重副作用。坚持服用这些药物对治愈这种疾病很重要。积极结局所需的治疗依从性程度尚不清楚。目的：为了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，从结核病作为模型疾病开始：目的1）使用预先存在的和新收集的数据源，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的依从性模式的风险相关。4）与建模同事一起工作，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.