1
|
Gichuhi HW, Magumba M, Kumar M, Mayega RW. A machine learning approach to explore individual risk factors for tuberculosis treatment non-adherence in Mukono district. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001466. [PMID: 37399173 DOI: 10.1371/journal.pgph.0001466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
Despite the availability and implementation of well-known efficacious interventions for tuberculosis treatment by the Ministry of Health, Uganda (MoH), treatment non-adherence persists. Moreover, identifying a specific tuberculosis patient at risk of treatment non-adherence is still a challenge. Thus, this retrospective study, based on a record review of 838 tuberculosis patients enrolled in six health facilities, presents, and discusses a machine learning approach to explore the individual risk factors predictive of tuberculosis treatment non-adherence in the Mukono district, Uganda. Five classification machine learning algorithms, logistic regression (LR), artificial neural networks (ANN), support vector machines (SVM), random forest (RF), and AdaBoost were trained, and evaluated by computing their accuracy, F1 score, precision, recall, and the area under the receiver operating curve (AUC) through the aid of a confusion matrix. Of the five developed and evaluated algorithms, SVM (91.28%) had the highest accuracy (AdaBoost, 91.05% performed better than SVM when AUC is considered as evaluation parameter). Looking at all five evaluation parameters globally, AdaBoost is quite on par with SVM. Individual risk factors predictive of non-adherence included tuberculosis type, GeneXpert results, sub-country, antiretroviral status, contacts below 5 years, health facility ownership, sputum test results at 2 months, treatment supporter, cotrimoxazole preventive therapy (CPT) dapsone status, risk group, patient age, gender, middle and upper arm circumference, referral, positive sputum test at 5 and 6 months. Therefore, machine learning techniques, specifically classification types, can identify patient factors predictive of treatment non-adherence and accurately differentiate between adherent and non-adherent patients. Thus, tuberculosis program management should consider adopting the classification machine learning techniques evaluated in this study as a screening tool for identifying and targeting suited interventions to these patients.
Collapse
Affiliation(s)
- Haron W Gichuhi
- Department of Biostatistics and Epidemiology, Makerere University School of Public Health, Kampala, Uganda
| | - Mark Magumba
- Department of Information Systems, Makerere University College of Computing, and Information Science, Kampala, Uganda
| | - Manish Kumar
- Public Health Leadership Program, Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Roy William Mayega
- Department of Biostatistics and Epidemiology, Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
2
|
Leddy AM, Jaganath D, Triasih R, Wobudeya E, Bellotti de Oliveira MC, Sheremeta Y, Becerra MC, Chiang SS. Social Determinants of Adherence to Treatment for Tuberculosis Infection and Disease Among Children, Adolescents, and Young Adults: A Narrative Review. J Pediatric Infect Dis Soc 2022; 11:S79-S84. [PMID: 36314549 PMCID: PMC9620428 DOI: 10.1093/jpids/piac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Global efforts to eliminate tuberculosis (TB) must address the unique barriers that children (ages 0 through 9 years) and adolescents/young adults (AYA; ages 10 through 24 years) face in adhering to treatment for TB infection and disease. We conducted a narrative review to summarize current knowledge on the social determinants of treatment adherence among these age groups to guide efforts and policy to address their unique needs. Our findings revealed that research on TB treatment adherence among children and AYA is still in its nascent stage. The current literature revealed structural/community-, health system-, household-, and individual-level factors that influence treatment adherence and varied with developmental stage. There is a need to develop multilevel interventions to address the unique challenges that children and AYA face in adhering to TB treatment.
Collapse
Affiliation(s)
- Anna M Leddy
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
| | - Devan Jaganath
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California, USA
- Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA
- Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
| | - Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - Yana Sheremeta
- All-Ukrainian Network of People Living With HIV/AIDS, Kyiv, Ukraine
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Silvia S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island, USA
| |
Collapse
|
3
|
Safa MD, Umaña-Taylor AJ. Biculturalism and adjustment among U.S. Latinos: A review of four decades of empirical findings. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 61:73-127. [PMID: 34266572 DOI: 10.1016/bs.acdb.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Incorporating both heritage (e.g., Latino) and national (e.g., American) cultural systems into our sense of self (i.e., bicultural identity) and developing the ability to successfully respond to demands associated with each of these systems (i.e., bicultural competence) have been theorized to be central to the development and positive adjustment of U.S. Latinos, a group that represents a large segment of the country's population. In this comprehensive review, we examined empirical research on biculturalism among U.S. Latinos spanning four decades (1980-2020), with a focus on synthesizing the field's understanding of antecedents and consequents associated with biculturalism and identifying directions for future research. Our review of 152 empirical articles revealed that this literature was characterized by multiple approaches to the conceptualization (i.e., dual-cultural adaptation, dual-cultural identity, bicultural identity integration, and bicultural competence) and subsequent operationalization of biculturalism. Although each conceptualization has different implications for the conclusions that can be drawn regarding an aspect or facet of biculturalism and potential influence on adjustment, a significant majority (78%) of studies, across conceptualizations, provided evidence supporting a positive association between biculturalism and Latinos' adjustment. In addition, a relatively small body of qualitative work was identified, and findings largely informed potential antecedents of biculturalism. We review this literature with attention to: the aspects of biculturalism that are associated with Latinos' adjustment (i.e., psychosocial and physical health), how sample characteristics may limit the generalizability of this work, and important directions for future research both in terms of conceptualization and study design.
Collapse
Affiliation(s)
- M Dalal Safa
- Harvard University, Cambridge, MA, United States.
| | | |
Collapse
|
4
|
Campbell JI, Sandora TJ, Haberer JE. A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking. BMJ Glob Health 2021; 6:e004836. [PMID: 34016576 PMCID: PMC8141435 DOI: 10.1136/bmjgh-2020-004836] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Identifying and treating children with latent tuberculosis infection (TB infection) is critical to prevent progression to TB disease and to eliminate TB globally. Diagnosis and treatment of TB infection requires completion of a sequence of steps, collectively termed the TB infection care cascade. There has been no systematic attempt to comprehensively summarise literature on the paediatric TB infection care cascade. METHODS We performed a scoping review of the paediatric TB infection care cascade. We systematically searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane and Embase databases. We reviewed articles and meeting abstracts that included children and adolescents ≤21 years old who were screened for or diagnosed with TB infection, and which described completion of at least one step of the cascade. We synthesised studies to identify facilitators and barriers to retention, interventions to mitigate attrition and knowledge gaps. RESULTS We identified 146 studies examining steps in the paediatric TB infection care cascade; 31 included children living in low-income and middle-income countries. Most literature described the final cascade step (treatment initiation to completion). Studies identified an array of patient and caregiver-related factors associated with completion of cascade steps. Few health systems factors were evaluated as potential predictors of completion, and few interventions to improve retention were specifically tested. CONCLUSIONS We identified strengths and gaps in the literature describing the paediatric TB infection care cascade. Future research should examine cascade steps upstream of treatment initiation and focus on identification and testing of at-risk paediatric patients. Additionally, future studies should focus on modifiable health systems factors associated with attrition and may benefit from use of behavioural theory and implementation science methods to improve retention.
Collapse
Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Thomas J Sandora
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
5
|
A systematic review of non-pharmacological interventions to improve therapeutic adherence in tuberculosis. Heart Lung 2019; 48:452-461. [PMID: 31084923 DOI: 10.1016/j.hrtlng.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Reviews examining non-pharmacological interventions to improve therapeutic adherence in tuberculosis have several limitations (design, quality assessment…). Consequently, for clinical practice, it is important to generate a review containing all the information to improve patient adherence, solving the previous issues. OBJECTIVES To examine non-pharmacological interventions to improve therapeutic adherence in tuberculosis through clinical trials. METHODS A systematic review in MEDLINE/EMBASE was performed. RESULTS Thirty seven papers were analysed. The disease treatment interventions were disparate, grouped into: education, psychological interventions, new technologies, directly observed treatment, incentives and improved access to health services. In the treatment of latent infection, the majority of studies were conducted in the marginal population (drug addicts, homeless individuals and prisoners) and were based mainly on the provision of incentives. Study quality was generally low. CONCLUSIONS Great variability exists in the studies comparing strategies for identifying interventions, objectives and effects. The designs carried out generally have methodological deficits.
Collapse
|
6
|
Guix-Comellas EM, Rozas-Quesada L, Velasco-Arnaiz E, Ferrés-Canals A, Estrada-Masllorens JM, Force-Sanmartín E, Noguera-Julian A. Impact of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: A nonrandomized controlled trial. J Adv Nurs 2018; 74:1819-1830. [PMID: 29726024 DOI: 10.1111/jan.13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the association of a new nursing intervention on the adherence to antituberculosis treatment in a paediatric cohort (<18 years). BACKGROUND Tuberculosis remains a public health problem worldwide. The risk of developing tuberculosis after primary infection and its severity are higher in children. Proper adherence to antituberculosis treatment is critical for disease control. DESIGN Nonrandomized controlled trial; Phase 1, retrospective (2011-2013), compared with Phase 2, prospective with intervention (2015-2016), in a referral centre for paediatric tuberculosis in Spain (NCT03230409). METHODS A total of 359 patients who received antituberculosis drugs after close contact with a smear-positive patient (primary chemoprophylaxis) or were treated for latent tuberculosis infection or tuberculosis disease were included, 261 in Phase 1 and 98 in Phase 2. In Phase 2, a new nurse-led intervention was implemented in all patients and included two educational steps (written information in the child's native language and follow-up telephone calls) and two monitoring steps (Eidus-Hamilton test and follow-up questionnaire) that were exclusively carried out by nurses. RESULTS Adherence to antituberculosis treatment increased from 74.7% in Phase 1% to 87.8% in Phase 2 (p = 0.014; Chi-square test), after the implementation of the nurse-led intervention. In Phase 2, nonadherence was only associated with being born abroad (28.6% vs. 7.8%; p = 0.019; Chi-square test) and with foreign origin families (27.3% vs. 0%; p < 0.0001; Chi-square test). CONCLUSION The nurse-led intervention was associated to an increase in adherence to antituberculosis treatment. Immigrant-related variables remained major risk factors for sub-optimal adherence in a low-endemic setting.
Collapse
Affiliation(s)
- Eva Maria Guix-Comellas
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Librada Rozas-Quesada
- Childhood Tuberculosis Specialist Unit, Nursing Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Eneritz Velasco-Arnaiz
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria, Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Ariadna Ferrés-Canals
- Childhood Tuberculosis Specialist Unit, Nursing Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Joan Maria Estrada-Masllorens
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Enriqueta Force-Sanmartín
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Antoni Noguera-Julian
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Ciberesp, Madrid, Spain
| |
Collapse
|
7
|
Barriers to treatment adherence for individuals with latent tuberculosis infection: A systematic search and narrative synthesis of the literature. Int J Health Plann Manage 2018; 33:e416-e433. [DOI: 10.1002/hpm.2495] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 11/07/2022] Open
|
8
|
Adherence to Antituberculosis Drugs in Children and Adolescents in A Low-Endemic Setting: A Retrospective Series. Pediatr Infect Dis J 2017; 36:616-618. [PMID: 28030525 DOI: 10.1097/inf.0000000000001508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adherence to antituberculosis drug regimens is critical for the prevention and treatment of tuberculosis in pediatrics. In a large retrospective series of children and adolescents in Barcelona, Spain, completion of treatment was worse among patients treated for latent infection, compared with those treated for active tuberculosis or receiving primary chemoprophylaxis. Toxicity and cultural and language barriers were identified as predictors of nonadherence.
Collapse
|
9
|
Abstract
There are approximately 56 million people who harbor Mycobacterium tuberculosis that may progress to active tuberculosis (TB) at some point in their lives. Modeling studies suggest that if only 8% of these individuals with latent TB infection (LTBI) were treated annually, overall global incidence would be 14-fold lower by 2050 compared to incidence in 2013, even in the absence of additional TB control measures. This highlights the importance of identifying and treating latently infected individuals, and that this intervention must be scaled up to achieve the goals of the Global End TB Strategy. The efficacy of LTBI treatment is well established, and the most commonly used regimen is 9 months of daily self-administered isoniazid. However, its use has been hindered by limited provider awareness of the benefits, concern about potential side effects such as hepatotoxicity, and low rates of treatment completion. There is increasing evidence that shorter rifamycin-based regimens are as effective, better tolerated, and more likely to be completed compared to isoniazid. Such regimens include four months of daily self-administered rifampin monotherapy, three months of once weekly directly observed isoniazid-rifapentine, and three months of daily self-administered isoniazid-rifampin. The success of LTBI treatment to prevent additional TB disease relies upon choosing an appropriate regimen individualized to the patient, monitoring for potential adverse clinical events, and utilizing strategies to promote adherence. Safer, more cost-effective, and more easily completed regimens are needed and should be combined with interventions to better identify, engage, and retain high-risk individuals across the cascade from diagnosis through treatment completion of LTBI.
Collapse
|
10
|
Wingfield T, Tovar MA, Huff D, Boccia D, Saunders MJ, Datta S, Montoya R, Ramos E, Lewis JJ, Gilman RH, Evans C. Beyond pills and tests: addressing the social determinants of tuberculosis. Clin Med (Lond) 2016; 16:s79-s91. [PMID: 27956446 PMCID: PMC6329567 DOI: 10.7861/clinmedicine.16-6-s79] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Poverty drives tuberculosis (TB) rates but the approach to TB control has been disproportionately biomedical. In 2015, the World Health Organization's End TB Strategy explicitly identified the need to address the social determinants of TB through socio-economic interventions. However, evidence concerning poverty reduction and cost mitigation strategies is limited. The research described in this article, based on the 2016 Royal College of Physicians Linacre Lecture, aimed to address this knowledge gap. The research was divided into two phases: the first phase was an analysis of a cohort study identifying TB-related costs of TB-affected households and creating a clinically relevant threshold above which those costs became catastrophic; the second was the design, implementation and evaluation of a household randomised controlled evaluation of socio-economic support to improve access to preventive therapy, increase TB cure, and mitigate the effects of catastrophic costs. The first phase showed TB remains a disease of people living in poverty - 'free' TB care was unaffordable for impoverished TB-affected households and incurring catastrophic costs was associated with as many adverse TB treatment outcomes (including death, failure of treatment, lost to follow-up and TB recurrence) as multidrug resistant (MDR) TB. The second phase showed that, in TB-affected households receiving socio-economic support, household contacts were more likely to start and adhere to TB preventive therapy, TB patients were more likely to be cured and households were less likely to incur catastrophic costs. In impoverished Peruvian shantytowns, poverty remains inextricably linked with TB and incurring catastrophic costs predicted adverse TB treatment outcome. A novel socio-economic support intervention increased TB preventive therapy uptake, improved TB treatment success and reduced catastrophic costs. The impact of the intervention on TB control is currently being evaluated by the Community Randomized Evaluation of a Socio-economic Intervention to Prevent TB (CRESIPT) study.
Collapse
Affiliation(s)
- Tom Wingfield
- Address for correspondence: Dr T Wingfield, The Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Stuurman AL, Vonk Noordegraaf-Schouten M, van Kessel F, Oordt-Speets AM, Sandgren A, van der Werf MJ. Interventions for improving adherence to treatment for latent tuberculosis infection: a systematic review. BMC Infect Dis 2016; 16:257. [PMID: 27268103 PMCID: PMC4897858 DOI: 10.1186/s12879-016-1549-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/07/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Latent tuberculosis infection (LTBI) control relies on high initiation and completion rates of preventive treatment to preclude progression to tuberculosis disease. Specific interventions may improve initiation and completion rates. The objective was to systematically review data on determinants of initiation, adherence and completion of LTBI treatment, and on interventions to improve initiation and completion. METHODS A systematic review of the literature (PubMed, Embase) published up to February 2014 was performed. Relevant prospective intervention studies were assessed using GRADE. RESULTS Sixty-two articles reporting on determinants of treatment initiation and completion were included and 23 articles on interventions. Determinants of LTBI treatment completion include shorter treatment regimen and directly observed treatment (DOT, positive association), adverse events and alcohol use (negative association), and specific populations with LTBI (both positive and negative associations). A positive effect on completion was noted in intervention studies that used short regimens and social interventions; mixed results were found for intervention studies that used DOT or incentives. CONCLUSION LTBI treatment completion can be improved by using shorter regimens and social interventions. Specific needs of the different populations with LTBI should be addressed taking into consideration the setting and condition in which the LTBI treatment programme is implemented.
Collapse
Affiliation(s)
- Anke L Stuurman
- Pallas health research and consultancy BV, Rotterdam, The Netherlands
| | | | - Femke van Kessel
- Pallas health research and consultancy BV, Rotterdam, The Netherlands
| | | | - Andreas Sandgren
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11a, Solna, 171 65, Sweden
| | - Marieke J van der Werf
- European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11a, Solna, 171 65, Sweden.
| |
Collapse
|
12
|
Fluegge KR, Roe BE. A comparative effectiveness analysis of treatment for latent tuberculosis infection using multilevel selection models. J Comp Eff Res 2015; 4:239-257. [PMID: 25965321 DOI: 10.2217/cer.15.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Nine months of isoniazid (9INH) is the gold standard for treatment of latent tuberculosis infection (LTBI). This paper compares the effectiveness of 9 months of isoniazid with 4 months of transitional rifampin (9H4R) to alternative therapies, including 9INH, 6 months of isoniazid (6INH) and 6 months of isoniazid with 4 months of transitional rifampin (6H4R), for treatment of LTBI. MATERIALS & METHODS Using an ethnically diverse clinic sample of 552 patients given treatment for LTBI with 9H4R, we use multilevel selection models to examine the adjusted comparative effectiveness of the regimens among ethnic groups that feature distinct genetic predispositions to side effects on INH. For unadjusted/absolute effectiveness, we simulated cost-effectiveness ratios for 4 months of rifampin (4RIF) and compared with bootstrapped confidence intervals for the alternative therapies. RESULTS There are variations in the comparative effectiveness across ethnic groups, with the most notable differences for 9H4R. For unadjusted/absolute effectiveness, 4RIF presents the greatest net benefit for US born black and African patients. For all other ethnic groups, 6H4R was the most effective. CONCLUSION Patient ethnicity affects tolerance to INH. 9H4R was the most effective LTBI treatment for all ethnicities. However, this result heavily depends on whether adjustments are made for self-selection.
Collapse
Affiliation(s)
- Kyle R Fluegge
- Department of Agricultural, Environmental & Development Economics, Ohio State University, 2120 Fyffe Road, Columbus, OH 43210, USA.,Division of Epidemiology, College of Public Health, Ohio State University, 2120 Fyffe Road, Columbus, OH 43210, USA.,Institute for Health & Environmental Research, Columbus, OH 43220, USA.,Department of Epidemiology & Biostatistics, Case Western Reserve University, 2103 Cornell Road, Cleveland, OH 44106, USA
| | - Brian E Roe
- Department of Agricultural, Environmental & Development Economics, Ohio State University, 2120 Fyffe Road, Columbus, OH 43210, USA
| |
Collapse
|
13
|
Nguyen T, Baptiste S. Innovative practice: exploring acculturation theory to advance rehabilitation from pediatric to adult “cultures” of care. Disabil Rehabil 2014; 37:456-63. [DOI: 10.3109/09638288.2014.932443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tram Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada and
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Sue Baptiste
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada and
| |
Collapse
|
14
|
Chang SH, Eitzman SR, Nahid P, Finelli MLU. Factors associated with failure to complete isoniazid therapy for latent tuberculosis infection in children and adolescents. J Infect Public Health 2013; 7:145-52. [PMID: 24361084 DOI: 10.1016/j.jiph.2013.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/13/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Completion of the recommended 9-month course of isoniazid to treat latent tuberculosis infection in children remains poor and is often affected by adverse effects, including hepatitis, to medication. We evaluated the frequency of isoniazid therapy completion and factors associated with failure to complete therapy in patients aged 0-18 years. METHODS We performed a retrospective review of medical records for patients aged 0-18 years who were referred for isoniazid therapy between January 2005 and August 2011 at 2 California county sites: a public health department and a pediatric latent tuberculosis infection clinic. Medication adherence to isoniazid therapy was measured by monthly pill count. RESULTS There were 1872 eligible patients who were referred for isoniazid therapy. Of the 1587 patients who met inclusion criteria and initiated treatment, 1235 patients (78%) completed the 9-month therapy, including 1046 of 1308 patients aged <15 years (80%) and 189 of 268 patients aged 15-18 years (71%). Factors that were significantly associated with failure to complete therapy included age 15-18 years, non-Hispanic race, development of hepatitis, and symptoms of adverse effects. The association between age and the development of hepatitis was similar for male and female patients. CONCLUSION Failure to complete isoniazid therapy in patients aged 0-18 years is affected by older age, non-Hispanic race, development of hepatitis, and symptoms of adverse effects. Additional support is needed for adolescents to complete therapy for latent tuberculosis infection.
Collapse
Affiliation(s)
- Shiow-Huey Chang
- Public Health Department, Santa Clara County, San Jose, CA, United States.
| | - Sarah R Eitzman
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States; Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Payam Nahid
- Division of Pulmonary and Critical Care, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, United States
| | | |
Collapse
|
15
|
Butcher K, Biggs BA, Leder K, Lemoh C, O'Brien D, Marshall C. Understanding of latent tuberculosis, its treatment and treatment side effects in immigrant and refugee patients. BMC Res Notes 2013; 6:342. [PMID: 23987744 PMCID: PMC3766130 DOI: 10.1186/1756-0500-6-342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/26/2013] [Indexed: 12/02/2022] Open
Abstract
Background Isoniazid treatment of latent tuberculosis infection (LTBI) is commonly prescribed in refugees and immigrants. We aimed to assess understanding of information provided about LTBI, its treatment and potential side effects. Methods A questionnaire was administered in clinics at a tertiary hospital. Total Knowledge (TKS) and Total Side Effect Scores (TSES) were derived. Logistic regression analyses were employed to correlate socio-demographic factors with knowledge. Results Fifty-two participants were recruited, 20 at isoniazid commencement and 32 already on isoniazid. The average TKS were 5.04/9 and 6.23/9 respectively and were significantly associated with interpreter use. Approximately half did not know how tuberculosis was transmitted. The average TSES were 5.0/7 and 3.5/7 respectively, but were not influenced by socio-demographic factors. Conclusions There was suboptimal knowledge about LTBI. Improvements in health messages delivered via interpreters and additional methods of distributing information need to be developed for this patient population.
Collapse
Affiliation(s)
- Katie Butcher
- Department of Medicine, University of Melbourne, Grattan St Parkville, Victoria 3050, Australia.
| | | | | | | | | | | |
Collapse
|
16
|
Olson NA, Davidow AL, Winston CA, Chen MP, Gazmararian JA, Katz DJ. A national study of socioeconomic status and tuberculosis rates by country of birth, United States, 1996-2005. BMC Public Health 2012; 12:365. [PMID: 22607324 PMCID: PMC3506526 DOI: 10.1186/1471-2458-12-365] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in developed countries has historically been associated with poverty and low socioeconomic status (SES). In the past quarter century, TB in the United States has changed from primarily a disease of native-born to primarily a disease of foreign-born persons, who accounted for more than 60% of newly-diagnosed TB cases in 2010. The purpose of this study was to assess the association of SES with rates of TB in U.S.-born and foreign-born persons in the United States, overall and for the five most common foreign countries of origin. METHODS National TB surveillance data for 1996-2005 was linked with ZIP Code-level measures of SES (crowding, unemployment, education, and income) from U.S. Census 2000. ZIP Codes were grouped into quartiles from low SES to high SES and TB rates were calculated for foreign-born and U.S.-born populations in each quartile. RESULTS TB rates were highest in the quartiles with low SES for both U.S.-born and foreign-born populations. However, while TB rates increased five-fold or more from the two highest to the two lowest SES quartiles among the U.S.-born, they increased only by a factor of 1.3 among the foreign-born. CONCLUSIONS Low SES is only weakly associated with TB among foreign-born persons in the United States. The traditional associations of TB with poverty are not sufficient to explain the epidemiology of TB among foreign-born persons in this country and perhaps in other developed countries. TB outreach and research efforts that focus only on low SES will miss an important segment of the foreign-born population.
Collapse
Affiliation(s)
- Nicole A Olson
- California Department of Public Health, STD Control Branch, Richmond, CA, USA
| | | | | | | | | | | |
Collapse
|
17
|
M'imunya JM, Kredo T, Volmink J. Patient education and counselling for promoting adherence to treatment for tuberculosis. Cochrane Database Syst Rev 2012; 2012:CD006591. [PMID: 22592714 PMCID: PMC6532681 DOI: 10.1002/14651858.cd006591.pub2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Non-adherence to tuberculosis treatment can lead to prolonged periods of infectiousness, relapse, emergence of drug-resistance, and increased morbidity and mortality. In this review, we assess whether patient education or counselling, or both, promotes adherence to tuberculosis treatment. OBJECTIVES To evaluate the effects of patient education or counselling, or both, on treatment completion and cure in people requiring treatment for active or latent tuberculosis. SEARCH METHODS Without language restriction, we searched for eligible studies in the Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS; checked reference lists of relevant articles; and contacted relevant researchers and organizations up to 24 November 2011. SELECTION CRITERIA Randomized controlled trials examining the effects of education or counselling, or both, on treatment completion and cure in people with clinical tuberculosis; and treatment completion and clinical tuberculosis in people with latent disease. DATA COLLECTION AND ANALYSIS We independently screened identified studies for eligibility, assessed methodological quality, and extracted data; with differences resolved by consensus. We expressed study results as risk ratios (RRs) with 95% confidence intervals (CI). MAIN RESULTS We found three trials, with a total of 1437 participants, which examined the effects of different educational and counselling interventions on adherence to treatment for latent tuberculosis.All three trials reported the proportion of people who successfully completed treatment for latent tuberculosis. Overall, education or counselling interventions may increase successful treatment completion but the magnitude of benefit is likely to vary depending on the nature of the intervention, and the setting (data not pooled, 923 participants, three trials, low quality evidence).In a four-arm trial in children from Spain, counselling by nurses via telephone increased the proportion of children completing treatment from 65% to 94% (RR 1.44, 95% CI 1.21 to 1.72; 157 participants, one trial), and counselling by nurses through home visits increased completion to 95% (RR 1.46, 95% CI 1.23 to 1.74; 156 participants, one trial). Both of these interventions were superior to counselling by physicians at the tuberculosis clinic (RR 1.20, 95% CI 0.98 to 1.47; 159 participants, one trial).In the USA, a programme of peer counselling for adolescents failed to show an effect on treatment completion rates at six months (RR 1.01, 95% CI 0.90 to 1.13; 394 participants, one trial). In this trial treatment completion was around 75% even in the control group.In the third study, in prisoners from the USA, treatment completion was very low in the control group (12%), and although counselling significantly improved this, completion in the intervention group remained low at 24% (RR 1.94, 95% CI 1.03 to 3.68; 211 participants, one trial).None of these trials aimed to assess the effect of these interventions on the subsequent development of active tuberculosis, and we found no trials that assessed the effects of patient education or counselling on adherence to treatment for active tuberculosis. AUTHORS' CONCLUSIONS Educational or counselling interventions may improve completion of treatment for latent tuberculosis. As would be expected, the magnitude of the benefit is likely to depend on the nature of the intervention, and the reasons for low completion rates in the specific setting.
Collapse
Affiliation(s)
- James Machoki M'imunya
- Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, Nairobi, Kenya.
| | | | | |
Collapse
|
18
|
Pho MT, Swaminathan S, Kumarasamy N, Losina E, Ponnuraja C, Uhler LM, Scott CA, Mayer KH, Freedberg KA, Walensky RP. The cost-effectiveness of tuberculosis preventive therapy for HIV-infected individuals in southern India: a trial-based analysis. PLoS One 2012; 7:e36001. [PMID: 22558301 PMCID: PMC3340407 DOI: 10.1371/journal.pone.0036001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/27/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Regimens for isoniazid-based preventive therapy (IPT) for tuberculosis (TB) in HIV-infected individuals have not been widely adopted given concerns regarding efficacy, adherence and drug resistance. Further, the cost-effectiveness of IPT has not been studied in India. METHODS We used an HIV/TB model to project TB incidence, life expectancy, cost and incremental cost-effectiveness of six months of isoniazid plus ethambutol (6EH), thirty-six months of isoniazid (36H) and no IPT for HIV-infected patients in India. Model input parameters included a median CD4 count of 324 cells/mm(3), and a rate ratio of developing TB of 0.35 for 6EH and 0.22 for 36H at three years as compared to no IPT. Results of 6EH and 36H were also compared to six months of isoniazid (6H), three months of isoniazid plus rifampin (3RH) and three months of isoniazid plus rifapentine (3RPTH). RESULTS Projected TB incidence decreased in the 6EH and 36H regimens by 51% and 62% respectively at three-year follow-up compared to no IPT. Without IPT, projected life expectancy was 136.1 months at a lifetime per person cost of $5,630. 6EH increased life expectancy by 0.8 months at an additional per person cost of $100 (incremental cost-effectiveness ratio (ICER) of $1,490/year of life saved (YLS)). 36H further increased life expectancy by 0.2 months with an additional per person cost of $55 (ICER of $3,120/YLS). The projected clinical impact of 6EH was comparable to 6H and 3RH; however when compared to these other options, 6EH was no longer cost-effective given the high cost of ethambutol. Results were sensitive to baseline CD4 count and adherence. CONCLUSIONS Three, six and thirty-six-month regimens of isoniazid-based therapy are effective in preventing TB. Three months of isoniazid plus rifampin and six-months of isoniazid are similarly cost-effective in India, and should be considered part of HIV care.
Collapse
Affiliation(s)
- Mai T. Pho
- Section of Hospital Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
| | | | | | - Elena Losina
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston Massachusetts, United States of America
| | - C. Ponnuraja
- National Institute for Research in Tuberculosis, Chennai, India
| | | | | | - Kenneth H. Mayer
- Miriam Hospital, Brown University, Providence, Rhode Island, United States of America
| | - Kenneth A. Freedberg
- Division of General Medicine
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston Massachusetts, United States of America
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Rochelle P. Walensky
- Division of General Medicine
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
19
|
Landier W. Adherence to oral chemotherapy in childhood acute lymphoblastic leukemia: an evolutionary concept analysis. Oncol Nurs Forum 2011; 38:343-52. [PMID: 21531684 DOI: 10.1188/11.onf.343-352] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To clarify the concept of adherence to daily oral chemotherapy in children with acute lymphoblastic leukemia (ALL), to examine its implications for clinical practice, and to provide a foundation for further research and knowledge development. DATA SOURCES Published literature identified through the MEDLINE®, CINAHL®, PsycINFO, and ERIC databases. DATA SYNTHESIS Identified attributes of adherence to oral chemotherapy in childhood ALL included motivation, persistence, collaboration, mindfulness, cognitive capacity, flexibility, active participation, and identification of key participants in the process. Identified antecedents included a diagnosis of leukemia, the perceived value of adherence, and patient, family, and healthcare system-related factors. Identified consequences included the potential for maintaining optimal drug levels and improving disease outcome, as well as increased patient and caregiver esteem through active participation in the process. Adherence in the context of childhood ALL is defined as the active self-care behavior of taking (or having the responsibility for administering) daily oral chemotherapy, in collaboration with and according to the instructions of the healthcare provider over a defined, prolonged treatment period. CONCLUSIONS Adherence to oral chemotherapy in childhood ALL is a complex, multidimensional behavior that involves not only a willingness to follow the prescribed regimen over a prolonged period, but also the cognitive capacity and psychomotor skills to carry out the process. IMPLICATIONS FOR NURSING Nurses should recognize the importance of clear communication of medication instructions, reinforcement of adherence-related behaviors, and assistance with common issues such as pill-swallowing skills and reminder systems in caring for children with ALL.
Collapse
Affiliation(s)
- Wendy Landier
- Center for Cancer Survivorship, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| |
Collapse
|
20
|
Abstract
OBJECTIVES To review published literature to determine what is known about adherence to oral antineoplastic agents in children with cancer, to identify adherence-related challenges, and to examine the implications of these challenges for clinical practice. DATA SOURCES Published literature identified through the MEDLINE, CINAHL, and PsycINFO databases. CONCLUSION Oral antineoplastic agents are frequently used in childhood cancer treatment; supportive care regimens for children with cancer also rely heavily on the administration of oral medications. Adherence in pediatric oncology is a complex process involving both parent and child, and requires knowledge and understanding of proper and safe home medication administration in the context of multiple developmental and behavioral concerns that may change over time. IMPLICATIONS FOR NURSING PRACTICE Nurses play an important role in adherence by providing patient and family education and psychosocial support targeted to the child's diagnosis, developmental stage, and specifics of the child's treatment regimen.
Collapse
Affiliation(s)
- Wendy Landier
- Center for Cancer Survivorship, Department of Population Sciences, City of Hope, 1500 E. Duarte Rd, DPS-173, Duarte, CA 91010, USA.
| |
Collapse
|
21
|
Medication Adherence in Hispanics to Latent Tuberculosis Treatment: A Literature Review. J Immigr Minor Health 2010; 14:23-9. [DOI: 10.1007/s10903-010-9393-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
22
|
Minodier P, Lamarre V, Carle ME, Blais D, Ovetchkine P, Tapiero B. Evaluation of a school-based program for diagnosis and treatment of latent tuberculosis infection in immigrant children. J Infect Public Health 2010; 3:67-75. [PMID: 20701894 DOI: 10.1016/j.jiph.2010.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 02/05/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To evaluate a 10-year school-based latent tuberculosis infection (LTBI) screening program, targeting immigrant children in Montreal, Canada, and to identify predictive factors for refusal and, poor adherence to treatment. METHODS Immigrant children were screened for LTBI with Tuberculin Skin Test (TST). Isoniazid was, given when LTBI was diagnosed. Predictors of LTBI, of refusal of follow-up and treatment and of poor, adherence to isoniazid were analyzed. RESULTS Four thousand three hundred and seventy-five children were offered screening, 82.3% consented to TST and 22.8% were positive. An, older age at migration (odds ratio (OR)=1 [95% CI: 1.0-1.01]), as well as migration from a none, established market economy country (OR varying from 2.41 to 4.23) were significantly associated with, positive TST. Among positive children, further evaluation was refused in 5.7%, mainly in migrants from, Eastern Europe (OR=4.05 [95% CI: 2.14-7.69]). Refusal of treatment (11.2%) was more frequent in, Eastern European when compared to South-eastern Asian (OR=6.91 [95% CI: 1.56-30.75]), in, blended families (OR=3.25 [95% CI: 1.25-8.46]) and when the first visit to hospital was delayed (OR=1.01 [95% CI: 1.0-1.02]). Adequate completion of treatment was noted in 61.3%. Age>16 years (OR=1.82 [95% CI: 1.82-2.99]), a delay between TST and first visit>15 days (OR=1.6 [95% CI: 1.12-2.28]), as well as the presence of relative>18 years in the household (OR=1.56 [95% CI: 1.0-2.43]), were associated with poor adherence to treatment. CONCLUSION Sociocultural and behavioural factors are involved in acceptance of LTBI treatment in, immigrant children. Adherence to treatment is challenging and requires comperhension of sociocultural beliefs and accessibility to TB clinic.
Collapse
Affiliation(s)
- Philippe Minodier
- Infectious Diseases Division, Department of Pediatrics, CHU Sainte Justine - Université de Montréal, 3175 Côte Sainte Catherine, Montréal, QC, Canada H3T 1C5
| | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Van Rie A, Sengupta S, Pungrassami P, Balthip Q, Choonuan S, Kasetjaroen Y, Strauss RP, Chongsuvivatwong V. Measuring stigma associated with tuberculosis and HIV/AIDS in southern Thailand: exploratory and confirmatory factor analyses of two new scales. Trop Med Int Health 2008; 13:21-30. [PMID: 18290998 DOI: 10.1111/j.1365-3156.2007.01971.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop scales to measure tuberculosis and HIV/AIDS stigma in a developing world context. METHODS Cross-sectional study of tuberculosis patients in southern Thailand, who were asked to rate their agreement with items measuring TB and HIV/AIDS stigma. Developing the scales involved exploratory and confirmatory factor analyses, internal consistency, construct validity, test-retest reliability and standardized summary scores. RESULTS Factor analyses identified two sub-scales associated with both tuberculosis and HIV/AIDS stigma: community and patient perspectives. Goodness-of-fit was good (TLI = 94, LFI = 0.88 and RMSEA = 0.11), internal consistency was excellent (Cronbach's alphas 0.82-0.91), test-retest reliability was moderate, and construct validity showed an inverse correlation with social support. CONCLUSION Our scales have good psychometric properties that measure stigma associated with tuberculosis and HIV/AIDS and allow assessment of stigma from community and patient perspectives. Their use will help document the burden of stigma, guide the development of interventions and evaluate stigma reduction programmes in areas with a high HIV/AIDS and tuberculosis burden.
Collapse
|
25
|
Ailinger RL, Moore JB, Nguyen N, Lasus H. Adherence to latent tuberculosis infection therapy among latino immigrants. Public Health Nurs 2006; 23:307-13. [PMID: 16817801 DOI: 10.1111/j.1525-1446.2006.00566.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND One third of the world population is infected with Mycobacterium tuberculosis. In the United States, a key component for eliminating tuberculosis (TB) is treating latent TB infection (LTBI) in high-risk persons such as immigrants. OBJECTIVE Examine the prevalence of adherence to LTBI therapy and the influence of basic conditioning factors on adherence among Latino immigrants, guided by Orem's Self-Care Deficit Theory. Adherence was treated as a health deviation self-care requisite; the self-care practice of taking daily medication for 9 months is essential to LTBI adherence. Conditioning factors include gender, age, sociocultural factors, environment, and health state. DESIGN Exploratory, cross-sectional. SAMPLE Nonprobability sample (n=53) of Latino immigrants attending an urban public health clinic in the Washington, DC metropolitan area. METHODS Participants completed a brief questionnaire documenting selected conditioning factors, and 9-month adherence to LTBI therapy was determined from their medical records. RESULTS Adherence dropped from 98% in month 2 to 72% at 9 months. The mean number of months adherent was 7.4. Adherence was not significantly associated with gender, country of origin, languages spoken, age, education, or years in the United States. Adherence was slightly lower (t=2.059, p=.059) in persons who knew someone with TB. CONCLUSIONS Nurses should emphasize the importance of adherence for the full 9 months to this population.
Collapse
Affiliation(s)
- Rita L Ailinger
- College of Nursing and Health Science, George Mason University, Fairfax, Virginia 22030, USA.
| | | | | | | |
Collapse
|
26
|
Szakacs TA, Wilson D, Cameron DW, Clark M, Kocheleff P, Muller FJ, McCarthy AE. Adherence with isoniazid for prevention of tuberculosis among HIV-infected adults in South Africa. BMC Infect Dis 2006; 6:97. [PMID: 16772037 PMCID: PMC1513236 DOI: 10.1186/1471-2334-6-97] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Accepted: 06/13/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is the most common opportunistic infection in HIV-infected adults in developing countries. Isoniazid (INH) is recommended for treatment of latent TB infection, however non-adherence is common. The purpose of this study was to apply in-house prepared isoniazid (INH) urine test strips in a clinical setting, and identify predictors of positive test results in an adherence questionnaire in HIV-infected adults taking INH for prevention of TB. METHODS Cross-sectional study of adherence using a questionnaire and urine test strips for detection of INH metabolites at two hospitals in Pietermaritzburg, South Africa. Participants were aged at least 18 years, HIV positive, and receiving INH for prevention of tuberculosis disease. Univariate and multivariate analyses are used to identify factors relevant to adherence. RESULTS 301 consecutive patients were recruited. 28% of participants had negative urine tests. 32 (37.2%, 95% CI25.4, 45.0) of the 86 patients who received INH from peripheral pharmacies said the pharmacy had run out of INH at some time, compared with central hospital pharmacies (p = 0.0001). In univariate analysis, a negative test was associated with self-reported missed INH doses (p = 0.043). Each 12-hour increment since last reported dose increased the likelihood of a negative test by 34% (p = 0.0007). Belief in INH safety was associated with a positive test (p = 0.021). In multivariate analysis, patients who believed INH is important for prevention of TB disease were more likely to be negative (p = 0.0086). CONCLUSION Adequate drug availability at peripheral pharmacies remains an important intervention for TB prevention. Key questions may identify potentially non-adherent patients. In-house prepared urine tests strips are an effective and cheap method of objectively assessing INH adherence, and could be used an important tool in TB control programs.
Collapse
Affiliation(s)
- Tom A Szakacs
- Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, 501 Smyth Rd., K1H 8L6, Ottawa, Canada
| | - Douglas Wilson
- Department of Medicine, Pietermaritzburg Hospital Complex, Greys Hospital, 3200 Townbush Rd., Pietermaritzburg, South Africa
| | - D William Cameron
- Department of Medicine, Pietermaritzburg Hospital Complex, Greys Hospital, 3200 Townbush Rd., Pietermaritzburg, South Africa
| | - Michael Clark
- Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, 501 Smyth Rd., K1H 8L6, Ottawa, Canada
| | - Paul Kocheleff
- Department of Medicine, Pietermaritzburg Hospital Complex, Greys Hospital, 3200 Townbush Rd., Pietermaritzburg, South Africa
| | - F James Muller
- Department of Medicine, Pietermaritzburg Hospital Complex, Greys Hospital, 3200 Townbush Rd., Pietermaritzburg, South Africa
| | - Anne E McCarthy
- Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, 501 Smyth Rd., K1H 8L6, Ottawa, Canada
| |
Collapse
|
27
|
Berg J, Nyamathi A, Christiani A, Morisky D, Leake B. Predictors of screening results for depressive symptoms among homeless adults in Los Angeles with latent tuberculosis. Res Nurs Health 2005; 28:220-9. [PMID: 15884031 PMCID: PMC3109748 DOI: 10.1002/nur.20074] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to examine predictors of screening results for depressive symptoms in a Los Angeles homeless population with latent tuberculosis (TB). Four hundred and fifteen homeless adults participating in a nurse case managed intervention were included in this analysis. Logistic regression results indicated that those who reported a physical health limitation, multiple sex partners, daily drug use, alcohol dependence, or not having completed high school, were more likely to screen positive. Social support from non-drug users was protective. Given the importance of adherence to TB treatment regimens, the high prevalence of a positive screening for depressive symptoms in the homeless and the potential for depression to reduce adherence rates, routine screening and treatment for depression in high risk homeless adults being treated for TB may be warranted.
Collapse
Affiliation(s)
- Jill Berg
- School of Nursing, University of California, Los Angeles, CA
| | | | | | | | | |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW Tuberculosis kills more people than any other infection. Despite advances in diagnostic methods and greater understanding of the reasons for treatment failure, tuberculosis remains common throughout Latin America. RECENT FINDINGS The impact of HIV and multidrug resistance on tuberculosis control has been enormous. HIV-positive patients may be at 10 times greater risk of multidrug resistant tuberculosis than HIV-negative patients. Hopefully, improved diagnostic techniques will allow more rapid diagnosis of tuberculosis and new colorimetric systems are being developed that will enable expedited drug-sensitivity testing. However, in alarming reports, only 58% of patients were treated with the recommended treatment regime in a Brazilian study, and dropout from treatment in parts of Bolivia was common. Many failings could be combated by rigorous education of patients and physicians. In an encouraging advance, multidrug resistant tuberculosis was successfully treated in a community-based programme, saving an estimated 90% of the cost of hospital-based treatment. An opportunity to identify treatment failure earlier is demonstrated by the finding that 2 months after the initiation of therapy, positive smears were found in only 3% of those whose treatment was successful, but 74% of those whose treatment failed. SUMMARY The importance of inexpensive and widely available drugs to treat HIV and multidrug resistant tuberculosis in Latin America is clear. The need for rapid, affordable tests for tuberculosis diagnosis, and for easy drug sensitivity testing is also evident. Finally, improving treatment success is achievable even in the resource poor setting.
Collapse
Affiliation(s)
| | - David A.J. Moore
- A. B. PRISMA, Lima, Peru
- Wellcome Centre for Clinical Tropical Medicine, Imperial College London, London, UK
| | - Robert Gilman
- A. B. PRISMA, Lima, Peru
- Wellcome Centre for Clinical Tropical Medicine, Imperial College London, London, UK
| | - Carlton Evans
- A. B. PRISMA, Lima, Peru
- Wellcome Centre for Clinical Tropical Medicine, Imperial College London, London, UK
| |
Collapse
|