High rates of death and loss to follow-up by 12 months of rifampicin resistant TB treatment in South Africa

Abstract Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and limited health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. Methods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. We used thematic analysis with deductive and inductive approaches. Results: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient’s TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients did not follow their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude. Conclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care. Keywords: tuberculosis TB, adherence, messaging, loss to follow up, knowledge, health literacy, patient-centered care

Download Full-text

‘They are inconveniencing us’ - Exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: Perspectives from patients and clinicians in the Free State Province, South Africa.

10.21203/rs.3.rs-15676/v2 ◽

2020 ◽

Author(s):

Nishila Moodley ◽

Amashnee Saimen ◽

Noor Mahomed Zakhura ◽

David Motau ◽

Geoff Setswe ◽

...

Keyword(s):

South Africa ◽

Health Literacy ◽

Treatment Adherence ◽

Treatment Interruption ◽

Social Dimension ◽

Free State ◽

Free State Province ◽

Loss To Follow Up ◽

Tb Treatment

Abstract Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and limited health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. Methods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. We used thematic analysis with deductive and inductive approaches. Results: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient’s TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients did not follow their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude. Conclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care. Keywords: tuberculosis TB, adherence, messaging, loss to follow up, knowledge, health literacy, patient-centered care

Download Full-text

Association Between Tuberculosis and Depression on Negative Outcomes of Tuberculosis Treatment: A Systematic Review and Meta-Analysis

10.1101/19010538 ◽

2019 ◽

Author(s):

Paulo Ruiz-Grosso ◽

Rodrigo Cachay ◽

Adriana de la Flor ◽

Alvaro Schwalb ◽

Cesar Ugarte-Gil

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Meta Analysis ◽

Strong Association ◽

Negative Outcomes ◽

Loss To Follow Up ◽

Tb Treatment ◽

Death And Loss ◽

Definition Of

AbstractBackgroundDepression is a common comorbidity of tuberculosis (TB) and is associated with poor adherence to treatment of multiple disorders. We conducted a systematic review to synthesize the existing evidence on the relationship between depression and negative outcomes of TB treatment.MethodsWe systematically reviewed studies that evaluated depressive symptoms (DS) directly or indirectly through psychological distress (PD) and measured negative treatment outcomes of drug-sensitive pulmonary TB, defined as death, loss to follow-up, or non-adherence. Sources included PubMed, Global Health Library, Embase, Scopus and Web of Science from inception to August 2019.ResultsOf the 2,970 studies initially identified, eight articles were eligible for inclusion and two were used for the primary outcome meta-analysis. We found a strong association between DS and negative TB treatment outcomes (OR=4.26; CI95%:2.33-7.79; I2=0%). DS were also associated with loss to follow-up (OR=8.70; CI95%:6.50-11.64; I2=0%) and death (OR=2.85; CI95%:1.52-5.36; I2=0%). Non-adherence was not associated with DS and PD (OR=1.34; CI95%:0.70-2.72; I2=94.36) or PD alone (OR=0.92; CI95%:0.81-1.05; I2=0%).ConclusionsDS are associated with the negative TB treatment outcomes of death and loss to follow-up. Considerable heterogeneity exists in the definition of depression and outcomes such as non-adherence across the limited number of studies on this topic.

Download Full-text

Evaluation of adherence monitoring system using evriMED with a differentiated response compared to standard of care among drug-sensitive TB patients in three provinces in South Africa: a protocol for a cluster randomised control trial

Trials ◽

10.1186/s13063-021-05337-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Noriah Maraba ◽

Catherine Orrell ◽

Candice M. Chetty-Makkan ◽

Kavindhran Velen ◽

Rachel Mukora ◽

...

Keyword(s):

South Africa ◽

Treatment Success ◽

Standard Of Care ◽

Treatment Completion ◽

Phone Call ◽

Randomised Control Trial ◽

Improve Medication Adherence ◽

Tb Treatment ◽

Differentiated Care

Abstract Background South Africa has achieved drug-susceptible TB (DS-TB) treatment success of only 77% among people with new and previously treated TB. Alternative approaches are required to improve medication adherence and treatment completion to limit transmission, TB relapse and the development of resistance. This study aims to implement and evaluate the use of adherence medication monitors (Wisepill evriMED 1000) with a differentiated response to patient care, among DS-TB patients in three provinces of South Africa. Methods In total, 18 public health clinics across three provinces were selected. Clinics were randomised to intervention or standard of care clinics. In each clinic, approximately 145 DS-TB patients are being enrolled to reach a total of 2610. All patients have their daily adherence monitored using medication monitors. In the intervention arm, patients are receiving medication monitor reminders and differentiated care in response to adherence data. This weekly review of daily real-time monitoring will be undertaken from a central database. The differentiated care model includes automated SMS reminders with a missed dose, research staff-initiated phone call to the patient with a second or third missed dose, a home visit if four or more doses are missed, and motivational counselling if four or more doses are missed repeatedly. Fidelity of the intervention will be measured through process evaluation. Patients in control clinics will receive medication monitors for adherence tracking, standard of care TB education, and normal clinic follow-up procedures. The primary outcome is the proportion of patients by arm with >80% adherence, as measured by the medication monitor. The feasibility and acceptability of the intervention will be assessed by in-depth interviews with patients, stakeholders, and study staff. A cost effectiveness analysis of the intervention and standard of care clinics will be conducted. Significance This trial will provide evidence for the use of an intervention, including medication monitors and differentiated care package, to improve adherence to TB treatment. Improved adherence should also improve TB treatment completion rates, thus reducing loss to follow-up rates, and TB relapse among people with TB. The intervention is intended to ultimately improve overall TB control and reduce TB transmission in South Africa. Trial registration Pan African Trial Registry PACTR201902681157721. Registered on 11 February 2019.

Download Full-text

High rate of loss to follow-up and virological non-suppression in HIV-infected children on antiretroviral therapy highlights the need to improve quality of care in South Africa.

Epidemiology and Infection ◽

10.1017/s0950268821000637 ◽

2021 ◽

pp. 1-26

Author(s):

Geneviève A.F.S. van Liere ◽

Rivka Lilian ◽

Jackie Dunlop ◽

Carol Tait ◽

Kate Rees ◽

...

Keyword(s):

South Africa ◽

Quality Of Care ◽

Antiretroviral Therapy ◽

High Rate ◽

Improve Quality ◽

Loss To Follow Up

Download Full-text

The Effect of Timing of Initiation of Antiretroviral Therapy on Loss to Follow-up in HIV–Tuberculosis Coinfected Patients in South Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000000995 ◽

2016 ◽

Vol 72 (4) ◽

pp. 430-436 ◽

Cited By ~ 6

Author(s):

Nonhlanhla Yende-Zuma ◽

Kogieleum Naidoo

Keyword(s):

South Africa ◽

Antiretroviral Therapy ◽

Loss To Follow Up ◽

Timing Of Initiation

Download Full-text

The impact of smoking on tuberculosis treatment outcomes: a meta-analysis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0002 ◽

2020 ◽

Vol 24 (2) ◽

pp. 170-175 ◽

Cited By ~ 3

Author(s):

E. Y. Wang ◽

R. A. Arrazola ◽

B. Mathema ◽

I. B. Ahluwalia ◽

S. R. Mase

Keyword(s):

Cigarette Smoking ◽

Treatment Outcomes ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Loss To Follow Up ◽

Tb Treatment ◽

The Impact ◽

Culture Conversion

BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14–1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04–2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21–1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts.

Download Full-text