Wang Yun, Chen Huijuan, Huang Zhongfeng, McNeil Edward B, Lu Xiaolong, Chongsuvivatwong Virasakdi
School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Patient Prefer Adherence. 2019 Sep 30;13:1641-1653. doi: 10.2147/PPA.S219920. eCollection 2019.
Treatment interruption and incorrect dosage for measuring drug non-adherence have seldom been studied in multidrug-resistant tuberculosis (MDR-TB) treatment. This study aimed to 1) estimate the overall and drug-specific incidence of short (≤14 days) and serious (>14 days) treatment interruption among MDR-TB patients, 2) identify main reasons and predictors for serious interruption, and 3) document the level of agreement of classification for incorrect drug dosage between self-report and pill count.
A cross-sectional study combining hospital-based interviews and home-based pill count was conducted from January to June 2018. Treatment interruption was determined from patient's medical records and interviews using a structured questionnaire among 202 patients treated at one designated hospital for MDR-TB treatment. Concordance of pills counted with self-reports for each drug use within one month was assessed for a subgroup of patients at their homes using kappa statistics.
Of 202 patients, the incidence of short and serious treatment interruption was 37.6% and 28.7%, respectively. Adverse drug reactions (ADRs) and financial hardship were the top two reasons for serious interruption. Amikacin and cycloserine had the highest rate of specific drug interruption (18.3% and 10.2%, respectively). ADRs (OR: 2.82, 95% CI: 1.41-5.61), monthly out-of-pocket expenses exceeding 250 US dollars (OR: 2.27, 95% CI: 1.14-4.50), and baseline co-morbidities (OR: 2.53, 95% CI: 1.19-5.38) were significantly associated with serious treatment interruption. Of 111 patients assessed for pill count at home, 5.4% had perfect drug adherence, 54.1% had drug under-use, 6.3% had drug over-use, and 34.2% had both problems. The respective number from self-reports was 7.2%, 56.8%, 5.4% and 30.6%. The two methods gave an acceptable level of agreement for most of the drugs (kappa: 0.52-0.95).
Close monitoring of ADRs, revision of drug regimens, and financial support for MDR-TB in this study population are needed. Self-report on drug under-use and over-use should be monitored monthly in clinical settings.
在耐多药结核病（MDR-TB）治疗中，很少有研究关注治疗中断和不正确剂量用于衡量药物不依从性的情况。本研究旨在：1）估计MDR-TB患者短期（≤14天）和严重（>14天）治疗中断的总体发生率及特定药物的发生率；2）确定严重中断的主要原因和预测因素；3）记录自我报告与药丸计数之间在不正确药物剂量分类方面的一致程度。
2018年1月至6月进行了一项横断面研究，该研究结合了基于医院的访谈和基于家庭的药丸计数。通过患者病历及使用结构化问卷进行访谈，确定了在一家指定医院接受MDR-TB治疗的202例患者的治疗中断情况。使用kappa统计量对一部分在家中的患者评估了一个月内每种药物使用的药丸计数与自我报告的一致性。
202例患者中，短期和严重治疗中断的发生率分别为37.6%和28.7%。药物不良反应（ADR）和经济困难是严重中断的前两个原因。阿米卡星和环丝氨酸特定药物中断率最高（分别为18.3%和10.2%）。ADR（比值比：2.
