Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
BMC Infect Dis. 2024 Oct 14;24(1):1154. doi: 10.1186/s12879-024-09994-7.
The COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa.
We analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered 'pre-COVID-19' and those enrolled after September 2020 were considered 'post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown.
DOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04-1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17-2.67; p = 0.006).
The COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times.
ClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016.
COVID-19 大流行对结核病（TB）治疗服务产生了负面影响，包括用于促进药物依从性的直接观察治疗（DOT）方案。我们比较了南非 COVID-19 封锁前后嵌入研究中的 DOT 依从性。
我们分析了 263 名接受药敏（DS）-TB DOT 的观察性研究参与者的数据，这些参与者于 2017 年 5 月至 2022 年 3 月入组。2019 年 10 月之前入组的参与者被视为“COVID-19 之前”，而 2020 年 9 月之后入组的参与者被视为“COVID-19 封锁后”。我们使用负二项回归模型比较了两个封锁组之间的 DOT 不依从率。然后，我们进行了敏感性分析，仅包括在第一次 COVID-19 封锁后立即入组的参与者。
与 COVID-19 封锁前相比，COVID-19 封锁后组的 DOT 不依从率更高（aIRR=1.42，95%CI=1.04-1.96；p=0.028），调整了年龄、性别、就业状况、家庭饥饿感、抑郁风险和使用物质的情况。在最初的封锁后立即，DOT 不依从率最高（aIRR=1.74，95%CI=1.17-2.67；p=0.006）。
COVID-19 封锁对封锁解除后结核病 DOT 的依从性产生了不利影响。即使在调整了社会经济和行为变量后，DOT 依从性的变化仍然存在。我们需要更好地了解 COVID-19 封锁加剧了哪些治疗依从性障碍，以改善大流行后的结果。
ClinicalTrials.gov 注册号：NCT02840877。于 2016 年 7 月 19 日注册。
