Successful Adherence to Observed Prophylaxis and Treatment of Tuberculosis Among Drug Users in a Methadone Program

Abstract

Incomplete antituberculous chemoprophylaxis and treatment are major causes of the resurgence of tuberculosis, often drug-resistant, among drug users. We offered directly observed antituberculous chemoprophylaxis (n = 102) or treatment (n = 12) to tuberculous chemoprophylaxis (n = 102) or treatment (n = 12) to eligible methadone maintenance treatment patients. Methadone dosing was not contingent upon ingestion of antituberculous medication(s). No material incentives were provided. Ninety (88%) prophylaxis and 9 (75%) treatment patients were administered > or = 5 weekly doses of antituberculous medications during > or = 80% of 4740 patient-weeks. The majority of patients were HIV-seropositive. Active substance abuse was not associated with diminished adherence. Over 80% of patients completed or were still receiving therapy at the end of the study. Adherence to and completion of directly observed antituberculous therapy can thus be attained by drug users in treatment, despite ongoing drug misuse. Substance abuse treatment programs provide opportunities for enhanced compliance, and should thus be viewed as critical components of strategies to address the tuberculosis epidemic in drug users.

The role of adherence in tuberculosis HIV‐positive patients treated in ambulatory regimen

“…As previously shown [10,23,24] and confirmed in the setting of the current study, a methadone programme has a clear impact in improving the prognosis of tuberculosis in human immunodeficiency virus-infected drug abusers, further preventing the spread of the disease to the whole community.…”

“…drug abusers, a group considered to be at higher risk to both HIV infection and tuberculosis, as well as a group in which nonadherence is a major concern [4,9,10]. Although nonadherence is a frequent and important problem, it is largely unpredictable, depending on the patient population and control programmes.…”

“…Associated with the increasing number of co-infected patients, multidrug resistant (MDR) tuberculosis has increased and spread, not only to those infected with HIV, but to the entire community [3,4,8,9]. The lack of adherence to therapy is the major factor associated with relapses of tuberculosis and emergence of MDR strains [4,5,[9][10][11][12]. Directly observed treatment (DOT), though improving, has not eliminated the problem of nonadherence [4, 8-10, 13, 14].…”

Is It Justifiable to Withhold Treatment for Hepatitis C from Illicit-Drug Users?

“…In some studies, drug users were less likely than other persons to adhere to medical therapy, 12-14 whereas in other studies, the adherence of drug users was similar to that of other patients. [15][16][17] It is difficult to make generalizations about drug users because they differ with regard to the drugs they use, the extent and frequency of use, the degree of their dependence, the stability of their lives, and many other factors. For example, regular users may be more impaired than occasional users, and persons who use stimulant drugs or who binge may have more chaotic lives and poorer adherence than those who have used opiates consistently for many years.…”

A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users

“…A randomized trial studying the impact of location of tuberculosis screening showed that chest radiograph completion by drug users was much higher in a methadone clinic than in a nearby medical clinic (86% vs. 23%) (Umbricht-Schneiter et al, 1994). Completion rates for directly observed INH have been as high as 80-90% in methadone programs (O'Connor et al, 1992;Gourevitch et al, 1998;Snyder et al, 1999), regardless of participants' drug use (Gourevitch et al, 1996). This contrasts with other settings, where TB medication adherence among substance users has been lower than among non-users (Combs et al, 1990), even with direct observation (Burman et al, 1997;Pablos-Maendez et al, 1997;Perlman et al, 1997).…”