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

Rocha, M.R.; Pereira, S; Ferreira, Luiz Oscar Cardoso; Barros, Henrique

doi:10.1183/09031936.03.00077302

Cited by 21 publications

(20 citation statements)

References 17 publications

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“…HIV infection is also a widely described risk factor 7,8,14,15,16 , and our results showed it was associated with death and unsuccessful outcome. Studies have shown that improved TB outcomes can be achieved through decentralization of treatment and the supply of an extended range of supervised DOT options (even in countries where HAART is not readily available, like Malawi 25 ) and the integration of the DOTs strategy with HIV/AIDS homecare 25,26,27 .…”

Section: Discussionmentioning

confidence: 50%

“…Some definitions consider only noncompliance, while others combine all negative outcomes: treatment failure, noncompliance, and death 4,5,6,7,8,9 . Determinants have included male gender 4,10 , older age 7 , migration 11 , homelessness 11,12,13 , history of incarceration 11,12 , alcoholism 12,13 , HIV infection 7,8,14,15,16 , intravenous drug use 12 , and decreased access to healthcare 4 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

et al. 2007

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A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

et al. 2007

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“…The studies had relatively comparable designs (retrospective TB register review) and were both large. Other work appears to support an association between HIV co-infection and default from TB treatment (Johnson et al 2000;Rocha et al 2003;Daniel et al 2006). Two of the studies included patients with MDR-TB of which one (Santha et al 2002), did not examine temporal trends in withdrawal among the MDR group.…”

Section: Discussionmentioning

confidence: 99%

Timing of default from tuberculosis treatment: a systematic review

Kruk

Schwalbe

Aguiar

2008

Tropical Med Int Health

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Summaryobjectives To provide a systematic assessment of the timing of default from tuberculosis (TB) treatment which could help to quantify the potential contribution of new shorter duration TB drugs to global TB control.methods We performed a systematic review following QUOROM guidelines. MEDLINE was searched from 1998 to the present using the terms TB and default or drop-out or compliance or adherence and therapy. A total of 840 articles were returned. A further detailed manual review selected 15 randomized trials and observational studies that reported timing of drop-out and focused on developing countries.results The selected studies comprised randomized controlled trials, retrospective record reviews, and qualitative assessments and spanned 10 countries. Both directly observed treatment (DOT) and non-DOT programs were represented. Thus results were highly heterogeneous and not statistically aggregated. Data suggest, but do not conclude, that the majority of defaulters across the studies completed the 2-month intensive phase of treatment.conclusions There is insufficient high-quality comparable information on the timing of default from TB treatment to permit any firm conclusions on trends in default. However, a substantial proportion of defaulters appear to leave treatment in the later stages of the current 6-month regimen, suggesting that new TB chemotherapeutic agents which can reduce the length of treatment have the potential to improve global TB treatment success rates.

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“…The following variables were strongly associated with unfavorable Portugal, (25) 25.7% of the TB/HIV co-infected patients evaluated were found to present complications of the treatment for TB due to adverse reactions, and this was more common in patients later presenting an unfavorable outcome. The concomitant use of antiretroviral therapy and TB treatment regimens is controversial, principally regarding the potential complex interaction among drugs, overlapping adverse reactions and noncompliance with treatment, as well as increased frequency and intensity of paradoxical reactions.…”

Section: Final Multivariate Analysis Modelmentioning

confidence: 99%

Desfecho do tratamento e confirmação laboratorial do diagnóstico de tuberculose em pacientes com HIV/AIDS no Recife, Pernambuco, Brasil

2008

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OBJETIVO: Comparar a freqüência de desfecho desfavorável (óbito, abandono e falência de tratamento) entre pacientes com co-infecção tuberculose (TB)/HIV submetidos a tratamento para TB com confirmação etiológica do diagnóstico e pacientes co-infectados com TB/HIV e tratados sem confirmação diagnóstica. MÉTODOS: Coorte retrospectivo de pacientes co-infectados com TB/HIV que iniciaram tratamento para TB entre julho de 2002 e junho de 2004, em um serviço de referência para HIV/AIDS no Recife (PE) Brasil. A exposição principal, confirmação laboratorial da TB, foi ajustada pelas variáveis de três blocos: variáveis sócio-demográficas; variáveis relacionadas ao HIV/AIDS; e variáveis relacionadas à TB. Para avaliar a significância estatística dos resultados, utilizaram-se o intervalo de confiança de 95% das odds ratios e o valor de p (teste de qui-quadrado e razão de verossimilhança). RESULTADOS: Foram estudados 262 pacientes. Não se observou associação entre confirmação laboratorial do diagnóstico de TB e desfecho desfavorável, mesmo após o ajuste pelos fatores de confusão. Permaneceram no modelo final da regressão logística múltipla: coexistência de outras doenças oportunistas; contagem de linfócitos CD4 abaixo de 50 células/mm³; carga viral entre 10.000 e 100.000 cópias/mL; dispnéia; forma disseminada de TB; e mudança do tratamento da TB por reação adversa ou intolerância. CONCLUSÕES: Os resultados sugerem que o tratamento para TB sem confirmação etiológica, em pacientes co-infectados, baseado na decisão de profissionais experientes em serviços de referência, não aumentou o risco de desfecho desfavorável do tratamento para TB. Além disso, identificaram-se grupos com maior risco de desfecho desfavorável, os quais devem ser cuidadosamente monitorados.

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

Cited by 21 publications

References 17 publications

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

Timing of default from tuberculosis treatment: a systematic review

Desfecho do tratamento e confirmação laboratorial do diagnóstico de tuberculose em pacientes com HIV/AIDS no Recife, Pernambuco, Brasil

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