Quantifying non-adherence to anti-tuberculosis treatment due to early discontinuation : a systematic literature review of timings to loss to follow-up
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ..
BACKGROUND: The burden of non-adherence to anti-tuberculosis (TB) treatment is poorly understood. One type is early discontinuation, that is, stopping treatment early. Given the implications of early discontinuation for treatment outcomes, we undertook a systematic review to estimate its burden, using the timing of loss to follow-up (LFU) as a proxy measure.
METHODS: Web of Science, Embase and Medline were searched up to 14 January 2021 using terms covering LFU, TB and treatment. Studies of adults (≥ 18 years) on the standard regimen for drug-sensitive TB reporting the timing of LFU (WHO definition) were included. A narrative synthesis was conducted and quality assessment undertaken using an adapted version of Downs and Black. Papers were grouped by the percentage of those who were ultimately LFU who were LFU by 2 months. Three groups were created: <28.3% LFU by 2 months, ≥28.3-<38.3%, ≥38.3%). The percentage of dose-months missed due to early discontinuation among (1) those LFU, and (2) all patients was calculated.
RESULTS: We found 40 relevant studies from 21 countries. The timing of LFU was variable within and between countries. 36/40 papers (90.0%) reported the percentage of patients LFU by the end of 2 months. 31/36 studies (86.1%) reported a higher than or as expected percentage of patients becoming LFU by 2 months. The percentage of dose-months missed by patients who became LFU ranged between 37% and 77% (equivalent to 2.2-4.6 months). Among all patients, the percentage of dose-months missed ranged between 1% and 22% (equivalent to 0.1-1.3 months).
CONCLUSIONS: A larger than expected percentage of patients became LFU within the first 2 months of treatment. These patients missed high percentages of dose months of treatment due to early discontinuation. Interventions to promote adherence and retain patients in care must not neglect the early months of treatment.
PROSPERO REGISTRATION NUMBER: CRD42021218636.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
|---|---|
| Enthalten in: |
BMJ open respiratory research - 11(2024), 1 vom: 15. Feb. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Walker, Elizabeth F [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Antitubercular Agents |
|---|
| Anmerkungen: |
Date Completed 19.02.2024 Date Revised 04.03.2024 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1136/bmjresp-2023-001894 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368500543 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368500543 | ||
| 003 | DE-627 | ||
| 005 | 20240304232527.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240216s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1136/bmjresp-2023-001894 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1316.xml |
| 035 | |a (DE-627)NLM368500543 | ||
| 035 | |a (NLM)38359965 | ||
| 035 | |a (PII)e001894 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Walker, Elizabeth F |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Quantifying non-adherence to anti-tuberculosis treatment due to early discontinuation |b a systematic literature review of timings to loss to follow-up |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 19.02.2024 | ||
| 500 | |a Date Revised 04.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ. | ||
| 520 | |a BACKGROUND: The burden of non-adherence to anti-tuberculosis (TB) treatment is poorly understood. One type is early discontinuation, that is, stopping treatment early. Given the implications of early discontinuation for treatment outcomes, we undertook a systematic review to estimate its burden, using the timing of loss to follow-up (LFU) as a proxy measure | ||
| 520 | |a METHODS: Web of Science, Embase and Medline were searched up to 14 January 2021 using terms covering LFU, TB and treatment. Studies of adults (≥ 18 years) on the standard regimen for drug-sensitive TB reporting the timing of LFU (WHO definition) were included. A narrative synthesis was conducted and quality assessment undertaken using an adapted version of Downs and Black. Papers were grouped by the percentage of those who were ultimately LFU who were LFU by 2 months. Three groups were created: <28.3% LFU by 2 months, ≥28.3-<38.3%, ≥38.3%). The percentage of dose-months missed due to early discontinuation among (1) those LFU, and (2) all patients was calculated | ||
| 520 | |a RESULTS: We found 40 relevant studies from 21 countries. The timing of LFU was variable within and between countries. 36/40 papers (90.0%) reported the percentage of patients LFU by the end of 2 months. 31/36 studies (86.1%) reported a higher than or as expected percentage of patients becoming LFU by 2 months. The percentage of dose-months missed by patients who became LFU ranged between 37% and 77% (equivalent to 2.2-4.6 months). Among all patients, the percentage of dose-months missed ranged between 1% and 22% (equivalent to 0.1-1.3 months) | ||
| 520 | |a CONCLUSIONS: A larger than expected percentage of patients became LFU within the first 2 months of treatment. These patients missed high percentages of dose months of treatment due to early discontinuation. Interventions to promote adherence and retain patients in care must not neglect the early months of treatment | ||
| 520 | |a PROSPERO REGISTRATION NUMBER: CRD42021218636 | ||
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Bacterial Infection | |
| 650 | 4 | |a Clinical Epidemiology | |
| 650 | 4 | |a Infection Control | |
| 650 | 4 | |a Respiratory Infection | |
| 650 | 4 | |a Tuberculosis | |
| 650 | 7 | |a Antitubercular Agents |2 NLM | |
| 700 | 1 | |a Flook, Mary |e verfasserin |4 aut | |
| 700 | 1 | |a Rodger, Alison J |e verfasserin |4 aut | |
| 700 | 1 | |a Fielding, Katherine L |e verfasserin |4 aut | |
| 700 | 1 | |a Stagg, Helen R |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t BMJ open respiratory research |d 2013 |g 11(2024), 1 vom: 15. Feb. |w (DE-627)NLM244313849 |x 2052-4439 |7 nnns |
| 773 | 1 | 8 | |g volume:11 |g year:2024 |g number:1 |g day:15 |g month:02 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1136/bmjresp-2023-001894 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 11 |j 2024 |e 1 |b 15 |c 02 | ||