Strategies for reducing treatment default in drug-resistant tuberculosis: systematic review and meta-analysis

被引:126
作者
Toczek, A. [1 ]
Cox, H. [2 ,3 ]
du Cros, P. [4 ]
Cooke, G. [1 ,5 ]
Ford, N. [3 ,4 ]
机构
[1] Univ London Imperial Coll Sci Technol & Med, Fac Med, London SW7 2AZ, England
[2] Med Sans Frontieres, Cape Town, South Africa
[3] Univ Cape Town, Ctr Infect Dis Epidemiol & Res, ZA-7700 Rondebosch, South Africa
[4] Med Sans Frontieres London, Manson Unit, London EC1N 8QX, England
[5] Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, Durban, South Africa
关键词
default; retention; MDR-TB; HIV-INFECTED PATIENTS; NEW-YORK-CITY; MULTIDRUG-RESISTANT; TREATMENT OUTCOMES; SOUTH-AFRICA; DOTS-PLUS; MDR-TB; COST-EFFECTIVENESS; FOLLOW-UP; CLINICAL-OUTCOMES;
D O I
10.5588/ijtld.12.0537
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
BACKGROUND: Scaling up treatment for multidrug-resistant tuberculosis is a global health priority. However, current treatment regimens are long and associated with side effects, and default rates are consequently high. This systematic review aimed to identify strategies for reducing treatment default. METHODS: We conducted a systematic search up to May 2012 to identify studies describing interventions to support patients receiving treatment for multidrug-resistant tuberculosis (MDR-TB). The potential influence of study interventions were explored through subgroup analyses. RESULTS: A total of 75 studies provided outcomes for 18294 patients across 31 countries. Default rates ranged from 0.5% to 56%, with a pooled proportion of 14.8% (95%CI 12.4-17.4). Strategies identified to be associated with lower default rates included the engagement of community health workers as directly observed treatment (DOT) providers, the provision of DOT throughout treatment, smaller cohort sizes and the provision of patient education. CONCLUSION: Current interventions to support adherence and retention are poorly described and based on weak evidence. This review was able to identify a number of promising, inexpensive interventions feasible for implementation and scale-up in MDR-TB programmes. The high default rates reported from many programmes underscore the pressing need to further refine and evaluate simple intervention packages to support patients.
引用
收藏
页码:299 / 307
页数:9
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