Research

Evaluation of adherence to national treatment guidelines among tuberculosis patients in three provinces of South Africa

Julia V Ershova, Laura Jean Podewils, Liza E Bronner, Heather G Stockwell, Sicelo S Dlamini, Lerole D Mametja

Abstract


Setting. Standardised tuberculosis (TB) treatment through directly observed therapy (DOT) is available in South Africa, but the level of adherence to standardised TB treatment and its impact on treatment outcomes is unknown.

Objectives. To describe adherence to standardised TB treatment and provision of DOT, and analyse its impact on treatment outcome.

Methods. We utilised data collected for an evaluation of the South African national TB surveillance system. A treatment regimen was considered appropriate if based on national treatment guidelines. Multivariate log-binomial regression was used to evaluate the association between treatment regimens, including DOT provision, and treatment outcome.

Results. Of 1 339 TB cases in the parent evaluation, 598 (44.7%) were excluded from analysis owing to missing outcome or treatment information. The majority (697, 94.1%) of the remaining 741 patients received an appropriate TB regimen. Almost all patients (717, 96.8%) received DOT, 443 (59.8%) throughout the treatment course and 274 (37.0%) during the intensive (256, 34.6%) or continuation (18, 2.4%) phase. Independent predictors of poor outcome were partial DOT (adjusted risk ratio (aRR) 3.1, 95% confidence interval (CI) 2.2 - 4.3) and previous treatment default (aRR 2.3, 95% CI 1.1 - 4.8).

Conclusion. Patients who received incomplete DOT or had a history of defaulting from TB treatment had an increased risk of poor outcomes.


Authors' affiliations

Julia V Ershova, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Laura Jean Podewils, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Liza E Bronner, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Heather G Stockwell, College of Public Health, University of South Florida, Tampa, Florida, USA

Sicelo S Dlamini, Tuberculosis Control and Management, National Department of Health, Pretoria, South Africa

Lerole D Mametja, Tuberculosis Control and Management, National Department of Health, Pretoria, South Africa

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Keywords

Tuberculosis; DOT compliance; Inappropriate treatment; Poor outcome

Cite this article

South African Medical Journal 2014;104(5):362-368. DOI:10.7196/SAMJ.7655

Article History

Date submitted: 2013-10-25
Date published: 2014-03-26

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