Does optimized adherence support improve treatment outcomes in RR / MDR-TB patients on 18-20 months regimen in Tbilisi, Georgia?

  • Tinatin Jomidava National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
  • Mohammed Khogali UNICEF / UNDP / World Bank / WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
  • Yuliia Sereda Joint Tuberculosis, HIV and Viral Hepatitis Program, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
  • Zaza Avaliani National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
  • Malkhaz Davitashvili National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
  • Mikheil Madzgharashvili National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
  • Nestan Tukvadze National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
  • Lali Chaphurishvili National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
  • Mamuka Chincharauli National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
  • Maia Kipiani National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
Keywords: drug-resistant tuberculosis, adherence, treatment outcomes, before-and-after study, SORT IT

Abstract

Introduction: Adherence to second-line antituberculosis drug is challenging. A combination of strategies needs to be implemented to achieve adherence. In Georgia an optimized adherence support (OAS) – a package of education, psychosocial support and adherence counselling – was added to the already existing package of adherence support (supervised treatment, adherence incentives, transport cost reimbursement) to improve adherence and increase treatment success. We assessed the additive benefits of OAS on adherence and treatment outcomes.

Methodology: This was a before and after cohort study using routine programme data in the National Center for Tuberculosis and Lung Diseases in Tbilisi. All adult rifampicin- and multidrug-resistant tuberculosis (RR/MDR-TB) patients enrolled for treatment under directly observed therapy in the NCTLD during the period before (June 2015 – January 2016) and after (June 2017 – January 2018) were included in the study. Primary outcomes were: i) adequate adherence defined as ≥ 85% of days covered by TB medication during the whole treatment period; ii) final treatment outcomes.

Results: Of 221 RR/MDR-TB, most patients were male (76%, N = 167) with a mean age of 41 ± 14 years. Adherence data was available for 111 patients in the ‘before’ and 97 patients in the ‘after’ cohort. Adequate adherence was achieved by 62% (69/111) in the ‘before’ and 70% (68/97) in the ‘after’ cohort (p = 0.290). Overall treatment success was 64% (73/114) and 63% (67/107) in the ‘before’ and ‘after’ cohorts respectively (p = 0.937).

Conclusions: Implementation of OAS had modest effect on adherence and had no additive benefits on treatment outcomes among RR/MDR-TB patients on 18-20 months regimen.

Published
2021-09-29
How to Cite
1.
Jomidava T, Khogali M, Sereda Y, Avaliani Z, Davitashvili M, Madzgharashvili M, Tukvadze N, Chaphurishvili L, Chincharauli M, Kipiani M (2021) Does optimized adherence support improve treatment outcomes in RR / MDR-TB patients on 18-20 months regimen in Tbilisi, Georgia?. J Infect Dev Ctries 15:34S-42S. doi: 10.3855/jidc.13783
Section
EECA Regional SORT IT