Evaluation of Reasons for Patients' Lost to Follow-up During MDR-TB Treatment in the Philippines
Dr. Thelma E. Tupasi, Founding President of the Tropical Disease Foundation presented the findings of the study “Evaluation of Reasons for Patients’ Lost to Follow-up During MDR-TB” Treatment in the Philippines” at the 35thAnnual Chest Convention on March 10, 2016 at the Sofitel Philippine Plaza, Manila. The convention with the theme PulmoConnect: Bridging the Gaps in Pulmonary Medicine was sponsored by the Philippine College of Chest Physicians.
In her study, Dr Tupasi showed that despite advances in MDR-TB diagnostic and treatment, there has been an increase in the patients lost to follow-up (from 21% – 39%) and a decrease in treatment success rates in 2007 (63%) – 2011 (44%). A third of the patients who were lost to follow-up (LTFU) started treatment with extensively drug resistant TB (XDR-TB) or pre-XDR-TB. For these reasons, the National TB Program, Department of Health requested that a study be done to identify factors associated with LTFU and to document patients’ perspectives on the types and delivery of interventions that could positively impact the prevention or reduction of LTFU among MDR-TB patients.
The study covered 273 patients who were randomly selected from 15 MDR-TB treatment centers. In-depth interviews were done as well as data extracted from their medical records. Once data collection was completed, a thematic analysis generated descriptive statistics of the behavioural data and factors associated with LTFU were identified.
Some of the significant findings of include:
- Predictors of LTFU
- Alcohol abuse
- Self-rated severity of vomiting (Adverse drug reaction)
- Protective Factors Against LTFU
- Receiving assistance from the TB Program (e.g. transportation allowance)
- Patients armed with better general knowledge about TB
- Higher level of trust and rapport with the Health Care Worker
- It was also reported that Adverse Drug Reactions (ADR) were the most common self-reported reason for termination of treatment. Although there was no significant difference in the number of instances of ADR, self-rated severity of vomiting was identified as an independently associated factor of LTFU.
- The top three enablers/barriers were Transportation Allowance and Food Assistance (enablers) and Medication Factors (barriers). Because of these the following recommendations were made:
- Assistance with cost of transportation, food, and housing are essential for patients living below or slightly above the poverty line as the lack of these might be an obstacle to treatment adherence. Delays or interruption in the provision of these assistance could cause patients to self-terminate treatment.
- Ensure a more patient-centered approach by providing care at no cost to help patients cope with medication side effects, provide one-on-one counselling for patients with psychological problems, and provide community education to improve relationships between the patient and the health care workers.
- Address adverse drug reactions by developing a comprehensive list based on the most reported side effects and making ancillary medicines available, provide additional trainings to all PMDT facilities, aggressively monitor and treat ADRs for free, and educate patients on expected side effects prior to the start of treatment.
Currently, the PMDT program has a system of enablers which includes a transportation allowance. On top of this, a proposed Enhanced Transportation Package (eTAP) is under discussion which will slightly increase the amount of funds, regardless of treatment adherence. In addition, the Community-Based PMDT Care Initiative (ComPCare) where patients received treatment at home was initiated in two pilot sites in 2014. The LTFU study conducted suggests that these two initiatives should be continued and scaled up.
Dr Tupasi was invited to discuss the results of the study which was conducted in 2014, funded by the United States Agency for International Development (USAID) through a cooperative agreement, under the auspices of the Philippine Business for Social Progress – Impact and with research oversight provided by the Lung Center for the Philippines. The research was implemented by Dr Tupasi (TDF) with Technical assistance from TASC Project, USAID Washington, US CDC, and WHO Philippines.
Posted by esjoson on June 8th, 2016 under News & Events