RESUMO
Classification: Research paper. Purpose: Haitian provincial prisons historically were strapped to provide directly observed therapy (DOT) for persons with TB (PwTB) due to healthcare understaffing. A non-governmental organization addressed this gap via correctional officer-administered video DOT (VDOT). Approach: A 16-month, quasi-experimental trial of officer-facilitated VDOT started in March 2019 at four prisons. Officers delivered doses directly without video when VDOT was inaccessible. Healthcare staff remotely tracked VDOT adherence asynchronously. Three fully-staffed prisons were controls. Our primary objective was to measure VDOT effectiveness for PwTB who began VDOT within 2 weeks of starting treatment. Our secondary objective was to measure program reach, implementation and maintenance through July 2023. Findings: Reach-55 PwTB on VDOT met study criteria. Effectiveness: median/mean VDOT adherence for 55 individuals enrolled in the pilot were 70.8% and 60.2% respectively. Median/mean total adherence, including doses delivered by officers, were 100% and 93.5%. Implementation: VDOT adherence varied by site but not demographic characteristics; similarity of adherence patterns between subjects within a facility was high. Nursing staff reported that adherence in controls was 100%. Correctional officers reported high comfort with the program technology. Maintenance: Since the pilot, 387 PwTB have received TB medications via VDOT in the Haitian prison system. Originality: VDOT for PwTB in low-resource Haitian prisons enabled close monitoring and follow-up; it could expand treatment options elsewhere. Total adherence neared that in control prisons. VDOT adherence varied by treatment day predominately in a group pattern, reflecting facility-level, rather than individual-level, factors.
RESUMO
Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15−34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support.
RESUMO
Since the 2010 earthquake, tuberculosis (TB) control has been a major priority for health sector response and recovery efforts in Haiti. The goal of this study was to analyze trends in TB case notification in Haiti from the aggregate data reported by the National TB Control Program to understand the effects of such efforts. A total of 95,745 TB patients were registered for treatment in Haiti between 2010 and 2015. Three regions, the West, Artibonite, and North departments accounted for 68% of the TB cases notified during the period. Patients in the 15-34 age groups represented 53% (50,560) of all cases. Case notification rates of all forms of TB increased from 142.7/100,000 in 2010 to 153.4 in 2015, peaking at 163.4 cases/100,000 in 2013. Case notification for smear-positive pulmonary TB increased from 85.5 cases/100,000 to 105.7 cases/100,000, whereas treatment success rates remained stable at 79-80% during the period. Active TB case finding efforts in high-risk communities and the introduction of new diagnostics have contributed to increasing TB case notification trends in Haiti from 2010 to 2015. Targeted interventions and novel strategies are being implemented to reach high-risk populations and underserved communities.
