Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns.

Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns.

Publication date: Oct 14, 2024

The COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa. We analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown. DOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1. 42, 95% CI = 1. 04-1. 96; p = 0. 028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1. 74, 95% CI = 1. 17-2. 67; p = 0. 006). The COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times. ClinicalTrials. gov Registration Number: NCT02840877. Registered on 19 July 2016.

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Concepts Keywords
July Adherence
Nct02840877 Adult
Socioeconomic Antitubercular Agents
Therapy Antitubercular Agents
Tuberculosis Cohort Studies
COVID-19
Directly Observed Therapy
Drug-susceptible TB
Female
Humans
Male
Medication Adherence
Middle Aged
Mycobacterium tuberculosis
Pandemics
SARS-CoV-2
SARS-CoV-2
South Africa
South Africa
Tuberculosis

Semantics

Type Source Name
disease MESH tuberculosis
pathway KEGG Tuberculosis
disease MESH COVID-19
disease MESH depression
disease MESH substance use
drug DRUGBANK Tropicamide
disease MESH Infectious Diseases
pathway REACTOME Reproduction
disease IDO country
drug DRUGBANK Ethanol
drug DRUGBANK Coenzyme M
drug DRUGBANK Rifampicin
disease MESH epilepsy
drug DRUGBANK Etoperidone
disease IDO blood
disease IDO history
drug DRUGBANK Indoleacetic acid
drug DRUGBANK Phosphatidyl ethanol
drug DRUGBANK Metamfetamine
drug DRUGBANK Methaqualone
disease MESH underweight
disease MESH overweight
drug DRUGBANK Trestolone
drug DRUGBANK Medical Cannabis
disease MESH unemployment
disease IDO symptom
disease MESH Allergy
disease MESH AIDS
disease MESH anxiety
disease MESH pulmonary tuberculosis
disease IDO colony
disease MESH treatment delays

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