title: Adherence to self-administered tuberculosis treatment in a high HIV-prevalence setting: a cross-sectional survey in Homa Bay, Kenya.
abstract: BACKGROUND
  Good adherence to treatment is crucial to control tuberculosis (TB). Efficiency and feasibility of directly observed therapy (DOT) under routine program conditions have been questioned. As an alternative, Médecins sans Frontières introduced self-administered therapy (SAT) in several TB programs. We aimed to measure adherence to TB treatment among patients receiving TB chemotherapy with fixed dose combination (FDC) under SAT at the Homa Bay district hospital (Kenya). A second objective was to compare the adherence agreement between different assessment tools.
  
  
  METHODS
  We conducted a cross-sectional survey amongst a series of new TB patients receiving 6 months of standard TB chemotherapy with FDC under SAT. Adherence was assessed at home with urine testing for Isoniazid (INH), pill count, interviewer-administered questionnaire and visual analogue scale (VAS).
  
  
  RESULTS
  In November 2008 and in June 2009, 212 of 279 eligible patients were assessed for adherence. Overall, 95.2% [95%CI: 91.3-97.7] of the patients reported not having missed a tablet in the last 4 days. On the VAS, complete adherence was estimated at 92.5% [95%CI: 88.0-95.6]. INH urine test was positive for 97.6% [95%CI: 94.6-99.2] of the patients. Pill count could be assessed among only 70% of the interviewed patients. Among them, it was complete for 82.3% [95%CI: 75.1-88.1]. Among the 212 surveyed patients, 193 (91.0%) were successfully treated (cured or treatment completed). The data suggest a fair agreement between the questionnaire and the INH urine test (k = 0.43) and between the questionnaire and the VAS (k = 0.40). Agreement was poor between the other adherence tools.
  
  
  CONCLUSIONS
  These results suggest that SAT, together with the FDC, allows achieving appropriate adherence to antituberculosis treatment in a high TB and HIV burden area. The use of a combination of a VAS and a questionnaire can be an adequate approach to monitor adherence to TB treatment in routine program conditions.
authors.affiliation: Epicentre, Paris, France. Fabienne.Nackers@msf.brussels.org
authors.forename: Fabienne
authors.initials: F
authors.lastname: Nackers
authors.forename: Helena
authors.initials: H
authors.lastname: Huerga
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Espié
authors.forename: Apollo Odongo
authors.initials: AO
authors.lastname: Aloo
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bastard
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.forename: Joseph
authors.initials: J
authors.lastname: Sitienei
authors.forename: Francis
authors.initials: F
authors.lastname: Varaine
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Chakaya
authors.forename: Maryline
authors.initials: M
authors.lastname: Bonnet
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D007538:Isoniazid / Q000652:urine; D007630:Kenya; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012646:Self Administration / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D007538:Isoniazid