title: Adherence to miltefosine treatment for visceral leishmaniasis under routine conditions in Nepal.
abstract: OBJECTIVE
  To assess patient adherence to unsupervised single-drug miltefosine treatment for visceral leishmaniasis and to identify the factors influencing adherence.
  
  
  METHODS
  This is a prospective cohort study of 171 patients with Visceral leishmaniasis (VL) in three healthcare settings in Nepal. Adherence was assessed through pill count, checking of treatment cards and adherence questionnaires, as well as miltefosine concentration measurements at the end of treatment. Poor adherence was defined as less than 90% of required capsules taken.
  
  
  RESULTS
  Patient adherence to miltefosine was 83%. Predictors of adherence were being the male sex (OR = 2.60, 95% CI 1.02-6.67) and knowing the duration of treatment (OR = 3.05, 95% CI 1.16-8.04). Adherence was also better for patients who were literate and knew the side effects of treatment. Gastrointestinal side effects and negligence after the resolution of clinical symptoms of VL were the main reasons for poor adherence. Poor adherence was associated (though not statistically significant) with future relapse.
  
  
  CONCLUSIONS
  Effective counselling during the treatment, a short take-home message on VL and on side effects and action of miltefosine, and follow-up visits are the best way to prevent poor adherence. Single end-of-treatment measurements of miltefosine concentrations as objective assessment of adherence would only be useful in addition to the subjective assessments when substantial doses of miltefosine have been missed.
authors.affiliation: Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal.
authors.forename: Surendra
authors.initials: S
authors.lastname: Uranw
authors.forename: Bart
authors.initials: B
authors.lastname: Ostyn
authors.forename: Thomas P C
authors.initials: TP
authors.lastname: Dorlo
authors.forename: Epco
authors.initials: E
authors.lastname: Hasker
authors.forename: Bruno
authors.initials: B
authors.lastname: Dujardin
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Dujardin
authors.forename: Suman
authors.initials: S
authors.lastname: Rijal
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
mesh_terms: D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D017326:Clinical Trials, Phase III as Topic; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy*; D008297:Male; D009390:Nepal / Q000453:epidemiology; D010767:Phosphorylcholine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000981:Antiprotozoal Agents; D010767:Phosphorylcholine; C039128:miltefosine