title: Adherence to tuberculosis therapy among patients receiving home-based directly observed treatment: evidence from the United Republic of Tanzania.
abstract: BACKGROUND
  Non-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice between home-based treatment supervised by a treatment supporter of their own choice, and health facility-based treatment observed by a medical professional. The aim of this study was to assess the extent and determinants of adherence to anti-TB therapy in patients opting for home-based treatment under the novel PCT approach.
  
  
  METHODS
  In this cross-sectional study, the primary outcome was the percentage of patients adherent to TB therapy as detected by the presence of isoniazid in urine (IsoScreen assay). The primary analysis followed a non-inferiority approach in which adherence could not be lower than 75%. Logistic regression was used to examine the influence of potentially predictive factors.
  
  
  RESULTS
  A total of 651 new TB patients were included. Of these, 645 (99.1%) provided urine for testing and 617 patients (95.7%; 90%CI 94.3-96.9) showed a positive result. This result was statistically non-inferior to the postulated adherence level of 75% (p<0.001).
  
  
  CONCLUSIONS
  Adherence to TB therapy under home-based Directly Observed Treatment can be ensured in programmatic settings. A reliable supply of medication and the careful selection of treatment supporters, who preferably live very close to the patient, are crucial success factors. Finally, we recommend a cohort study to assess the rate of adherence throughout the full course of TB treatment.
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania. amkopi@ihi.or.tz
authors.forename: Abdallah
authors.initials: A
authors.lastname: Mkopi
authors.forename: Nyagosya
authors.initials: N
authors.lastname: Range
authors.forename: Fred
authors.initials: F
authors.lastname: Lwilla
authors.forename: Saidi
authors.initials: S
authors.lastname: Egwaga
authors.forename: Alexander
authors.initials: A
authors.lastname: Schulze
authors.forename: Eveline
authors.initials: E
authors.lastname: Geubbels
authors.forename: Frank
authors.initials: F
authors.lastname: van Leth
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012646:Self Administration / Q000706:statistics & numerical data; D013636:Tanzania; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000995:Antitubercular Agents