The influence of art on adherence to TB treatment in patients using the ' eMUM ' electronic dose monitoring tool-a pilot study
Date
2014-02-18
Authors
Knight, Marlene
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Abstract
Health care workers are often reluctant to start anti-retroviral therapy (ART) in
patients on Mycobacterium tuberculosis (TB) treatment. Reasons include fear of
reduced adherence in response to the high pill burden of concomitant TB
treatment and ART, risk of Immune reconstitution inflammatory syndrome (IRIS)
and cumulative side effects. On the other hand, earlier initiation of ART leads to
more rapid restoration of the immune-competence needed to cure the tuberculosis
and the enhancement of immune responses to other specific pathogens thereby
reducing the risk of opportunistic infections. Health care workers want patients to
be adherent as it improves patient outcome, prevents the spread of TB, decreases
the risk for treatment failure, prevents the emergence of multi-drug resistant and
extensively drug resistant TB and reduces cost of treatment. The aim of this study
was to measure whether adherence to TB medication changes when ART is
added to a patient’s TB medication regimen. Consented adults (>18years)
diagnosed with pulmonary TB and Human Immunodeficiency Virus (HIV) coinfection
were enrolled in the study. Study participants were followed from one
month before initiating ART and for the first month that the patient was taking ART.
Adherence was measured before and after starting ART using an electronic dose
monitoring (‘eMUM’) tool, pill count and patient self-report. The study results
shows that the change in adherence is not statistically significant
and health care workers can thus confidently prescribe ART in patients on TB
treatment, without fear of decline in patient adherence.