The influence of art on adherence to TB treatment in patients using the ' eMUM ' electronic dose monitoring tool-a pilot study

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.