UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era

Stagg, HR; Flook, M; Martinecz, A; Kielmann, K; Abel Zur Wiesch, P; Karat, AS; Lipman, MCI; ... Fielding, KL; + view all (2020) All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era. ERJ Open Research , 6 (4) , Article 00315-2020. 10.1183/23120541.00315-2020. Green open access

[thumbnail of 00315-2020.full.pdf]
Preview
Text
00315-2020.full.pdf - Published Version

Download (1MB) | Preview

Abstract

Adherence to treatment for tuberculosis (TB) has been a concern for many decades, resulting in the World Health Organization's recommendation of the direct observation of treatment in the 1990s. Recent advances in digital adherence technologies (DATs) have renewed discussion on how to best address nonadherence, as well as offering important information on dose-by-dose adherence patterns and their variability between countries and settings. Previous studies have largely focussed on percentage thresholds to delineate sufficient adherence, but this is misleading and limited, given the complex and dynamic nature of adherence over the treatment course. Instead, we apply a standardised taxonomy – as adopted by the international adherence community – to dose-by-dose medication-taking data, which divides missed doses into 1) late/noninitiation (starting treatment later than expected/not starting), 2) discontinuation (ending treatment early), and 3) suboptimal implementation (intermittent missed doses). Using this taxonomy, we can consider the implications of different forms of nonadherence for intervention and regimen design. For example, can treatment regimens be adapted to increase the “forgiveness” of common patterns of suboptimal implementation to protect against treatment failure and the development of drug resistance? Is it reasonable to treat all missed doses of treatment as equally problematic and equally common when deploying DATs? Can DAT data be used to indicate the patients that need enhanced levels of support during their treatment course? Critically, we pinpoint key areas where knowledge regarding treatment adherence is sparse and impeding scientific progress.

Type: Article
Title: All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era
Open access status: An open access version is available from UCL Discovery
DOI: 10.1183/23120541.00315-2020
Publisher version: https://doi.org/10.1183/23120541.00315-2020
Language: English
Additional information: Copyright © ERS 2020. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Respiratory Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
URI: https://discovery.ucl.ac.uk/id/eprint/10113852
Downloads since deposit
22Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item