Background:
Tuberculosis (TB) continues to be a leading cause of infectious disease mortality globally. Although Directly Observed Therapy (DOT) is widely recommended to enhance compliance, nonadherence remains a critical barrier to achieving the treatment success targets established by the END TB Strategy. Understanding how even minor deviations in medication intake influence clinical outcomes in real-world settings is essential for improving TB care and preventing the development of drug resistance.
Abstract:
- Methods: This prospective multi-center study followed 578 adults with drug-sensitive TB from the RePORT-Brazil cohort (2015–2019) for two years. Adherence was monitored daily via DOT, and nonadherence was defined as the percentage of missed doses relative to the prescribed regimen. The primary composite unfavorable outcome included treatment failure, disease recurrence, drug resistance, death, or loss to follow-up (LTFU) after 30 days.
- Results: Overall, 37.7% of participants experienced unfavorable outcomes. A significant dose-response relationship was found: missing just 2.8% of prescribed doses increased the predicted risk of an unfavorable outcome by 10%. Participants missing more than 10% of doses had an 81.2% likelihood of unfavorable outcomes compared to 21.6% for those with complete adherence. Multivariable analysis confirmed that the percentage of missed doses was independently associated with poor outcomes (adjusted OR: 1.11; 95% CI: 1.07–1.14).
- Conclusion: Even minimal nonadherence significantly compromises TB treatment success. Routine adherence monitoring and early intervention are critical to prevent treatment failure and transmission.
Keywords: Tuberculosis; Adherence; Treatment; Compliance; Unfavorable treatment outcome.
Clique aqui
- Data de Publicação: 16/08/2025
- Autores: Isabella B. B. Ferreira,a,b,l Rodrigo C. Menezes,b,c,d,l Mariana Araújo-Pereira,b,c,d Valeria C. Rolla,e Afrânio L. Kritski,f Marcelo Cordeiro-Santos,g,h Timothy R. Sterling, i Cody Staats,i Gustavo Amorim,j Anete Trajman,k and Bruno B. Andrade,a,b,c,d,i,∗ for the RePORT-Brazil Consortiumm
