E-drug: RFI: Scientific basis for defining non-adherence
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Hi all
I've been asked to pose this question to the lists by Jakes
Rawlinson <RawlinsonJ@dhw.norprov.gov.za>. I've included some
of Jakes' remarks at the end. In addition to responding to the list,
please also cc to Dennis Falzon <medco@msfh-tashkent.uz>.
thanks
Andy
MSF, Uzbekistan
- Scientific basis for defining non-adherence
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Medecins Sans Frontieres in Uzbekistan and Turkmenistan run
one of the largest TB DOTS programmes within MSF. Since we
started our programmes in the environmentally-degraded areas of
the Aral Sea in 1998, we have registered over 8000 treatment
episodes for first-line DOTS. While we experience a modest
number of defaulters as per WHO definition (about 7%), we observe
non-optimal compliance with DOTS through frequently missed
doses over both the continuation and the intensive phases.
Sometimes, such interruptions are 'compensated' through
extension of patients' regimes.
We intend to research the effect of adherence on final treatment
outcomes. We are looking for case definitions for non-compliance
based on pharmacological rationale, such as time from drug
ingestion until the plasma level of medication is expected to drop
below therapeutic levels.
Unfortunately, there seems to be little published associating
pharmacodynamics to decision making in treating TB patients who
miss doses. The guidelines I have seen developed for classifying
such patients do not quote a pharmacological basis for the
suggested categorization.
In this respect I would appreciate if someone out there could either
advise us directly on how to proceed or indicate literature, which
would help us, devise appropriate epidemiological definitions. I
thank people in advance
Dennis FALZON, MD
Medical Coordinator
Medecins Sans Frontieres, Aral Sea Area
4 Konstitutsiya street
Tashkent, Uzbekistan
Tel: 998 71 152 4031/2/3
Fax: 998 71 120 7072
Email: medco@msfh-tashkent.uz
RawlinsonJ@dhw.norprov.gov.za
"I don't know if you are familiar with the term 'cryptic interrupter' i.e.
patient who has not taken all their doses, but who has not
interrupted treatment completely and is not lost from the
programme. This we picked up quite often in patient on treatment
for MDR TB with ethionamide (because of the nausea) which
expressed itself with a negative smear/culture becoming positive
again".
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Andy Gray
Discipline Chair: Pharmacy Practice
School of Pharmacy and Pharmacology
University of Durban-Westville
PBag X54001 Durban 4000
South Africa
Tel: +27-31-2044356/4937
Fax: +27-31-2044792
email: agray@pixie.udw.ac.za
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