Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns
Background: The COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa. Methods: We...
| Main Authors: | , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2024
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| Online Access: | http://hdl.handle.net/20.500.11937/96551 |
| _version_ | 1848766169716097024 |
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| author | Overbeck, V. Malatesta, S. Carney, T. Myers, Bronwyn Parry, C.D.H. Horsburgh, C.R. Theron, D. White, L.F. Warren, R.M. Jacobson, K.R. Bouton, T.C. |
| author_facet | Overbeck, V. Malatesta, S. Carney, T. Myers, Bronwyn Parry, C.D.H. Horsburgh, C.R. Theron, D. White, L.F. Warren, R.M. Jacobson, K.R. Bouton, T.C. |
| author_sort | Overbeck, V. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: The COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa. Methods: We analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown. Results: DOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04–1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17–2.67; p = 0.006). Conclusion: The COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times. Trial registration: ClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016. |
| first_indexed | 2025-11-14T11:46:53Z |
| format | Journal Article |
| id | curtin-20.500.11937-96551 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:46:53Z |
| publishDate | 2024 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-965512025-01-17T05:07:40Z Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns Overbeck, V. Malatesta, S. Carney, T. Myers, Bronwyn Parry, C.D.H. Horsburgh, C.R. Theron, D. White, L.F. Warren, R.M. Jacobson, K.R. Bouton, T.C. Mycobacterium tuberculosis Adherence Drug-susceptible TB SARS-CoV-2 South Africa Humans Medication Adherence Male Female COVID-19 Directly Observed Therapy Adult South Africa Tuberculosis Antitubercular Agents Middle Aged SARS-CoV-2 Pandemics Cohort Studies Humans Tuberculosis Antitubercular Agents Directly Observed Therapy Cohort Studies Adult Middle Aged South Africa Female Male Medication Adherence Pandemics COVID-19 SARS-CoV-2 Background: The COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa. Methods: We analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown. Results: DOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04–1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17–2.67; p = 0.006). Conclusion: The COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times. Trial registration: ClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016. 2024 Journal Article http://hdl.handle.net/20.500.11937/96551 10.1186/s12879-024-09994-7 eng http://creativecommons.org/licenses/by-nc-nd/4.0/ fulltext |
| spellingShingle | Mycobacterium tuberculosis Adherence Drug-susceptible TB SARS-CoV-2 South Africa Humans Medication Adherence Male Female COVID-19 Directly Observed Therapy Adult South Africa Tuberculosis Antitubercular Agents Middle Aged SARS-CoV-2 Pandemics Cohort Studies Humans Tuberculosis Antitubercular Agents Directly Observed Therapy Cohort Studies Adult Middle Aged South Africa Female Male Medication Adherence Pandemics COVID-19 SARS-CoV-2 Overbeck, V. Malatesta, S. Carney, T. Myers, Bronwyn Parry, C.D.H. Horsburgh, C.R. Theron, D. White, L.F. Warren, R.M. Jacobson, K.R. Bouton, T.C. Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns |
| title | Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns |
| title_full | Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns |
| title_fullStr | Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns |
| title_full_unstemmed | Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns |
| title_short | Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns |
| title_sort | understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-covid-19 lockdowns |
| topic | Mycobacterium tuberculosis Adherence Drug-susceptible TB SARS-CoV-2 South Africa Humans Medication Adherence Male Female COVID-19 Directly Observed Therapy Adult South Africa Tuberculosis Antitubercular Agents Middle Aged SARS-CoV-2 Pandemics Cohort Studies Humans Tuberculosis Antitubercular Agents Directly Observed Therapy Cohort Studies Adult Middle Aged South Africa Female Male Medication Adherence Pandemics COVID-19 SARS-CoV-2 |
| url | http://hdl.handle.net/20.500.11937/96551 |