PDF(Pubmed)
Abstract：
The burden of non-adherence to anti-tuberculosis (TB) treatment is poorly understood. One type is early discontinuation, that is, stopping treatment early. Given the implications of early discontinuation for treatment outcomes, we undertook a systematic review to estimate its burden, using the timing of loss to follow-up (LFU) as a proxy measure.
Web of Science, Embase and Medline were searched up to 14 January 2021 using terms covering LFU, TB and treatment. Studies of adults (≥ 18 years) on the standard regimen for drug-sensitive TB reporting the timing of LFU (WHO definition) were included. A narrative synthesis was conducted and quality assessment undertaken using an adapted version of Downs and Black. Papers were grouped by the percentage of those who were ultimately LFU who were LFU by 2 months. Three groups were created: <28.3% LFU by 2 months, ≥28.3-<38.3%, ≥38.3%). The percentage of dose-months missed due to early discontinuation among (1) those LFU, and (2) all patients was calculated.
We found 40 relevant studies from 21 countries. The timing of LFU was variable within and between countries. 36/40 papers (90.0%) reported the percentage of patients LFU by the end of 2 months. 31/36 studies (86.1%) reported a higher than or as expected percentage of patients becoming LFU by 2 months. The percentage of dose-months missed by patients who became LFU ranged between 37% and 77% (equivalent to 2.2-4.6 months). Among all patients, the percentage of dose-months missed ranged between 1% and 22% (equivalent to 0.1-1.3 months).
A larger than expected percentage of patients became LFU within the first 2 months of treatment. These patients missed high percentages of dose months of treatment due to early discontinuation. Interventions to promote adherence and retain patients in care must not neglect the early months of treatment.
CRD42021218636.
Web of Science, Embase and Medline were searched up to 14 January 2021 using terms covering LFU, TB and treatment. Studies of adults (≥ 18 years) on the standard regimen for drug-sensitive TB reporting the timing of LFU (WHO definition) were included. A narrative synthesis was conducted and quality assessment undertaken using an adapted version of Downs and Black. Papers were grouped by the percentage of those who were ultimately LFU who were LFU by 2 months. Three groups were created: <28.3% LFU by 2 months, ≥28.3-<38.3%, ≥38.3%). The percentage of dose-months missed due to early discontinuation among (1) those LFU, and (2) all patients was calculated.
We found 40 relevant studies from 21 countries. The timing of LFU was variable within and between countries. 36/40 papers (90.0%) reported the percentage of patients LFU by the end of 2 months. 31/36 studies (86.1%) reported a higher than or as expected percentage of patients becoming LFU by 2 months. The percentage of dose-months missed by patients who became LFU ranged between 37% and 77% (equivalent to 2.2-4.6 months). Among all patients, the percentage of dose-months missed ranged between 1% and 22% (equivalent to 0.1-1.3 months).
A larger than expected percentage of patients became LFU within the first 2 months of treatment. These patients missed high percentages of dose months of treatment due to early discontinuation. Interventions to promote adherence and retain patients in care must not neglect the early months of treatment.
CRD42021218636.
摘要：
背景：对不坚持抗结核（TB）治疗的负担知之甚少。一种是早期停药，也就是说,尽早停止治疗。鉴于早期停药对治疗结果的影响，我们进行了系统的审查，以估计其负担，使用后续损失时机(LFU)作为代理措施。
方法：WebofScience，截至2021年1月14日，使用涵盖LFU的术语搜索了Embase和Medline，结核病和治疗。包括对成年人（≥18岁）的药物敏感性结核病标准方案的研究，报告了LFU（WHO定义）的时机。进行了叙事综合，并使用改编版的DownsandBlack进行了质量评估。论文按最终为LFU的人在2个月内为LFU的百分比进行分组。三组被创建：<28.3%LFU2个月，≥28.3-<38.3%,≥38.3%)。由于早期停药而错过的剂量月百分比（1）那些LFU，(2)计算所有患者。
结果：我们发现了来自21个国家的40项相关研究。LFU的时间在国家内部和国家之间是可变的。36/40的论文（90.0％）报告了2个月结束时LFU患者的百分比。31/36研究（86.1％）报告的患者在2个月内成为LFU的百分比高于或符合预期。成为LFU的患者错过的剂量月百分比在37％至77％之间（相当于2.2-4.6个月）。在所有患者中，剂量-月遗漏的百分比介于1%和22%之间(相当于0.1-1.3个月).
结论：在治疗的前2个月内发生LFU的患者比例高于预期。这些患者由于早期停药而错过了高百分比的剂量月治疗。促进依从性和保留患者护理的干预措施不得忽视治疗的早期几个月。
■CRD42021218636。
方法：WebofScience，截至2021年1月14日，使用涵盖LFU的术语搜索了Embase和Medline，结核病和治疗。包括对成年人（≥18岁）的药物敏感性结核病标准方案的研究，报告了LFU（WHO定义）的时机。进行了叙事综合，并使用改编版的DownsandBlack进行了质量评估。论文按最终为LFU的人在2个月内为LFU的百分比进行分组。三组被创建：<28.3%LFU2个月，≥28.3-<38.3%,≥38.3%)。由于早期停药而错过的剂量月百分比（1）那些LFU，(2)计算所有患者。
结果：我们发现了来自21个国家的40项相关研究。LFU的时间在国家内部和国家之间是可变的。36/40的论文（90.0％）报告了2个月结束时LFU患者的百分比。31/36研究（86.1％）报告的患者在2个月内成为LFU的百分比高于或符合预期。成为LFU的患者错过的剂量月百分比在37％至77％之间（相当于2.2-4.6个月）。在所有患者中，剂量-月遗漏的百分比介于1%和22%之间(相当于0.1-1.3个月).
结论：在治疗的前2个月内发生LFU的患者比例高于预期。这些患者由于早期停药而错过了高百分比的剂量月治疗。促进依从性和保留患者护理的干预措施不得忽视治疗的早期几个月。
■CRD42021218636。
