Adherence to miltefosine treatment for visceral leishmaniasis under routine conditions in Nepal. Issue 2 (30th November 2012)

• Record Type: Journal Article
• Authors: Uranw, Surendra; Ostyn, Bart; Dorlo, Thomas P.C.; Hasker, Epco; Dujardin, Bruno; Dujardin, Jean‐Claude; Rijal, Suman; Boelaert, Marleen
• Is Part Of: Tropical medicine & international health. Volume 18:Issue 2(2013:Feb.)
• Page Start: 179
• Page End: 187
• Publication Date: 2012-11-30
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12025
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" xml:lang="en" id="tmi12025-abs-0001"> <title>Abstract</title> <sec id="tmi12025-sec-0001" sec-type="section"> <title>Objective</title> <p>To assess patient adherence to unsupervised single‐drug miltefosine treatment for visceral leishmaniasis and to identify the factors influencing adherence.</p> </sec> <sec id="tmi12025-sec-0002" sec-type="section"> <title>Methods</title> <p>This is a prospective cohort study of 171 patients with Visceral leishmaniasis (VL) in three healthcare settings in Nepal. Adherence was assessed through pill count, checking of treatment cards and adherence questionnaires, as well as miltefosine concentration measurements at the end of treatment. Poor adherence was defined as less than 90% of required capsules taken.</p> </sec> <sec id="tmi12025-sec-0003" sec-type="section"> <title>Results</title> <p>Patient adherence to miltefosine was 83%. Predictors of adherence were being the male sex (OR = 2.60, 95% CI 1.02–6.67) and knowing the duration of treatment (OR = 3.05, 95% CI 1.16–8.04). Adherence was also better for patients who were literate and knew the side effects of treatment. Gastrointestinal side effects and negligence after the resolution of clinical symptoms of VL were the main reasons for poor adherence. Poor adherence was associated (though not statistically significant) with future relapse.</p> </sec> <sec id="tmi12025-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Effective counselling during the treatment, a short take‐home message on VL and on side effects and action of miltefosine, and follow‐up visits are the best way to prevent poor adherence. Single end‐of‐treatment measurements of miltefosine concentrations as objective assessment of adherence would only be useful in addition to the subjective assessments when substantial doses of miltefosine have been missed.</p> </sec> </abstract>