P167 The usefulness of tablet counting to identify potential tb treatment non-compliance. (15th November 2017) - Patel, H
Abstract : Background: Early identification of non-compliance in patients taking anti-tuberculous therapy (ATT) may improve treatment outcomes and prevent the emergence of drug therapy resistance. Since 2012, the TB Pharmacy Team has been tablet counting to identify missed doses. Strategies to improve ATT compliance such as provision of dosette boxes, more frequent appointments and directly observed therapy (DOT) can then be initiated. Aim: To evaluate the usefulness of tablet counting as an effective strategy to help identify and reduce non-compliance with ATT. Methods: A retrospective review of active TB cases diagnosed between January 2012 to December 2016 was undertaken. Objective compliance was graded according to accuracy of tablet counting. Treatment outcomes were assessed clinically and subsequent change from normal practice identified. Results: 248 persons received at least 2 months ATT from the TB Clinic and were further evaluated. The majority of persons (87.5%) were graded as fully (61.3%) compliant (accurate tablet counting) or mostly (26.2%) compliant (few missed doses) both with good clinical response. The commonest strategy to improve treatment outcome in 25 (10.1%) with partial compliance (missed doses with adequate clinical response) was to increase duration of therapy. Poor compliance (missed doses, poor clinical response, more than 1 non-attendance) in 4 patients resulted in admission and completion of DOT as an in-patient. NICE guidance would have identified 22 persons for DOT. 19/22 received DOT (2 MDR-TB; 12 prisoners; 3 homelessness, 2 intravenous iv drug users). 3 (2 with mental health disorders; 1 alcohol dependence) successfully completed therapy with increased frequency of appointments and family involvement. Tablet counting identified 25 partially compliant persons (12 had no obvious risk factor; 5 prisoners on DOT; 2 persons with mental health disorders and 1 with alcohol dependence as above; 3 HIV; 2 pregnant). Treatment outcomes were adequate although 11/25 were lost to follow-up (did not attend their end of treatment consultation) including 5 prisoners (released or transferred). Conclusions: Treating TB in prisoners and homeless persons continues to be a challenge, even when DOT is undertaken. Tablet counting can help identify potential non-compliance in persons without obvious risk factors. In our experience, tablet counting is an effective and relatively cheap objective adjunct in the assessment of ATT compliance.