Evidence map›Paper›PMID 37173761›Full record

Trial reportTrials2023

Comparing adherence to MDR-TB treatment among patients on self-administered therapy and those on directly observed therapy: non-inferiority randomized controlled trial.

Clara Wekesa, Christine Sekaggya-Wiltshire, Stella Zawedde Muyanja, Ivan Lume, Maria Sarah Nabaggala, Rosalind Parkes-Ratanshi, Susan Adakun Akello

Open access · goldAbstract readRandomized Controlled TrialEquivalence Trial
In one paragraph

Trial report in Trials, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
1.4field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 7 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 2 countries.

Clara WekesaInfectious Diseases Institute, Makerere University, Kampala, Uganda. clara.wekesa@gmail.com.ORCID http://orcid.org/0000-0001-6064-237X
Christine Sekaggya-WiltshireInfectious Diseases Institute, Makerere University, Kampala, Uganda.
Stella Zawedde MuyanjaInfectious Diseases Institute, Makerere University, Kampala, Uganda.
Ivan LumeInfectious Diseases Institute, Makerere University, Kampala, Uganda.
Maria Sarah NabaggalaInfectious Diseases Institute, Makerere University, Kampala, Uganda.
Rosalind Parkes-RatanshiInfectious Diseases Institute, Makerere University, Kampala, Uganda.
Susan Adakun AkelloTB unit, Mulago National Referral Hospital, Kampala, Uganda.
Infectious Diseases Institute · UGMakerere University · UGMulago Hospital · UGUniversity of Cambridge · GB

Funding

Janssen Pharmaceutica NV 1550786
6 · The paper itself

Abstract

backgroundAdherence is key to the treatment success of multi-drug resistant tuberculosis (MDR-TB) and prevention of community transmission. Directly observed therapy (DOT) is the recommended approach for the management of patients with MDR-TB. Uganda implements a health facility-based DOT approach where all patients diagnosed with MDR-TB report to the nearest private or public health facility for daily observation of ingesting their medicines by a health care provider. Directly observed therapy is very costly for both the patient and health care system. It follows the assumption that MDR TB patients have a history of poor adherence to TB treatment. But only 21% of MDR-TB patients notified globally and 1.4-12% notified in Uganda had been previously treated for TB. The shift to all oral treatment regimen for MDR-TB provides an opportunity for the exploration of self-administered therapy for this group of patients even with use of remotely operated adherence technology. We are conducting a non-inferiority open-label randomized controlled trial to compare adherence to MDR-TB treatment among patients on self-administered therapy (measured by Medication Events Monitoring System (MEMS) technology) with a control group on DOT.

methodsWe plan to enrol 164 newly diagnosed MDR-TB patients aged ≥ 8 years from three regional hospitals based in rural and urban Uganda. Patients with conditions that affect their dexterity and ability to operate the MEMS-operated medicine equipment will not be eligible to participate in the trial. Patients are randomized to either of the two study arms: self-administered therapy with adherence being monitored using MEMS technology (intervention arm) or health facility-based DOT (control arm) and will be followed up monthly. Adherence is measured by the number of days the medicine bottle is open to access medication as recorded by the MEMS software in the intervention arm and treatment complaint days as recorded in the TB treatment card in the control arm. The primary outcome is the comparison of adherence rates between the two study arms. DISCUSSION: The evaluation of self-administered therapy for patients with MDR-TB is important to inform cost-effective management strategies for these patients. The approval of all oral regimens for the treatment of MDR-TB provides an opportunity for innovations such as MEMS technology to support sustainable options for MDR-TB treatment adherence support in low-resource settings.

trial registrationPan African Clinical Trials Registry, Cochrane #PACTR202205876377808. Retrospectively registered on 13 May 2022.

Indexed as

Antitubercular AgentsTuberculosis, Multidrug-ResistantClinical ProtocolsDirectly Observed TherapyHumansMedication AdherenceTreatment OutcomeAntitubercular AgentsDifferentiated careDirectly observed therapyMedication events monitoring system technologyMulti-drug-resistant tuberculosisResource-limited settingsSub-Saharan AfricaTB drug PK levelsTB treatment adherenceTB treatment outcomes

Identifiers

PMID37173761
PMCPMC10176679
OpenAlexW4376280261

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.