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Adherence to miltefosine treatment for visceral leishmaniasis under routine conditions in N epal
Author(s) -
Uranw Surendra,
Ostyn Bart,
Dorlo Thomas P.C.,
Hasker Epco,
Dujardin Bruno,
Dujardin JeanClaude,
Rijal Suman,
Boelaert Marleen
Publication year - 2013
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12025
Subject(s) - miltefosine , medicine , visceral leishmaniasis , leishmaniasis , pill , cohort , prospective cohort study , immunology , pharmacology
Objective To assess patient adherence to unsupervised single‐drug miltefosine treatment for visceral leishmaniasis and to identify the factors influencing adherence. Methods This is a prospective cohort study of 171 patients with V isceral leishmaniasis ( VL ) in three healthcare settings in N epal. 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. Results 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. Conclusion 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.