Browsing by Person "Lipman, Marc"

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All non-adherence is equal, but is some more equal than others? TB in the digital era
(European Respiratory Society, 2020-11-02) Stagg, Helen R.; Flook, Mary; Martinecz, Antal; Kielmann, Karina; Abel Zur Wiesch, Pia; Karat, Aaron S.; Lipman, Marc; Sloan, Derek J.; Walker, Elizabeth F.; Fielding, Katherine L.
Adherence to treatment for tuberculosis (TB) has been a concern for many decades, resulting in the World Health Organization’s recommendation of the direct observation of treatment in the 1990s. Recent advances in digital adherence technologies (DATs) have renewed discussion on how to best address non-adherence, as well as offering important information on dose-by-dose adherence patterns and their variability between countries and settings. Previous studies have largely focussed on percentage thresholds to delineate sufficient adherence, but this is misleading and limited, given the complex and dynamic nature of adherence over the treatment course. Instead, we apply a standardised taxonomy- as adopted by the international adherence community- to dose-by-dose medication-taking data, which divides missed doses into a) late/non-initiation (starting treatment later than expected/not starting), b) discontinuation (ending treatment early), and c) suboptimal implementation (intermittent missed doses). Using this taxonomy, we can consider the implications of different forms of non-adherence for intervention and regimen design. For example, can treatment regimens be adapted to increase the ‘forgiveness’ of common patterns of suboptimal implementation to protect against treatment failure and the development of drug resistance? Is it reasonable to treat all missed doses of treatment as equally problematic and equally common when deploying DATs? Can DAT data be used to indicate the patients that need enhanced levels of support during their treatment course? Critically, we pinpoint key areas where knowledge regarding treatment adherence is sparse and impeding scientific progress.
Determinants of non-adherence to anti-TB treatment in high income, low TB incidence settings: A scoping review
(The Union, 2021-06-01) Jones, Annie; Bidad, Natalie; Horne, Rob; Stagg, Helen R.; Wurie, Fatima; Kielmann, Karina; Karat, Aaron S.; Kunst, Heinke; Campbell, Colin N. J.; Darvell, Marcia; Clarke, Amy Louise; Lipman, Marc
Background Improving adherence to anti-tuberculosis (TB) treatment is a public health priority in high income, low incidence (HILI) regions. We conducted a scoping review to identify reported determinants of non-adherence in HILI settings.
IMPACT study on intervening with a manualised package to achieve treatment adherence in people with tuberculosis: Protocol paper for a mixed-methods study, including a pilot randomised controlled trial
(BMJ, 2019-12-17) Stagg, Helen R.; Abubakar, Ibrahim; Campbell, Colin N. J.; Copas, Andrew; Darvell, Marcia; Horne, Robert; Kielmann, Karina; Kunst, Heinke; Mandelbaum, Mike; Pickett, Elisha; Story, Alistair; Vidal, Nicole L.; Wurie, Fatima; Lipman, Marc
Introduction Compared with the rest of the UK and Western Europe, England has high rates of the infectious disease tuberculosis (TB). TB is curable, although treatment is for at least 6 months and longer when disease is drug resistant. If patients miss too many doses (non-adherence), they may transmit infection for longer and the infecting bacteria may develop resistance to the standard drugs used for treatment. Non-adherence may therefore risk both their health and that of others. Within England, certain population groups are thought to be at higher risk of non-adherence, but the factors contributing to this have been insufficiently determined, as have the best interventions to promote adherence. The objective of this study was to develop a manualised package of interventions for use as part of routine care within National Health Services to address the social and cultural factors that lead to poor adherence to treatment for TB disease.