Title
Adherence to miltefosine treatment for visceral leishmaniasis under routine conditions in Nepal Adherence to miltefosine treatment for visceral leishmaniasis under routine conditions in Nepal
Author
Faculty/Department
Institute of Development Policy and Management
Faculty of Pharmaceutical, Biomedical and Veterinary Sciences . Biomedical Sciences
Publication type
article
Publication
Oxford ,
Subject
Human medicine
Source (journal)
Tropical medicine and international health. - Oxford
Volume/pages
18(2013) :2 , p. 179-187
ISSN
1360-2276
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Abstract
Methods 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. Results Patient adherence to miltefosine was 83%. Predictors of adherence were being the male sex (OR = 2.60, 95% CI 1.026.67) and knowing the duration of treatment (OR = 3.05, 95% CI 1.168.04). 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.
E-info
https://repository.uantwerpen.be/docman/iruaauth/05ca5a/4fc320bcf0a.pdf