Medicine - Medicine-Infectious Diseases
Risk Factors for Tuberculosis Treatment default in Moroccan Communities with Extremely High Tuberculosis Incidence Rates: A Case-Control Study and Pilot Intervention.
Tuberculosis (TB) is the second-leading cause of death by infection. Even in countries with well-structured TB control programs including directly-observed therapy (DOTS), success may be hampered by high rates of treatment default. Patients who default are at increased risk of relapse, drug resistance, and death; moreover, they are infectious for longer, promoting transmission. In Morocco, while overall TB incidence is declining, in some urban communities, incidence is staggeringly high, and default rates are climbing. The overall objective of this proposal is to investigate the risk factors for treatment default in urban Moroccan populations and to pilot a targeted intervention for at-risk individuals including TB education, improved tracking systems, earlier detection of inadherence, and clinic-pharmacy communication to promote treatment completion. We will build on a new US-Maghrebi collaboration with the National Institutes of Hygiene of Morocco (INH), the Moulay Youssef Pulmonary Hospital, and the Epidemiology and Disease Control Directorate of Morocco, which houses the National TB Program (NTP) and recruit patients from three public TB clinics, each serving 1000-1800 TB patients per year, and one public pulmonary specialty hospital. Enhancing treatment completion is a crucial component of a multi-pronged attack on TB in areas with high rates of incident TB and emerging drug resistance. This international health grant will advance our understanding of the impact of patient, community, and health system characteristics on TB treatment completion in an understudied population– urban, predominately Muslim, North Africans—and allow us to establish the groundwork for future TB- and/or HIV-focused interventional trials in Morocco.