A new study led by the University of North Carolina Gillings School of Global Public Health researchers has found that combining social services with tuberculosis (TB) treatments lowers the rate of treatment default, which improves patient outcomes and could help stymie the rates of multidrug resistance to the disease.
Dr. Martha Priedeman Skiles, Gillings School alumna, is first author of the paper, which was published online Aug. 9 in PLoS One. Gillings School co-authors are Dr. Sian Curtis, associate professor, and Dr. Gustavo Angeles, assistant professor, both in the School’s Department of Maternal and Child Health.
The work was supported by MEASURE Evaluation, UNC Chapel-Hill’s largest research project in global health, led by UNC through the Carolina Population Center and comprising a consortium of five organizations. MEASURE Evaluation is funded by the United States Agency for International Development (USAID).
The study is based in Ukraine, which is among the top 20 countries in the world for high rates of drug-resistant TB, a significant public-health threat largely due to unmitigated treatment default rates. When TB patients stop taking the treatment, they are not able to kill off the remainder of the bacteria, which become resistant to the drugs used to treat the disease.
This evaluation measured the effect of social support provided to TB patients at risk of stopping treatment during outpatient treatment in 2011 and 2012 in Ukraine. In 2012, TB patients receiving social support reduced their probability of defaulting on treatment by 10 percentage points, compared to high-risk patients who did not receive social support in 2012 or 2011.
Dr. Curtis said offering social support helps TB patients continue with treatment because it decreases the stigma associated with the disease and provides comfort and consolation to patients as they endure unpleasant side effects of the treatment.
“Patients withdraw from treatment because the side effects, such as nausea and weakness, can be severe,” she said. “Many patients at high risk of treatment default are already in poor health, whether from substance use or food insecurity, and they already struggle in other aspects of their lives. This support gives them someone to turn to, which has a positive psychological effect.”
Dr. Curtis said the study confirms that offering this kind of support has multiple benefits for this population, as well as the public health of Ukraine, and other countries may be able to use this evidence in the context of their own countries’ TB populations. Further studies on cost effectiveness and ways that this approach compares to other treatment-adherence initiatives still are needed.
“Removing barriers to receiving the medication and having someone for support through the process helps patients complete the treatment,” she said. “Having quantitative data showing that this really works allows government entities to make evidence-based decisions about providing this kind of support.”