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Abstract

Background
Poor treatment adherence among leprosy patients contribute to relapse, development of antimicrobial resistance, and the eventual plateauing of the prevalence and incidence of leprosy not just in the Philippines, but also worldwide. For this reason, we aimed to identify the patterns and determinants affecting treatment completion and default among multibacillary leprosy patients.

Methods
We conducted a retrospective cohort study involving three large hospitals in Metro Manila, Philippines. Patients who started the World Health Organization – Multiple Drug Therapy for multibacillary leprosy between January 1, 2007 and December 31, 2013 were included in the study. Selected socio-demographic and clinical data were abstracted from the patient treatment records. Survival analysis and proportional hazards regression were used to analyze the data.

Results
Records of 1,034 patients with a total follow-up time of 12,287 person-months were included in the analysis. Most patients were male, younger than 45 years old, had an initial bacterial index between 1 and 4, and were residents of Metro Manila. Less than 20% had their treatment duration extended to more than 12 months. Treatment adherence of the patients was poor with less than 60% completing treatment. Most patients complete their treatment within 12 months, but treatment duration may be extended for up to three years. Patients who default from treatment usually do so a few months after initiating it. After adjusting for other variables, hospital, initial bacterial index, and non-extended treatment duration were associated with treatment completion. These factors, in addition to age, were also found to be associated with treatment default.

Conclusion
This study provides quantitative evidence that there might be marked variations in how doctors in particular hospitals manage their patients, and these findings underscore the need to revisit and re-evaluate clinical practice guidelines to improve treatment outcomes and adherence

۱٫ Introduction

Poor treatment adherence among leprosy patients is associated with relapse and the occurrence of antimicrobial resistance [[1]]. It has also been reported to contribute to the plateauing incidence and prevalence of leprosy in the Philippines [[2]], and worldwide [[3], [4], [5], [6]]. A perceived reason for poor treatment adherence is the long duration of the World Health Organization (WHO) multiple drug therapy (MDT) regimen, lasting a year for multibacillary leprosy patients [[7], [8]], which could even be extended for up to three years [[9], [10]]. In addition to the long duration of treatment, a host of psychosocial, economic, medical and health service, as well as personal factors were found to affect treatment adherence [[11]]. Two earlier reviews reported the following factors to be associated with poor treatment adherence: socio-economic status; educational attainment; gender; alcohol consumption; knowledge about leprosy; stigma associated with the disease; cultural factors; transportation costs; remoteness of residence; financial concerns; adverse effects of MDT; source of MDT; MDT drug shortages; poor relationship between patient and healthcare provider; and occurrence of leprosy reactions [[1], [12]]