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The value of urine testing for verifying adherence to anti-tuberculosis chemotherapy in children and adults in Uganda

Meissner, P.E., Musoke, P., Okwera, A., Bunn, J. and Coulter, John B.S. (2002) 'The value of urine testing for verifying adherence to anti-tuberculosis chemotherapy in children and adults in Uganda'. International Journal of Tuberculosis and Lung Disease, Vol 6, Issue 10, pp. 903-908.

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Abstract

SETTING: Mulago Hospital, Kampala, Uganda. OBJECTIVE: To evaluate the usefulness of urine dipsticks for monitoring adherence to anti-tuberculosis chemotherapy. DESIGN: In-house urine dipsticks for detection of isoniazid (INH) metabolites were compared to commercial test strips. The value of n-butanol to detect rifampicin was compared to coloration of the urine. Non-adherence was assessed through a questionnaire and reviews of the Mulago Hospital TB register. RESULTS: Urine was obtained from 236 patients (127 adults and 109 children) on daily chemotherapy. Using commercial test strips as standard, the sensitivity of in-house urine dipsticks was 99.5% and specificity was 96.4%. The sensitivity and the specificity of n-butanol and of coloration of urine to detect rifampicin were low (64.0% and 54.9%, and 85.5% and 64.8%, respectively). Fifty patients (21.2%) admitted non-adherence to treatment during the previous month. An additional 15 (6.8%) were detected through urine testing. Of 911 patients in the TB register of Mulago Hospital who had started treatment in the first 3 months of 2000, 39.7% did not complete their treatment. Two-thirds of these had discontinued treatment in the first 2 months. CONCLUSION: In-house INH test strips are as effective as commercially available strips for detecting isoniazid in the urine. They are a simple tool for monitoring adherence. Adherence to anti-tuberculosis chemotherapy as determined by the use of isoniazid test strips and review of the TB register showed poor compliance. Tests for rifampicin are less sensitive and specific.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 310 Therapy
WF Respiratory System > Tuberculosis > WF 360 Drug therapy
Faculty: Department: Groups (2002 - 2012) > Child & Reproductive Health Group
Depositing User: Users 476 not found.
Date Deposited: 19 Dec 2012 14:36
Last Modified: 06 Feb 2018 13:05
URI: http://archive.lstmed.ac.uk/id/eprint/2961

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