2014 ASPHO Abstracts

Abstract

Background: Cure requires sustained treatment, but, failure to complete indicated treatment (treatment abandonment) occurs in up to one quarter of pediatric tuberculosis cases and half of pediatric oncology cases in some low- and middleincome settings (LMIS). Objectives: This systematic review assesses the design, delivery and outcomes of adherence interventions utilized in pediatric tuberculosis in LMIS, and evaluates the potential application of these interventions for pediatric oncology treatment adherence. Design/Method: A protocol was drafted in alignment with PRISMA standards and registered with PROSPERO. 412 reports published between 2003 and 2013 were identified from PubMed, COCHRANE bibliographies, hand-searching including of the grey literature, and expert consultation. 163 reports qualified for full-text review. Randomized control, quasi-experimental, and observational studies that utilized an intervention specific to treatment completion, adherence, prevention of refusal, or family-efficacy with a reported adherence-related outcome for pediatric-age populations (<19 years) in LMIS (defined by World Bank) were included. Studies were categorized for utilization of educational, psychosocial support, care delivery, health systems, or social protective/financial interventions. Adherence outcomes included referral to care, prevention of refusal, appointment attendance, medication adherence, self-efficacy, and treatment completion. 14 studies (10 countries) were included in synthesis. Risk of bias was systematically assessed. Results: Four randomized and eight non-randomized studies were included (8 prospective), representing. urban outpatient (n=4), rural outpatient (n=3), township (n=2), rural camp (n=1), and mixed settings (n=4). Interventions targeting adherence education (n=2), counseling (n=2), decentralization of care delivery (n=7), support clubs (n=1), social franchising (n=1), and social protection/ financial provision (n=1) were feasible across diverse, rural/urban settings, and demonstrated to impact on tuberculosis treatment adherence outcomes in 13 studies, and equivocal in 1 studies. This study incorporates critical analyses of comparative pediatric oncology outcomes in the same countries, relevant to solid tumor diagnoses. Findings were also applied to generate a preliminary model to stimulate further transsectoral collaborations. Conclusion: These findings highlight needs and next steps for rigorous methodology with attentiveness to implementation and cost analyses to examine effectiveness, local acceptability, feasibility, affordability, and sustainability of successful treatment completion interventions in the context of pediatric solid tumor therapy completion in LMIS.