Statistical factors associated with utilisation of ototoxicity monitoring services for multi-drug-resistant tuberculosis patients in the Western Cape.
Lebogang Ramma, Primrose T Nhokwara, Christine Rogers
PMID 30843411WHAT IT FOUND
Most MDR-TB patients did not attend all scheduled hearing-monitoring visits.
Delayed baseline tests and normal hearing were linked to lower uptake. Living closer to the service was not linked to attendance.
Key findings
01Only 10% of patients attended all six recommended ototoxicity monitoring appointments.
02Longer delay from treatment initiation to baseline audiometry was associated with lower likelihood of using services.
03Hearing status was linked to attendance: normal hearing at baseline was 30% less likely to attend (RR 0.7), developing hearing loss was 60% more likely (RR 1.6), and disabling hearing loss was 2.2 times more likely (RR 2.2).
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This was a retrospective record review, so it could not establish why patients missed appointments. The study covered only patients who had already accessed the service at one hospital, so it may not represent patients who never attended. Records with missing information were excluded, and the number excluded is not reported. The data were collected during early decentralisation of MDR-TB treatment, and later changes such as more audiologists, portable audiometry and a kanamycin-free regimen may have altered patterns. The study reports associations with attendance, not effects of an intervention.
The easy way to misread this
Do not conclude that placing ototoxicity monitoring services near patients will increase attendance. The study found no association between proximity and attendance, and most patients did not complete the recommended monitoring schedule.