{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T14:00:39Z","timestamp":1784815239628,"version":"3.55.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001322","name":"South African Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wellcome Discovery Research Platform in Infection"},{"DOI":"10.13039\/501100003793","name":"Swedish Heart and Lung Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007687","name":"Swedish Society of Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001409","name":"Department of Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001409","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adherence to anti-tuberculosis (TB) therapy is an important determinant of treatment outcome in rifampicin-resistant tuberculosis (RR-TB). Understanding adherence to contemporary treatment regimens in routine care is needed to support implementation in TB programs. We aimed to characterize temporal adherence patterns among people receiving oral treatment for RR-TB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective observational cohort study at a referral TB hospital in South Africa. People aged \u226515 years with pulmonary RR-TB starting an oral 9- to 12-month regimen were included. Treatment adherence was measured using a digital pillbox during ambulatory care and with directly observed therapy during hospital care. The primary outcome was proportion of adherence days through 9 months. Latent class group-based trajectory modeling was used to identify temporal adherence patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 248 participants, 209 (84.3%) had assessable adherence data from the digital pillbox or directly observed therapy. Overall median adherence was 82% (interquartile range [IQR], 63%\u201398%) with combined measures, and 72% (IQR, 51%\u201392%) with digital pillbox only. Four distinct adherence patterns were identified. Adherence was 93%\u2013100% in the first month. Two groups, representing 136 (65.1%) individuals, had small reductions in adherence over time, separated by higher and lower early adherence. In the other 2 groups, there was a 50% reduction in adherence by month 3 (48\/209 [23.0%]) and month 6 (25\/209 [12.0%]), respectively. Lower adherence over time was associated with having exclusive ambulatory care, treatment with the shorter regimen only, and age &amp;lt;40 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Treatment adherence declined over time in distinct temporal patterns. Group characteristics could identify individuals who may benefit from enhanced treatment support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag069","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T08:59:12Z","timestamp":1770713952000},"page":"e145-e154","source":"Crossref","is-referenced-by-count":0,"title":["Treatment Adherence With an Oral 9-Month Regimen for Rifampicin-Resistant Tuberculosis in South Africa"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3398-2421","authenticated-orcid":false,"given":"Johanna","family":"Kuhlin","sequence":"first","affiliation":[{"name":"Department of Medicine Solna, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Department of Infectious Diseases, Karolinska University Hospital , Stockholm ,","place":["Sweden"]},{"name":"Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1704-5208","authenticated-orcid":false,"given":"Jacob A M","family":"Stadler","sequence":"additional","affiliation":[{"name":"Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8001-6544","authenticated-orcid":false,"given":"Daniel J","family":"Grint","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7927-6506","authenticated-orcid":false,"given":"Richard","family":"Court","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1196-4414","authenticated-orcid":false,"given":"Graeme","family":"Meintjes","sequence":"additional","affiliation":[{"name":"Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Blizard Institute, Queen Mary University of London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nomfuneko","family":"Mtwa","sequence":"additional","affiliation":[{"name":"Department of Health, Eastern Cape Province , East London ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3080-6606","authenticated-orcid":false,"given":"Gary","family":"Maartens","sequence":"additional","affiliation":[{"name":"Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Division of Clinical Pharmacology, Department of Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3508-6719","authenticated-orcid":false,"given":"Sean","family":"Wasserman","sequence":"additional","affiliation":[{"name":"Wellcome Discovery Research Platforms in Infection, Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town , Cape Town ,","place":["South Africa"]},{"name":"Institute for Infection and Immunity, City St George's, University of London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"2026072309022283300_ciag069-B1","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1038\/s41591-018-0224-2","article-title":"A patient-level pooled analysis of treatment-shortening regimens for drug-susceptible pulmonary 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Hospital, Kampala, Uganda","volume":"21","author":"Batte","year":"2021","journal-title":"Afr Health Sci"},{"key":"2026072309022283300_ciag069-B9","doi-asserted-by":"crossref","first-page":"e571","DOI":"10.1093\/cid\/ciaf467","article-title":"Characterizing treatment adherence trajectories in the endTB multisite cohort of drug-resistant tuberculosis patients: an application of group-based trajectory modelling","volume":"82","author":"Law","year":"2026","journal-title":"Clin Infect Dis"},{"issue":"Suppl 1","key":"2026072309022283300_ciag069-B10","first-page":"S8","article-title":"Non-adherence to anti-TB drugs among TB\/HIV co-infected patients in Mbarara Hospital Uganda: prevalence and associated factors","volume":"9","author":"Amuha","year":"2009","journal-title":"Afr Health Sci"},{"issue":"Suppl 1","key":"2026072309022283300_ciag069-B11","doi-asserted-by":"crossref","first-page":"S72","DOI":"10.1016\/j.ijtb.2024.01.001","article-title":"Risk factors of treatment interruptions among drug-sensitive and drug-resistant pulmonary tuberculosis patients\u2014a study from South Delhi, New Delhi, India","volume":"71","author":"Kumar","year":"2024","journal-title":"Indian J Tuberc"},{"key":"2026072309022283300_ciag069-B12","doi-asserted-by":"crossref","first-page":"e088556","DOI":"10.1136\/bmjopen-2024-088556","article-title":"Patients\u2019 acceptability, adherence and satisfaction on the modified shorter all-oral multidrug-resistant tuberculosis regimen: a two-phase cross-sectional study in Tanzania","volume":"15","author":"Lalashowi","year":"2025","journal-title":"BMJ Open"},{"key":"2026072309022283300_ciag069-B13","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ijtb.2022.03.021","article-title":"Outcomes and adherence of shorter MDR TB regimen in patients with multidrug resistant tuberculosis","volume":"70","author":"Kumari","year":"2023","journal-title":"Indian J 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A causal associations approach to analyses of digital adherence data","volume":"17","author":"Stagg","year":"2020","journal-title":"Ann Am Thorac Soc"},{"key":"2026072309022283300_ciag069-B22","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/QAI.0000000000003736","article-title":"HIV patient treatment adherence trajectories in first 24 months after ART initiation among adults: an electronic health records cohort from South Africa","volume":"100","author":"Dzomba","year":"2025","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2026072309022283300_ciag069-B23","doi-asserted-by":"crossref","first-page":"e1002884","DOI":"10.1371\/journal.pmed.1002884","article-title":"The importance of adherence in tuberculosis treatment clinical trials and its relevance in explanatory and pragmatic trials","volume":"16","author":"Vernon","year":"2019","journal-title":"PLoS Med"},{"key":"2026072309022283300_ciag069-B24","doi-asserted-by":"crossref","first-page":"e1002595","DOI":"10.1371\/journal.pmed.1002595","article-title":"Adherence interventions and outcomes of tuberculosis treatment: a systematic review and meta-analysis of trials and observational studies","volume":"15","author":"Alipanah","year":"2018","journal-title":"PLoS Med"},{"key":"2026072309022283300_ciag069-B25","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12981-017-0138-y","article-title":"Comparison of six methods to estimate adherence in an ART-naive cohort in a resource-poor setting: which best predicts virological and resistance outcomes?","volume":"14","author":"Orrell","year":"2017","journal-title":"AIDS Res Ther"},{"key":"2026072309022283300_ciag069-B26","doi-asserted-by":"crossref","first-page":"ofab532","DOI":"10.1093\/ofid\/ofab532","article-title":"Measuring tuberculosis medication adherence: a comparison of multiple approaches in relation to urine isoniazid metabolite testing within a cohort study in India","volume":"8","author":"Subbaraman","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2026072309022283300_ciag069-B27","doi-asserted-by":"crossref","first-page":"107173","DOI":"10.1016\/j.cct.2023.107173","article-title":"Using a medication event monitoring system to evaluate self-report and pill count for determining treatment completion with self-administered, once-weekly isoniazid and rifapentine","volume":"129","author":"Scott","year":"2023","journal-title":"Contemp Clin Trials"},{"key":"2026072309022283300_ciag069-B28","doi-asserted-by":"crossref","first-page":"e238","DOI":"10.1371\/journal.pmed.0040238","article-title":"Patient adherence to tuberculosis treatment: a systematic review of qualitative research","volume":"4","author":"Munro","year":"2007","journal-title":"PLoS Med"},{"key":"2026072309022283300_ciag069-B29","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s12889-019-8035-z","article-title":"\u201cA very humiliating illness\u201d: a qualitative study of patient-centered care for rifampicin-resistant tuberculosis in South Africa","volume":"20","author":"Furin","year":"2020","journal-title":"BMC Public Health"},{"key":"2026072309022283300_ciag069-B30","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1186\/s12879-016-1723-8","article-title":"Where there is hope: a qualitative study examining patients\u2019 adherence to multi-drug resistant tuberculosis treatment in Karakalpakstan, Uzbekistan","volume":"16","author":"Horter","year":"2016","journal-title":"BMC Infect Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciag069\/66838226\/ciag069.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/1\/e145\/66838226\/ciag069.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/83\/1\/e145\/66838226\/ciag069.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:02:33Z","timestamp":1784811753000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/83\/1\/e145\/8470982"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,9]]},"published-print":{"date-parts":[[2026,7,23]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciag069","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7,15]]},"published":{"date-parts":[[2026,2,9]]}}}