{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:15:23Z","timestamp":1794003323828,"version":"4.8.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1205388"],"award-info":[{"award-number":["OPP1205388"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"TB REACH Wave 6 project of Stop TB Partnership","award":["STBP\/TBREACH\/GSA\/W6-34"],"award-info":[{"award-number":["STBP\/TBREACH\/GSA\/W6-34"]}]},{"name":"South African Medical Research Council through the Strategic Health Innovation Partnerships"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Inadequate adherence to tuberculosis (TB) treatment increases the risk of treatment failure and recurrence. Identifying factors contributing to poor adherence could refine targeting strategies and optimize resource distribution. We examined specific individual-level factors for TB treatment adherence among adults with drug-sensitive TB, including HIV status, antiretroviral therapy, time to access clinical care, and perceived stigma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data are from the \u201cTB Mate\u201d cluster-randomized trial, which evaluated a TB treatment adherence intervention across 18 public health clinics in South Africa (PACTR201902681157721). Treatment adherence was measured using smart pillboxes, with pillbox opening recorded as a proxy for the dose taken. Adults in the control group, utilizing the pillbox in silent mode, were included in this analysis. We used logistic regression to model poor adherence (&lt;\u200980% pillbox engagement), and negative binomial regression to model adherence as a count of pillbox engagement. Directed acyclic graphs informed confounder selection in the models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,213 participants (nine clinics) in the control group, 61.2% (742) were male, the median age was 36 years, 63% (769) were living with HIV, with 66% (507\/769) on antiretroviral therapy. The median time to access clinical care was 127\u00a0min and 95% (1151\/1213) reported no perceived stigmatization upon starting TB treatment. Overall 51% (614) exhibited adherence below 80%, with a geometric mean pillbox engagement of 59.6%. Living with HIV was associated with poor adherence to TB treatment, with an adjusted odds ratio of 1.68 (95% confidence interval [CI] 1.27\u20132.22) for &lt;\u200980% adherence and an adjusted rate ratio of 0.90 (0.83\u20130.97) for pillbox engagement, compared to being HIV-negative. Antiretroviral therapy, time to clinical care access, and perceived stigma showed no association with either measure of adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The low adherence underscores the necessity for TB treatment support interventions, particularly among those living with HIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-12304-4","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:22:48Z","timestamp":1767795768000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Baseline determinants of adherence for drug-sensitive TB treatment in a South African prospective cohort: a focus on HIV infection and anti-retroviral therapy, clinical care access, and TB stigma"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7656-1136","authenticated-orcid":false,"given":"Adrian","family":"Steulet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2530-7917","authenticated-orcid":false,"given":"Piotr","family":"Hippner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3974-5961","authenticated-orcid":false,"given":"Noriah","family":"Maraba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4749-2404","authenticated-orcid":false,"given":"Lauren","family":"Jennings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2807-4562","authenticated-orcid":false,"given":"Israel","family":"Rabothata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4304-1729","authenticated-orcid":false,"given":"Rachel","family":"Mukora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3423-7191","authenticated-orcid":false,"given":"Nokhanyo","family":"Xaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5086-4392","authenticated-orcid":false,"given":"Lihle","family":"Mchunu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8577-3915","authenticated-orcid":false,"given":"Kavindhran","family":"Velen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1134-7475","authenticated-orcid":false,"given":"Catherine","family":"Orrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7143-1009","authenticated-orcid":false,"given":"Salome","family":"Charalambous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6524-3754","authenticated-orcid":false,"given":"Katherine","family":"Fielding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"12304_CR1","unstructured":"Global Tuberculosis Report. 2022 [Internet]. 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In addition, ethics approval was obtained from the MSc Research Ethics Committee at the London School of Hygiene and Tropical Medicine (Ref 27519) to conduct this secondary data analysis. The research was conducted in accordance with the Declaration of Helsinki. The study also obtained approval from the three district health departments: eThekwini, Ekurhuleni and the City of Cape Town. The trial was registered with the Pan African Trial Registry PACTR201902681157721, date of registry 11\/02\/2019. Written informed consent was obtained from all study participants prior to study initiation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from all study participants prior to study enrolment.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"251"}}