A core component of this strategy is to ensure that everyone with the disease has access to adequate treatment and care. Since the s, the global burden of drug resistant TB has resulted in concern about how well patients adhere to treatment. Internationally, unease was such that the WHO recommended that patients were observed taking every single dose of their medication. Only recently, however, has the technology become available to accurately collect data on how patients miss doses of their treatment and what this means for the likely success of their regimen. Knowing how people miss doses of their treatment, and at what stage this becomes important, is only part of the picture. We also need to know why people miss doses in order to build effective interventions to help them take their treatment. One of the reasons patients may miss doses of their treatment is the development of drug toxicity side effects , e. Toxicity can both be a cause of clinically mandated and non-clinically mandated non-adherence, and can recur when essential treatment is restarted. Safely re-starting treatment after an interruption due to toxicity and avoiding a recurrence of toxicity is a clinical challenge; the evidence base regarding which drugs to reintroduce first or at all and how rapidly to increase drug doses is weak. Current diagnostic toxicity markers are sub-optimal. There are new mechanistically informative liver toxicity biomarkers with qualifying data from large USA and European studies. Given the global burden of TB this inequality must be addressed. The global picture on the extent to which non-adherence occurs due to treatment side effects and how drugs can be reintroduced safely is minimal and poorly consolidated. Both areas have important implications for regimen design. To investigate the relationship between non-adherence to, and side effects from, TB treatment and the implications of this for the reintroduction of medication and treatment outcomes. Additionally, determine if a severe recurrence can be detected earlier using these biomarkers versus traditional clinical tests. We have generated pilot data which support enhanced biomarker sensitivity in this global context of use. Completion of this PhD will provide the student with a sought-after skill set in statistics, epidemiology, toxicology and clinical pharmacology, and transferrable skills. There is a shortage of professionals in pharmacoepidemiology, giving the student career options in the academic sphere, pharmaceuticals industry and policy arena. The student will have the opportunity to attend training courses in pharmacology e. World Health Organization. Global tuberculosis report All non-adherence is equal, but is some more equal than others? TB in the digital era. ERJ Open Res , in press. National Institute for Health and Care Excellence. NG Tuberculosis. MicroRNA and cytokeratin have potential as a biomarkers of drug-induced liver injury in European and African patients on treatment for tuberculosis. Skip to main content. Search: Search. Precision Medicine Doctoral Training Programme. Contact us. Aims To investigate the relationship between non-adherence to, and side effects from, TB treatment and the implications of this for the reintroduction of medication and treatment outcomes. Objectives 1 Determine the burden and patterns of non-adherence due to side effects from treatment using epidemiological approaches.
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