Medication adherence and its determinants among Brucellosis patients in China: A multi-center follow-up study
- 1Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, Nanning, China
- 2National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Chinese Center for Disease Control and Prevention (Chinese Academy of Preventive Medicine), Beijing, China
- 3The First Affiliated Hospital of Guangxi Medical University, Nanning, China
Abstract
Background: Brucellosis patients in China face challenges in adhering to prescribed oral medication regimens during home-based treatment. Improving adherence is critical for disease control and relapse prevention. However, systematic studies on medication adherence and its determinants among Chinese brucellosis patients remain scarce. This study aimed to assess medication adherence and identify its multilevel determinants in this population. Methods: A multi-center study was conducted across six prefectures in China from December 2019 to August 2021. Demographic and clinical data were collected via questionnaires and medical records. Medication adherence was evaluated using the Chinese Morisky-8 Medication Adherence Scale (C-MMAS-8) at 6 and 12 weeks of treatment. Multilevel logistic regression models were employed to identify determinants of adherence. Results: Among 820 enrolled patients, 801 (49.49 ± 11.51 years) and 426 (50.81 ± 11.11 years) completed follow-ups at 6 and 12 weeks, respectively. Adherence scores declined significantly from 8 (IQRs: 5.75–8), (53.18% optimal adherent) at 6 weeks to 7 (IQRs: 5.5–8), (41.31% optimal adherent) at 12 weeks (P < 0.01). Quality of life scores correlated positively with adherence scores at both follow-ups (r=0.28 and 0.21; P < 0.01). Compared with inner Mongolia, medication adherence in Xinjiang (OR=2.14, 95% CI: 1.01–4.51, P < 0.05) and Shandong (OR=2.94, 95% CI: 1.41–6.15, P < 0.01) was significantly high. Key determinants included social support (OR=1.06, 95% CI: 1.01–1.11), prior brucellosis episodes (OR=0.42, 95% CI: 0.18–0.99), and concomitant use of hepatoprotective medications (OR=0.39, 95% CI: 0.23–0.67). Conclusions: Nearly half of brucellosis patients exhibited sub-optimal medication adherence, with adherence declining over time and significantly regional difference in optimal adherence. Enhancing social support, prioritizing patients with prior infection history for tailored education, and ensuring safe and rational medication use represent key strategies to improve adherence. Tailored interventions incorporating these elements are urgently needed to optimize disease management and reduce the risk of chronicity. Author summary: Brucellosis requires prolonged oral antibiotics, yet home-treated patients often struggle with adherence, increasing relapse and chronicity risk. We enrolled 820 patients across six Chinese prefectures, and 801 of these patients completed the 6-week follow-up. Of the 801 participants, 346 completed the standard 6-week regimen, while 455 continued to the 12-week stage. In conclusion, 426 of the 12-week regimen completed the 12-week follow-up. We found that optimal adherence dropped from 53.2% at week 6 to 41.3% at week 12, and correlated positively with quality of life at both time points. Compared with Inner Mongolia, adherence was significantly higher in Xinjiang (OR=2.14, 95% CI: 1.01–4.51, P < 0.05) and Shandong (OR=2.94, 95% CI: 1.41–6.15, P < 0.01). Multilevel regression identified three determinants: social support (OR=1.06) promoted adherence, while prior episodes (OR=0.42) and hepatoprotective use (OR=0.39) were linked to poorer adherence, possibly due to fatigue or pill burden. Nearly half failed to maintain adherence over time; inter-regional variation calls for context-sensitive strategies. Strengthening social support, targeted education for recurrent cases, and rationalizing medication use are essential to improve completion and reduce chronic brucellosis burden in China.
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BibTeX
@article{lu2026medication,
title = {{Medication adherence and its determinants among Brucellosis patients in China: A multi-center follow-up study}},
author = {Qiaoshan Lu and Huijie Qin and Shijian Zhou and Sihan Li and Junyuan Chen and Qiulan Chen and Xianyan Tang},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014741},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014741},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Medication adherence and its determinants among Brucellosis patients in China: A multi-center follow-up study
AU - Qiaoshan Lu
AU - Huijie Qin
AU - Shijian Zhou
AU - Sihan Li
AU - Junyuan Chen
AU - Qiulan Chen
AU - Xianyan Tang
PY - 2026
DA - 2026/10/05
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014741
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014741
AB - Background: Brucellosis patients in China face challenges in adhering to prescribed oral medication regimens during home-based treatment. Improving adherence is critical for disease control and relapse prevention. However, systematic studies on medication adherence and its determinants among Chinese brucellosis patients remain scarce. This study aimed to assess medication adherence and identify its multilevel determinants in this population. Methods: A multi-center study was conducted across six prefectures in China from December 2019 to August 2021. Demographic and clinical data were collected via questionnaires and medical records. Medication adherence was evaluated using the Chinese Morisky-8 Medication Adherence Scale (C-MMAS-8) at 6 and 12 weeks of treatment. Multilevel logistic regression models were employed to identify determinants of adherence. Results: Among 820 enrolled patients, 801 (49.49 ± 11.51 years) and 426 (50.81 ± 11.11 years) completed follow-ups at 6 and 12 weeks, respectively. Adherence scores declined significantly from 8 (IQRs: 5.75–8), (53.18% optimal adherent) at 6 weeks to 7 (IQRs: 5.5–8), (41.31% optimal adherent) at 12 weeks (P < 0.01). Quality of life scores correlated positively with adherence scores at both follow-ups (r=0.28 and 0.21; P < 0.01). Compared with inner Mongolia, medication adherence in Xinjiang (OR=2.14, 95% CI: 1.01–4.51, P < 0.05) and Shandong (OR=2.94, 95% CI: 1.41–6.15, P < 0.01) was significantly high. Key determinants included social support (OR=1.06, 95% CI: 1.01–1.11), prior brucellosis episodes (OR=0.42, 95% CI: 0.18–0.99), and concomitant use of hepatoprotective medications (OR=0.39, 95% CI: 0.23–0.67). Conclusions: Nearly half of brucellosis patients exhibited sub-optimal medication adherence, with adherence declining over time and significantly regional difference in optimal adherence. Enhancing social support, prioritizing patients with prior infection history for tailored education, and ensuring safe and rational medication use represent key strategies to improve adherence. Tailored interventions incorporating these elements are urgently needed to optimize disease management and reduce the risk of chronicity. Author summary: Brucellosis requires prolonged oral antibiotics, yet home-treated patients often struggle with adherence, increasing relapse and chronicity risk. We enrolled 820 patients across six Chinese prefectures, and 801 of these patients completed the 6-week follow-up. Of the 801 participants, 346 completed the standard 6-week regimen, while 455 continued to the 12-week stage. In conclusion, 426 of the 12-week regimen completed the 12-week follow-up. We found that optimal adherence dropped from 53.2% at week 6 to 41.3% at week 12, and correlated positively with quality of life at both time points. Compared with Inner Mongolia, adherence was significantly higher in Xinjiang (OR=2.14, 95% CI: 1.01–4.51, P < 0.05) and Shandong (OR=2.94, 95% CI: 1.41–6.15, P < 0.01). Multilevel regression identified three determinants: social support (OR=1.06) promoted adherence, while prior episodes (OR=0.42) and hepatoprotective use (OR=0.39) were linked to poorer adherence, possibly due to fatigue or pill burden. Nearly half failed to maintain adherence over time; inter-regional variation calls for context-sensitive strategies. Strengthening social support, targeted education for recurrent cases, and rationalizing medication use are essential to improve completion and reduce chronic brucellosis burden in China.
SN - 1935-2735
ER -