02933nas a2200265   4500000000100000008004100001260001200042653001700054653002300071100001600094700001500110700001400125700001700139700001300156700001500169700001300184700001200197700001500209245009300224856009900317300001300416490000700429520221700436022001402653       2020                            d  c05/202010aBuruli ulcer10aTreatment barriers1 aCollinson S1 aFrimpong V1 aAgbavor B1 aMontgomery B1 aOppong M1 aFrimpong M1 aAmoako Y1 aMarks M1 aPhillips R00aBarriers to Buruli ulcer treatment completion in the Ashanti and Central Regions, Ghana.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0008369&type=printable  ae00083690 v143 a<p><b>BACKGROUND: </b>Buruli ulcer is a chronic ulcerating skin condition, with the highest burden found in Central and West Africa where it disproportionately affects the most vulnerable populations. Treatment is demanding, comprising eight-weeks of daily antibiotics, regular wound care and possible surgical intervention. Treatment completion is key to optimising outcomes, however the degree of and barriers to this are not well understood. Recent change from injectable treatment (SR8) to oral treatment (CR8) has made it feasible to further decentralise care, potentially improving treatment access and completion. However, the impact of this and of other demographic and clinical influences on treatment completion must be explored first to ensure appropriate models of care are developed.</p><p><b>METHODOLOGY/PRINCIPAL FINDINGS: </b>A retrospective clinical notes review and secondary data analysis of records from patients diagnosed between 1 January 2006-31 December 2018 at four district hospital clinics in the Ashanti and Central Regions, Ghana. Univariable analyses and multivariable logistic regression were performed to assess the association between explanatory variables and treatment completion. There were 931 patient episodes across the four clinics with overall treatment completion of 84.4%. CR8 was associated with higher treatment completion compared to SR8 (OR 4.1, P = 0.001). There was no statistically significant association found between distance from patient residence to clinic and treatment completion.</p><p><b>CONCLUSIONS/SIGNIFICANCE: </b>Improved treatment completion with CR8 supports its use as first line therapy and may enable decentralisation to fully community-based care. We did not find an association between distance to care and treatment completion, though analyses were limited by data availability. However, we did find evidence that distance to care continues to be associated with more severe forms of disease, which may reflect the higher costs of accessing care and lower awareness of the condition the further a patient lives. Decentralised care must therefore also continue to support community engagement and active outreach to identify cases early.</p>  a1935-2735