Adherence to TB treatment remains low during continuation phase among adult patients in Northwest Ethiopia

Abstract Background Patients’ failure to adhere to TB treatment was a major challenge that leads to poor treatment outcomes. In Ethiopia, TB treatment success was low as compared with the global threshold. Despite various studies done in TB treatment adherence, little was known specifically in continuation phase where TB treatment is mainly patient-centered. This study aimed to determine adherence to TB treatment and its determinants among adult patients during continuation phase. Methods We deployed a facility-based cross-sectional study design supplemented with qualitative data to explore perspectives of focal healthcare providers. The study population was all adult (≥18 years) TB patients enrolled in the continuation phase and focal healthcare workers in TB clinics. The study included 307 TB patients from 22 health facilities and nine TB focal healthcare providers purposively selected as key-informant. A short (11 questions) version Adherence to Refill and Medication Scale (ARMS) was used for measuring adherence. Data was collected using an interviewer-administered questionnaire and in-depth interview for qualitative data. Binary logistic regression was applied to identify factors associated with patient adherence. We followed a thematic analysis for the qualitative data. The audio data was transcribed, coded and categorized into themes using OpenCode software. Results Among 307 participants, 64.2% (95% CI (58.6–69.4%) were adherent to TB treatment during continuation phase. A multi-variable analysis shown that secondary education (AOR = 4.138, 95% CI; 1.594–10.74); good provider-patient relationship (AOR = 1.863, 95% CI; 1.014–3.423); good knowledge on TB treatment (AOR = 1.845, 95% CI; 1.012–3.362) and middle family wealth (AOR = 2.646, 95% CI; 1.360–5.148) were significantly associated with adherence to TB treatment. The majority (58%) of patients mentioned forgetfulness, and followed by 17.3% of them traveling away from home without pills as major reasons for non-adherence to TB treatment. Conclusions The study indicated that patients’ adherence to TB treatment remains low during continuation phase. The patient’s education level, knowledge, family wealth, and provider-patient relationship were found positively associated with patient adherence. Forgetfulness, traveling away, and feeling sick were major reasons for non-adherence to TB treatment. Interventional studies are needed on those factors to improve patient adherence to TB treatment during continuation phase.

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Adherence to TB Treatment Remains Low during Continuation Phase among Adult Patients in Northwest Ethiopia

10.21203/rs.3.rs-143700/v1 ◽

2021 ◽

Author(s):

kassahun Dessie Gashu ◽

Kassahun Alemu Gelaye ◽

Binyam Tilahun

Keyword(s):

Patient Adherence ◽

Northwest Ethiopia ◽

Adult Patients ◽

Patient Relationship ◽

Care Providers ◽

Cross Sectional ◽

Continuation Phase ◽

Tb Treatment ◽

Family Wealth ◽

Key Informant

Abstract Background: Adherence to Tuberculosis (TB) treatment remained a challenge for TB treatment programs. However, paucity of evidences specifically during continuation phase where the treatment is mainly patient-centered. This study aimed to determine the level and determinants of adherence to TB treatment among adult patients during continuation phase.Methods: We deployed a facility-based cross-sectional study design supplemented with lived experiences and perspectives of focal care providers. The study population included all adult (≥18 years) TB patients enrolled in the continuation treatment phase and TB focal care providers (for key-informant interviews). The study included 307 participants from 22 health facilities. Nine TB focal care providers were purposively selected for key-informant interviews. A shorter form, 11-item ARMS (adherence to refill and medication scale) was used for measuring adherence. Binary logistic regression was applied to identify factors associated with patient adherence. The audio data was transcribed, coded and categorized into themes using OpenCode software. The interpretation and analysis were conducted using thematic analysis.Results: Among 307 participants, 197 (64.2%) [95% CI (58.6% - 69.4%)] were adhere to TB treatment. A multi-variable analysis shown that secondary education (AOR = 4.138, 95% CI; 1.594-10.74); good provider-patient relationship (AOR=1.863, 95% CI; 1.014-3.423); good knowledge on TB treatment (AOR=1.845, 95% CI; 1.012-3.362) and middle family wealth (AOR= 2.646, 95% CI; 1.360-5.148) have shown significant association with adherence. Many patients mentioned that forgetfulness, traveling away from home without pills, and feeling sick were major reasons for non-adherence to TB treatment. Conclusions: The study indicated that patients’ adherence to TB treatment remains low during continuation phase. The patient’s education level, knowledge, family wealth, and provider-patient relationship were found positively associated with patient adherence. Forgetfulness, traveling away, and feeling sick were major reasons for non-adherence to TB treatment. Interventional studies are needed on those factors to improve patient adherence to TB treatment during continuation phase.

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Adherence to TB Treatment Remains Low During Continuation Phase Among Adult Patients in Northwest Ethiopia

10.21203/rs.3.rs-135056/v1 ◽

2020 ◽

Author(s):

Kassahun Dessie Gashu ◽

Kassahun Alemu Gelaye ◽

Binyam Tilahun

Keyword(s):

Patient Adherence ◽

Northwest Ethiopia ◽

Adult Patients ◽

Patient Relationship ◽

Care Providers ◽

Cross Sectional ◽

Continuation Phase ◽

Tb Treatment ◽

Family Wealth ◽

Key Informant

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Effect of a phone reminder system on patient-centered tuberculosis treatment adherence among adults in Northwest Ethiopia: a randomised controlled trial

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2020-100268 ◽

2021 ◽

Vol 28 (1) ◽

pp. e100268

Author(s):

Kassahun Dessie Gashu ◽

Kassahun Alemu Gelaye ◽

Richard Lester ◽

Binyam Tilahun

Keyword(s):

Controlled Trial ◽

Treatment Success ◽

Intervention Group ◽

Routine Care ◽

Control Group ◽

Patient Relationship ◽

Continuation Phase ◽

Reminder System ◽

Tb Treatment ◽

Randomised Controlled

ObjectivesThis study aimed to evaluate the effect of the phone reminder system on patient-centred TB treatment adherence during continuation phase, where patients are responsible for taking medication at home.MethodsWe conducted a two-arm randomised controlled trial on adult patients with TB during the continuation phase. In the intervention arm, patients received routine care plus phone-based weekly pill refilling and daily medication reminders. In the control arm, participants received only routine care. A covariate adaptive randomisation technique was used to balance covariates during allocation. The primary outcome was adherence to patient-centred TB treatment, and secondary outcomes included provider–patient relationship and treatment outcomes. We applied per-protocol and intention-to-treat analysis techniques.ResultsWe randomised 306 patients to intervention (n=152) and control (n=154) groups. Adherence to patient-centred TB treatment was 79% (110/139) in intervention and 66.4% (95/143) in control groups, with relative risk (RR) (95% lower CI) (RR=1.632 (1.162 to ∞); p=0.018, one tailed). Good provider–patient relationship was 73.3% (102/139) in intervention group and 52.4% (75/143) in control group, p=0.0001. TB treatment success was 89.5% (136/152) in intervention group and 85.1% (131/154) in control group, p=0.1238.ConclusionsMobile phone-based weekly refilling with daily medication reminder system improved adherence to patient-centred TB treatment and provider–patient relationship; however, there was no significant effect on treatment success.Trial registration numberPan African Clinical Trials Registry (PACTR201901552202539).

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Prevalence and socio-demographic correlates of HIV among Tuberculosis patients of DOTS centre in Delhi

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i1.12744 ◽

2015 ◽

Vol 7 (1) ◽

pp. 53-58 ◽

Cited By ~ 1

Author(s):

Vishal C Soyam ◽

Jyoti Das ◽

Rajeeva TC ◽

Pallavi Boro ◽

Charu Kohli

Keyword(s):

Cross Sectional Study ◽

Point Of View ◽

Hiv Care ◽

Hiv Status ◽

Medical Sciences ◽

Hiv Diagnosis ◽

Cross Sectional ◽

Continuation Phase ◽

Tb Treatment ◽

Demographic Correlates

Background: Knowledge of HIV status of a TB patient is critical from both patient and public health point of view. Early HIV diagnosis among TB patients could serve as an entry point for HIV care and treatment. Surveillance of HIV among TB patients has been recognized to be important as the HIV epidemic continues to fuel TB epidemics. Hence, this study was conducted with an objective to assess the socio-demographic profile and the prevalence of HIV among TB patients.Methodology: Cross sectional study was carried out in eight DOTS cum DMCs of Delhi. Data was collected from January 2012 to December 2012. Registered TB patients (new and retreatment) were interviewed on a predesigned questionnaire at the end of five months of treatment.Results: In 2012, out of the total 552 TB patients interviewed, 524 (94.9%) had been tested for HIV by the end of fifth month of their TB treatment. In them, 13 patients (2.4%) were HIV positive. All of them had been initiated on ART and CPT during continuation phase of TB treatment. In present study no variable was found to be significantly associated with HIV status except number family member and patients on retreatment category.Conclusions: The prevalence of HIV infection in TB patients in current study was (2.4%) substantially lower than reported in studies from other states. If HIV testing done by all TB patients then routine reporting of HIV status for all TB patients would provide even better information on which to base future planning.Asian Journal of Medical Sciences Vol.7(1) 2015 53-58

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Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0248408 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248408

Author(s):

Mrinalini Das ◽

Taanya Mathur ◽

Shilpa Ravi ◽

Augusto C. Meneguim ◽

Aparna Iyer ◽

...

Keyword(s):

Qualitative Study ◽

Children And Adolescents ◽

Health Care Providers ◽

Treatment Success ◽

Healthcare Providers ◽

Drug Resistant ◽

Care Providers ◽

Tb Treatment ◽

Adolescent Patients ◽

Mdr Tb

Background Childhood multidrug-resistant TB (MDR-TB) still affects around 25000 children every year across the globe. Though the treatment success rates for drug-resistant TB (DR-TB) in children are better than adults, children and adolescents face unique hurdles during DR-TB (MDR-TB, Pre-XDR TB and XDR-TB) treatment. This study aimed to understand the patients, guardians and healthcare providers’ perspectives about DR-TB treatment journey of patients and caregivers. Methods This is a qualitative study involving in depth-interviews of purposively selected adolescents (n = 6), patients guardians (for children and adolescents, n = 5) and health care providers (n = 8) of Médecins Sans Frontières (MSF) clinic, Mumbai, India. In-depth face to face interviews were conducted in English or Hindi language using interview guides during September-November 2019. The interviews were audio-recorded after consent. Thematic network analysis was used to summarize textual data. ATLAS.ti (version 7) was used for analysis. Result The age of adolescent patients ranged from 15–19 years and four were female. Five guardians (of three child and two adolescent patients) and eight healthcare providers (including clinicians- 2, DOT providers-2, counselors-2 and programme managers-2) were interviewed. The overarching theme of the analysis was: Challenging DR-TB treatment journey which consisted of four sub-themes: 1) physical-trauma, 2) emotional-trauma, 3) unavailable social-support and 4) non-adapted healthcare services. Difficulties in compounding of drugs were noted for children while adolescents shared experiences around disruption in social life due to disease and treatment. Most of the patients and caregivers experienced treatment fatigue and burnout during the DR-TB treatment. Participants during interviews gave recommendations to improve care. Discussion The TB programmes must consider the patient and family as one unit when designing the package of care for paediatric DR-TB. Child and adolescent friendly services (paediatric-formulations, age-specific counselling tools and regular interaction with patients and caregivers) will help minimizing burnout in patients and caregivers.

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HUBUNGAN PENGETAHUAN DAN SIKAP TERHADAP KEPATUHAN MINUM OBAT PASIEN TUBERKULOSIS PARU FASE LANJUTAN DI KECAMATAN UMBULSARI JEMBER

IKESMA ◽

10.19184/ikesma.v14i1.10401 ◽

2018 ◽

Vol 14 (1) ◽

pp. 11

Author(s):

Elita Ismi Mientarini ◽

Yohanes Sudarmanto ◽

M Hasan

Keyword(s):

Total Sample ◽

Spearman Correlation ◽

Cross Sectional ◽

Continuation Phase ◽

Tb Treatment ◽

Knowledge Questionnaire ◽

Sample Technique ◽

Spearman Correlation Test ◽

Knowledge And Attitude ◽

Level Of Understanding

Tuberkulosis (TB) is a infectious disease caused by t Mycobacterium Tuberculosis. Indonesia is the second country with highest number of TB cases in the world after India. Medication adherence is essential for successful TB treatment. One of the factors that can influence someone adherence to TB treatment is knowledge and attitude. This study aimed to know the correlation between knowledge and attitude towards the adherence of medication in tuberkulosis pulmonary patient on continuation phase in umbulsari jember. This study was an obsevational analytic using cross sectional with total sample technique method. Data were obtained through questionnaire (knowledge questionnaire, HRHS, and MMAS-8) then analyzed with Spearman correlation test (p= <0,05). The results showed a significant between compliance with knowledge at the level of know with the value of p = 0.041. While the results of the correlation of compliance with knowledge at the level of understanding and application and between attitudes and compliance obtained results not signifikan.

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Patient Adherence to Tuberculosis Treatment: A Relation between Family Support and Patient Behavior

Critical Medical and Surgical Nursing Journal ◽

10.20473/cmsnj.v10i2.26491 ◽

2021 ◽

Vol 10 (2) ◽

pp. 42

Author(s):

Rani Putri Haji Soleman ◽

Tintin Sukartini ◽

Arina Qona'ah

Keyword(s):

Family Support ◽

Treatment Adherence ◽

Patient Adherence ◽

Treatment Compliance ◽

Sampling Technique ◽

Tuberculosis Treatment ◽

Cross Sectional ◽

Patient Behavior ◽

Control Programs ◽

Tb Treatment

Introduction: Knowledge, family support, and behavior have a significant impact on an individual's and community's health. They play a critical part in deciding disease control programs and transmission prevention of tuberculosis. The purpose of the study was to determine the association between family support, patient behavior, and tuberculosis treatment compliance in the Baing Primary Health Care of Wulla-Waijilu DistrictMethods:The study design was cross-sectional using the Spearman Rho test. The sample was 123 respondents with purposive sampling technique. The data collection was using sociodemographic questionnaires, family support, behavior, TB treatment adherence and MMAS-8. The dependent variable in this study was family support. The independent variables in this study were patient behavior and TB treatment adherence.Result:There was a relationship between family support and patient behavior (p=0.025), a relationship between family support and compliance with TB treatment (p=0.042)Conclusion:It can be concluded that there was a relationship between family support and TB patient behavior and there was a strong and significant relationship between family support and the level of TB treatment adherence.

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Gambaran dan Rasionalitas Penggunaan Antibiotik pada Pasien Dewasa dengan Community Acquired Pneumonia di RSUP Prof. Dr. R. D. Kandou Manado Periode Juni 2017-Mei 2018

Jurnal e-Biomedik ◽

10.35790/ebm.6.2.2018.22156 ◽

2018 ◽

Vol 6 (2) ◽

Author(s):

Dimas Prakoso ◽

Jimmy Posangi ◽

Edward Nangoy

Keyword(s):

Random Sampling ◽

Healthcare Providers ◽

Simple Random Sampling ◽

Community Acquired Pneumonia ◽

Adult Patients ◽

Beta Lactam ◽

Cross Sectional ◽

Antibiotic Utilization ◽

General Drug ◽

Cross Sectional Design

Abstract: Irrational utilization of antibiotic led to several burdens for healthcare providers, one of them is antibiotic resistance. Community acquired pneumonia (CAP) has increased mortality rate due to irrational antibiotic utilization. This study was aimed to obtain a general depiction and antibiotic rational utilization quantitatively assessed of CAP in adult patients at Prof. Dr. R. D. Kandou Hospital Manado from June 2017 to May 2018. This was a retrospective descriptive study with a cross sectional design. Samples were 42 patients with CAP obtained by using simple random sampling. The results showed that values of DDD/100 inpatient days were, as follows: beta-lactam (33), macrolides (13.758), and fluoroquinolone (20.072). According to the ratio between estimated DDD value of Prof. Dr. R. D. Kandou and DDD WHO, all prescribed antibiotics had DDD values below or close to the value of DDD WHO. Albeit, there were discrepancies between antibiotic utilization in the field and reccomendation of Clinical Practice Guideline of Internal Medicine Department. Conclusion: Within the period of June 2017 - May 2018 the most prescribed antibiotic classes for CAP in adult patients at Prof. Dr. R. D. Kandou Hospital were beta-lactam, macrolides, and fluoroquinolone meanwhile the most prescribed antibiotics were ceftriaxone and azithromycin. In general, drug utilization was rational assessed quantitatively by using DDD WHO criteria.Keywords: antibiotic rationality, CAP, DDD WHO, Prof. Dr. R. D. Kandou Abstrak: Penggunaan antibiotik yang tidak rasional dapat membebani tenaga kesehatan, salah satunya ialah resistensi antibiotik. Community acquired pneumonia (CAP) mengalami peningkatan mortalitas tinggi akibat penggunaan antibiotik yang tidak tepat. Penelitian ini bertujuan untuk mendapatkan gambaran umum dan penilaian rasionalitas secara kuantitatif dari penggunaan antibiotik pada pasien dewasa dengan CAP di RSUP Prof. Dr. R. D. Kandou Manado periode Juni 2017-Mei 2018. Jenis penelitian ialah deskriptif retrospektif dengan desain potong lintang. Sampel sebanyak 41 pasien dewasa dengan CAP diambil dengan simple random sampling. Hasil penelitian mendapatkan DDD/100 hari rawat inap penggunaan antibiotik dari tiga golongan antibiotik yaitu beta-lactam (33), makrolida (13,758), dan florokuinolon (20,072). Berdasarkan rasio estimasi DDD di RSUP Prof. Dr. R. D. Kandou Manado dan DDD WHO seluruh obat yang digunakan masih berada di bawah DDD WHO atau mendekati nilai tersebut. Terdapat perbedaan antara penggunaan antibiotik di lapangan dan rekomendasi dari Panduan Praktek Klinis dari Bagian Ilmu Penyakit Dalam. Simpulan: Pada periode Juni 2017 - Mei 2018 golongan antibiotik yang paling banyak diberikan untuk pasien dewasa dengan CAP di RSUP Prof. Dr. R. D. Kandou Manado ialah beta-lactam, diikuti makrolida dan florokuinolon sedangkan antibiotik yang paling banyak diberikan ialah ceftriaxone dan azithromisin. Secara keseluruhan penggunaan obat sudah rasional secara kuantitatif diukur dengan kriteria DDD WHO.Kata kunci: rasionalitas antibiotik, CAP, DDD WHO, RSUP Prof. Dr. R. D. Kandou Manado

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The effects of family, society and national policy support on treatment adherence among newly diagnosed tuberculosis patients: a cross-sectional study

10.21203/rs.3.rs-25273/v3 ◽

2020 ◽

Author(s):

Xu Chen ◽

Liang Du ◽

Ruiheng Wu ◽

Jia Xu ◽

Haoqiang Ji ◽

...

Keyword(s):

Medication Adherence ◽

Treatment Adherence ◽

Family Members ◽

National Policy ◽

Policy Support ◽

Patient Relationship ◽

Newly Diagnosed ◽

Cross Sectional ◽

Good Doctor ◽

Tb Treatment

Abstract Background Non-adherence to tuberculosis (TB) treatment is the most important cause of poor TB outcomes, and improving support for TB patients is a primary priority for governments, but there has been little research on the effects of family, social and national policy support factors on TB treatment adherence. The current study evaluated treatment adherence among newly diagnosed TB patients in Dalian, north-eastern China, and determined the effects of family, society, and national policy support factors on treatment adherence. Methods A cross-sectional survey was conducted among newly diagnosed TB patients treated at the outpatient department of Dalian Tuberculosis Hospital from September 2019 to January 2020. Data were collected using a questionnaire that measured medication adherence, family support, social support, and national policy support and so on. Differences between groups were assessed using Chi-square tests and Fisher’s exact tests. Ordinal logistic regression analysis was used to determine the predictors of adherence. Results A total of 481 newly diagnosed TB patients were recruited, of whom 45.7% had good adherence, and 27.4% and 26.8% had moderate and low adherence, respectively. Patients who had family members who frequently supervised medication (OR:0.34, 95% CI:0.16-0.70), family members who often provided spiritual encouragement (OR:0.13, 95% CI:0.02-0.72), a good doctor-patient relationship (OR:0.61, 95% CI:0.40-0.93), more TB-related knowledge (OR:0.49, 95% CI:0.33-0.72) and a high need for TB treatment policy support (OR:0.38, 95% CI:0.22-0.66) had satisfactory medication adherence. However, patients who had a college degree or higher (OR:1.69, 95% CI:1.04-2.74) and who suffered adverse drug reactions (OR:1.45, 95% CI:1.00-2.11) were more likely to have lower adherence. Conclusions Our findings suggested that non-adherence was high in newly diagnosed TB patients. Patients who had family members who frequently supervised medication and provided spiritual encouragement and a good doctor-patient relationship and TB-related knowledge and a high need for policy support contributed to high adherence. It is recommended to strengthen medical staff training and patient and family health education and to increase financial support for improving adherence.

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Tuberculosis Treatment Outcome In Patients With Tb-Hiv Co-Infection In Kuala Lumpur, Malaysia

10.21203/rs.2.16876/v1 ◽

2019 ◽

Author(s):

Diana Safraa Selimin ◽

Aniza Ismail ◽

Norfazilah Ahmad ◽

Rohani Ismail ◽

Nurul Farhana Mohd Azman ◽

...

Keyword(s):

Treatment Outcome ◽

Healthcare Providers ◽

Risk Groups ◽

Health Department ◽

Cross Sectional Study ◽

National Database ◽

Kuala Lumpur ◽

Treatment Rate ◽

Cross Sectional ◽

Tb Treatment

Abstract Background Tuberculosis (TB) is a serious health threat to people living with human immunodeficiency virus (HIV). This study aimed to identify the characteristics, unsuccessful TB treatment rate and determinants of unsuccessful TB treatment outcome among patients with TB-HIV co-infection in Kuala Lumpur.Methods This was a cross-sectional study. The data of all patients with TB-HIV in the federal territory of Kuala Lumpur from 2013 to 2017 were collected and reviewed. The data were retrieved from the national database (TB Information System) at the Kuala Lumpur Health Department from 1 March 2018 to 31 May 2018.Results Out of 235 randomly selected patients with TB-HIV, TB treatment outcome was successful in 57.9% (cured and completed treatment) and unsuccessful in 42.1% (died, failed or defaulted treatment). Patients who did not receive DOTS (directly observed treatment, short course) (adjusted odds ratio [aOR] 21.71; 95% confidence interval [CI]: 5.36–87.94) and those who received shorter treatment duration of <6 months (aOR 34.54; 95% CI: 5.97–199.93) had higher odds for unsuccessful TB treatment outcome.Conclusions Nearly half of the patients with TB-HIV had unsuccessful TB treatment outcome. Therefore, it is important to ensure that such patients receive DOTS and continuous TB treatment of >6 months. It is crucial to strengthen and widen the coverage of DOTS, especially among high-risk groups, in healthcare settings. Strict follow-up by healthcare providers is needed for patients with TB-HIV to gain treatment adherence and for better rates of successful TB treatment.

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