‘They are inconveniencing us’ - Exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: Perspectives from patients and clinicians in the Free State Province, South Africa.

Abstract Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and limited health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. Methods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. We used thematic analysis with deductive and inductive approaches. Results: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient’s TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients did not follow their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude. Conclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care. Keywords: tuberculosis TB, adherence, messaging, loss to follow up, knowledge, health literacy, patient-centered care

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‘They are inconveniencing us’ - exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: perspectives from patients and clinicians in the Free State Province, South Africa

BMC Public Health ◽

10.1186/s12889-020-08562-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

N. Moodley ◽

A. Saimen ◽

N. Zakhura ◽

D. Motau ◽

G. Setswe ◽

...

Keyword(s):

South Africa ◽

Patient Education ◽

Treatment Adherence ◽

Free State ◽

Free State Province ◽

Tb Treatment

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Factors associated with loss to follow-up among people with tuberculosis in the country of Georgia: a cohort study

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1705 ◽

2021 ◽

Vol 91 (1) ◽

Author(s):

Natalia Adamashvili ◽

Kristina Akopyan ◽

Nestani Tukvadze ◽

Kostyantyn Dumchev ◽

Yuliia Sereda ◽

...

Keyword(s):

Cohort Study ◽

Universal Access ◽

Treatment Interruption ◽

Second Line ◽

First Line ◽

Loss To Follow Up ◽

Pulmonary Tb ◽

Factors Associated ◽

Tb Treatment

Despite having universal access to tuberculosis (TB) treatment, loss to follow-up (LFU) rates remain high in Georgia, 6% among drug-susceptible TB (DS-TB) patients (2017 cohort) and 19% among drug-resistant TB (DR-TB) patients diagnosed in 2016. A cohort study was conducted to analyze secondary data from the Georgian National Tuberculosis Surveillance Database. Study population included adult (≥18 y.o.) patients with bacteriologically confirmed pulmonary TB who were enrolled in Georgian National TB program during 2015-2017. The outcome of interest was loss to follow-up, defined as treatment interruption for more than 2 consecutive months. Patients were stratified by treatment profile (first-line drugs or second-line drugs) and survival analysis was performed within the stratified groups. A total of 7860 treatment episodes were identified during 2015-2017 which corresponded to 6696 bacteriologically confirmed pulmonary TB treatment episodes of whom 795 (12%) were LFU. After adjustment, final multivariate analysis showed that male sex (aHR 1.5, 95%CI 1.2-2.0), being diagnosed in Tbilisi (aHR 1.3, 95%CI 1.1-1.6), unemployment at the time of diagnosis (aHR 1.7, 95%Ci 1.2-2.3) and previous history of TB treatment were independent risk factors for LFU (aHR 2.3, 95%CI 1.9-2.8) among patients on first-line drugs. Among patients on second-line drugs being male (aHR 2.0, 95%CI 1.2-3.2), past TB treatment with second-line drugs (aHR 2.2, 95%CI 1.5-3.2) were significantly associated with LFU. LFU rate was high among patients on first-line drugs and second line drugs (10% and 22% respectively). Patients with past TB treatment history should further research to identify factors that lead to treatment interruption in this group. Other factors associated with LFU (being internally displaced person (IDP), being unemployed, and having imprisonment history) were in some level indication of a poor social-economic status, and strengthening approaches for TB care based on patients’ need could be considered in light of this finding.

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High rates of death and loss to follow-up by 12 months of rifampicin resistant TB treatment in South Africa

PLoS ONE ◽

10.1371/journal.pone.0205463 ◽

2018 ◽

Vol 13 (10) ◽

pp. e0205463 ◽

Cited By ~ 1

Author(s):

Kamban Hirasen ◽

Rebecca Berhanu ◽

Denise Evans ◽

Sydney Rosen ◽

Ian Sanne ◽

...

Keyword(s):

South Africa ◽

Loss To Follow Up ◽

Tb Treatment ◽

Death And Loss

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USING DRONE TECHNOLOGY, PHOTOGRAMMETRY, AND VIRTUAL REALITY IN THE ANALYSIS OF REMOTE AND INACCESSIBLE CLASSIC LOCALITIES: THE VERTEBRATE-DEFINED PERMIAN–TRIASSIC SECTION ON THE BETHEL FARM, FREE STATE PROVINCE, SOUTH AFRICA

10.1130/abs/2018am-318053 ◽

2018 ◽

Author(s):

Timothy R. Stonesifer ◽

◽

Ruofei Jia ◽

Robert A. Gastaldo ◽

Johann Neveling

Keyword(s):

South Africa ◽

Virtual Reality ◽

Free State ◽

Free State Province

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Evaluation of adherence monitoring system using evriMED with a differentiated response compared to standard of care among drug-sensitive TB patients in three provinces in South Africa: a protocol for a cluster randomised control trial

Trials ◽

10.1186/s13063-021-05337-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Noriah Maraba ◽

Catherine Orrell ◽

Candice M. Chetty-Makkan ◽

Kavindhran Velen ◽

Rachel Mukora ◽

...

Keyword(s):

South Africa ◽

Treatment Success ◽

Standard Of Care ◽

Treatment Completion ◽

Phone Call ◽

Randomised Control Trial ◽

Improve Medication Adherence ◽

Tb Treatment ◽

Differentiated Care

Abstract Background South Africa has achieved drug-susceptible TB (DS-TB) treatment success of only 77% among people with new and previously treated TB. Alternative approaches are required to improve medication adherence and treatment completion to limit transmission, TB relapse and the development of resistance. This study aims to implement and evaluate the use of adherence medication monitors (Wisepill evriMED 1000) with a differentiated response to patient care, among DS-TB patients in three provinces of South Africa. Methods In total, 18 public health clinics across three provinces were selected. Clinics were randomised to intervention or standard of care clinics. In each clinic, approximately 145 DS-TB patients are being enrolled to reach a total of 2610. All patients have their daily adherence monitored using medication monitors. In the intervention arm, patients are receiving medication monitor reminders and differentiated care in response to adherence data. This weekly review of daily real-time monitoring will be undertaken from a central database. The differentiated care model includes automated SMS reminders with a missed dose, research staff-initiated phone call to the patient with a second or third missed dose, a home visit if four or more doses are missed, and motivational counselling if four or more doses are missed repeatedly. Fidelity of the intervention will be measured through process evaluation. Patients in control clinics will receive medication monitors for adherence tracking, standard of care TB education, and normal clinic follow-up procedures. The primary outcome is the proportion of patients by arm with >80% adherence, as measured by the medication monitor. The feasibility and acceptability of the intervention will be assessed by in-depth interviews with patients, stakeholders, and study staff. A cost effectiveness analysis of the intervention and standard of care clinics will be conducted. Significance This trial will provide evidence for the use of an intervention, including medication monitors and differentiated care package, to improve adherence to TB treatment. Improved adherence should also improve TB treatment completion rates, thus reducing loss to follow-up rates, and TB relapse among people with TB. The intervention is intended to ultimately improve overall TB control and reduce TB transmission in South Africa. Trial registration Pan African Trial Registry PACTR201902681157721. Registered on 11 February 2019.

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