Patient-perceived treatment burden of tuberculosis treatment.

Natasha C. H. Ting,Claudia C. Dobler,Nicole El-Turk,Michael S. H. Chou,Vijayaprasad Gopichandran

doi:10.1371/journal.pone.0241124

Natasha C. H. Ting, Claudia C. Dobler + Show 3 more

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https://doi.org/10.1371/journal.pone.0241124

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Abstract

BackgroundTreatment for tuberculosis lasts for a minimum of 6 months. The treatment burden experienced by patients in a low-incidence setting where directly observed therapy is the standard of care is not well-known.MethodsPatients receiving tuberculosis treatment through the chest clinic at a tertiary hospital in Sydney, Australia, participated in a semi-structured interview. The interviews explored the treatment burden experienced by patients and possible solutions to ameliorate this burden. Interviews were conducted until data saturation was achieved. They were recorded, transcribed and analysed using NVivo 12 software.ResultsTwenty participants (80% male, mean age 40 years) with pulmonary (n = 13) and extra-pulmonary (n = 7) tuberculosis were interviewed. Participants experienced healthcare, financial, social and medication burdens along with lifestyle changes due to treatment. Medication intake was challenging due to the high number of pills, and 55% (n = 11) of patients experienced fatigue amongst other side effects. Patients found clinic-based directly observed therapy inconvenient, especially those working and/or studying. Suggestions to lessen treatment burden included reducing medication burden and better access to health services.ConclusionTuberculosis treatment is associated with substantial treatment burden for patients. Measures to reduce treatment burden including alternative treatment delivery methods which are more accommodating to patients than clinic-based directly observed therapy, such as video directly observed therapy or partially self -administered treatment, should be considered on a case-by-case basis.

Highlights

First-line treatment for drug-sensitive tuberculosis (TB) as outlined by the World Health Organization (WHO) involves a combination of isoniazid, rifampicin, pyrazinamide and ethambutol for a minimum of 6 months [1]
Receiving TB treatment can worsen real or perceived stigma associated with TB, as patients might fear that people around them will learn about their disease when they know that they are attending the TB clinic
Given the lack of evidence that clinic-based directly observed therapy (DOT) improves TB treatment completion and cure [3] but anecdotal experience of a significant treatment burden associated with DOT in our patients, we aimed to explore the treatment burden associated with TB treatment in a lowincidence setting for TB, where clinic-based and video DOT are commonly used, and to explore ways to alleviate treatment burden

Summary

Introduction

First-line treatment for drug-sensitive tuberculosis (TB) as outlined by the World Health Organization (WHO) involves a combination of isoniazid, rifampicin, pyrazinamide and ethambutol for a minimum of 6 months [1]. Treatment burden is the workload that a patient must manage to take care of their health and its impact on the patient’s daily life [4]. Previous interview studies have demonstrated that there is a ‘pill burden’ caused by the many tablets that patients must consume and related medication side effects [8, 9]. This burden substantially increases in patients with multi-drug resistant TB with an increased treatment timeframe (up to 24 months) and the inclusion of injectable medications [12]. The treatment burden experienced by patients in a low-incidence setting where directly observed therapy is the standard of care is not well-known

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