Abstract
BackgroundDespite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge. The co-infection between TB and HIV adds to this disease burden. TB is completely curable through the intake of a strict anti-TB drug treatment regimen which requires an extremely high and consistent level of adherence.The aim of this study was to investigate factors associated with adherence to anti-TB and HIV treatment drugs.MethodsA cross-sectional survey method was used. Three study districts (14 primary health care facilities in each) were selected on the basis of the highest TB caseload per clinic. All new TB and new TB retreatment patients were consecutively screened within one month of anti-tuberculosis treatment. The sample comprised of 3107 TB patients who had been on treatment for at least three weeks and a sub-sample of the total sample were on both anti-TB treatment and anti-retro-viral therapy(ART) (N = 757). Data collection tools included: a Socio-Demographic Questionnaire; a Post-Traumatic-Stress-Disorder (PTSD) Screen; a Psychological Distress Scale; the Alcohol Use Disorder Identification Test (AUDIT); and self-report measures of tobacco use, perceived health status and adherence to anti-TB drugs and ART.ResultsThe majority of the participants (N = 3107) were new TB cases with a 55.9% HIV co-infection rate in this adult male and female sample 18 years and older. Significant predictors of non-adherence common to both anti-TB drugs and to dual therapy (ART and anti-TB drugs) included poverty, having one or more co-morbid health condition, being a high risk for alcohol mis-use and a partner who is HIV positive. An additional predictor for non-adherence to anti-TB drugs was tobacco use.ConclusionsA comprehensive treatment programme addressing poverty, alcohol mis-use, tobacco use and psycho-social counseling is indicated for TB patients (with and without HIV). The treatment care package needs to involve not only the health sector but other relevant government sectors, such as social development.
Highlights
Despite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge
In the African region, which accounted for 82% of the new TB cases that were HIV positive, an estimated 900 000 (39%) of the 2.3 million people who developed TB were living with HIV [1]
The public primary health care clinics that were utilized in this study followed the South Africa (SA) Department of Health’s (DoH) Guidelines for TB treatment who in turn are guided by the World Health Organization (WHO) TB treatment guidelines framed by the Stop TB strategy which strongly recommends the DOT programme [16]
Summary
Despite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge. Despite the downward trend in the absolute number of TB cases since 2006 and the fall in the incidence rates since 2001, the burden of tuberculosis (TB) disease remains a global health challenge [1]. TB is completely curable through the intake of a strict drug treatment regimen. The Directly Observed Treatments ShortCourse Strategy (DOTS) introduced by the World Health Organization (WHO) and subsequently the Stop TB Strategy is an inexpensive strategy that could prevent millions of TB cases and deaths. In the African region, which accounted for 82% of the new TB cases that were HIV positive, an estimated 900 000 (39%) of the 2.3 million people who developed TB were living with HIV [1]
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