Public Health Care Practitioner’s Reflections on Tuberculosis Patient’s Perspectives on Factors Influencing their Adherence to the Directly

Abstract

The high prevalence of tuberculosis (TB) in South Africa is well established. TB, Human Immunodeficiency Virus (HIV), and Auto Immune Deficiency Syndrome (AIDS) co-exist, which contributes to the high incidence, prevalence, and recurrent infection rate of TB. Despite the implementation of the Directly Observed Treatment Short Course (DOTS) strategy, a World Health Organisation (WHO) initiative to stop the spread of the disease by 2015, TB continues to threaten the health of many, especially those in under-resourced, communities. TB patients' adherence to the treatment programme (DOTS) is vital to the reduction of the re-infection rate and the prevention of new cases. Health care practitioner's commitment and professional engagement within a patient-centred health care model is essential to the success of the DOTS initiative. th highest TB rate in the world, with a low treatment success rate (1). It is reported that South Africa's cure rate for TB is 57% despite the implementation of the DOTS strategy (2). Consequently, the effectiveness of this strategy has been called into question. Further, the fact that 70% of the budget of the TB Control Programme in SA is going into multi-drug resistant (MDR) and extensively-drug resistant (XDR), TB has been highlighted (2). TB and HIV co-infection are added to the disease burden. TB speeds up the progress of HIV and AIDS and vice versa. The percentage of smear positive cases for TB and HIV co- infection in SA was 24.9% in 2005. Given the epidemio- logical context of TB and TB/HIV/AIDS co-infection, adherence to anti-TB treatment methods, such as the DOTS strategy, is critical. Treatment success is of course also influenced by external factors of the infected individual, such as the overall quality of the health care provided. The aim of this study was to explore, through the use of a focus group, TB health care practitioner's responses to TB patient's understanding of the factors that promote and the factors that serve as barriers to their adherence to the DOTS programme. It was expected that ascertaining health care practitioner's perspectives will assist in improving health care by modifying existing programmes and introducing new and innovative ones. Understanding health care practitioner's perspectives is critical in promoting the anti-TB drive worldwide, primarily because it is well established that the quality of the communication between the patients and the health service practitioner may pose a barrier to adherence (or may indeed improve it) (3). Moreover, there is an evi-