Treatment Adherence Of Tuberculosis Patients Research Articles

Factors Affecting Treatment Adherence Among Patients with Tuberculosis in Indonesia: Literature Review

Introduction: Tuberculosis (TB) is the leading cause of death from infectious diseases in the world and Indonesia is the second largest contributor to TB cases after India. Treatment adherence problems are a major obstacle to TB elimination. The purpose of this Literature Review is to determine the factors that affect treatment adherence among TB patients in Indonesia.
 Methods: Literature obtained from Science Direct, PubMed, and Google Scholar; published from 2018 – 2023, research from reputable international journals and from national journals at least with SINTA 3, located in Indonesia. Indonesian and English with full text of all types of research designs. Article selection was carried out using the method "Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and analyzed using descriptive analysis techniques.
 Results: A total of 225 articels were deemed appropriate for the topic, but only 15 articles were included based on inclusion criteria. It was found that there are several factors that affect treatment adherence in tuberculosis patients in Indonesia, namely: predisposing factors as many as 11 articles (age, education, occupation, knowledge, self-efficacy, concordance, health behavior, motivation, marital status, income level, drug side effects, already feeling cured, and duration of treatment). Reinforcing factors as many as 2 articles (family support). Enabling factors as many as 5 articles (the role of officers, reminder SMS messages from officers, health counseling, and distance of residence to health services).
 Conclusion: The most dominant factor affecting treatment adherence among tuberculosis patients in Indonesia is the Predesposising factors, namely education and sefl-efficacy.

Effect of face-to-face psychoeducation intervention combined with motivational interviewing on adherence in prevention and treatment of pulmonary tuberculosis patients

Introduction: TB can be cured if patients routinely seek treatment for six months without breaking. Poor adherence to tuberculosis treatment is a global health challenge. Whereas adherence to the treatment regimen is important for tuberculosis (TB) control. The consequences of this non-compliance lead to treatment failure and the risk of infection of the disease is widespread. Objectives: The objective of the study is to examine what Face-to-Face Psychoeducation Intervention Combined with Motivational Interviewing effective to improve Adherence in Prevention and Treatment of Pulmonary Tuberculosis Patients. Methods: The research design used quantitative with experimental quasi research design t. The research was conducted at 4 Community Health Centers (Puskesmas), namely Puskesmas Takal, Puskesmas Perak, Puskesmas Pegirian and Puskesmas Sutopo in Surabaya. Through purposive sampling, the sample number was 60 respondents, divided by 30 respondents for the intervention group and 30 respondents for the control group. Results: There was a significant difference after the intervention. In the intervention group, there were changes in outcomes in both preventive adherence (12.37) and medication adherence (4.52). While in the control group, only the value of prevention compliance experienced a change of 5.67. Conclusions: Face-to-face method combined with motivation interviewing is effective in improving prevention and treatment adherence in TB patients. Motivational interviewing has a tendency to reduce hopelessness, an increasing motivation to recover and the admonition of taking medication in tuberculosis patients.

How Integrated Digital Tools Can Improve Tuberculosis Medication Adherence: A Longitudinal Study in China.

Background: Poor medication adherence remains one of the major problems in the treatment of tuberculosis (TB) patients, while digital technologies have been proven effective to improve the treatment results. However, reports on the effectiveness of comprehensive practice integrating different intervention methods and technologies are limited. The aim of this study is to evaluate the effectiveness of an integrated digital adherence intervention for TB patients. Methods: We developed a digital adherence intervention platform integrating instant WeChat message, electronic medication monitors (EMMs), and manual reminders. The primary goal of the platform was to improve the accessibility of digital adherence technologies, and thus improve treatment adherence. TB patients were newly diagnosed at 10 TB-designated hospitals and came from 220 communities, from January to June 2022. The basic characteristics and treatment adherence of TB patients in WeChat, EMM, and conventional groups were compared, and the influencing factors of high medication adherence were analyzed by logistic regression. Results: A total of 2,498 TB patients were enrolled in the study, 14.5% were managed by digital technologies, 9.5% by WeChat, and 5.0% by EMM, respectively. After intervention, the median medication rate of TB patients was significantly higher in the WeChat group (95.3%) and EMM group (95.7%) compared with that of the conventional group (83.8%). On the contrary, the median number of missed medications among patients of the conventional group (nine times) was significantly higher than that in the WeChat (three times) group and EMM (three times) group. The proportion of high adherence (adherence medication rate ≥90%) among TB patients was 64.7%, 64.5%, and 43.2% in WeChat, EMM, and conventional group, respectively. Conclusions: The application of the integrated digital adherence intervention platform could significantly improve medication adherence among TB patients. The accessibility of digital adherence technologies could be improved by integrating complementary technologies in practice.

Meta-Analysis: Drug Side Effect, Smoking, Alcohol Consumptions and Their Relationships with Drug Taking Adherence in Tuberkulosis Patients

Background: Inappropriate tuberculosis treatment is a major determinant of multidrug-resistant tuberculosis (MDR) TB, which is related to patient adherence to treatment. There are several factors that affect MDR-TB such as drug side effects, smoking and alcohol consumption. The aim is to estimate the magnitude of the effect of drug side effects on tuberculosis treatment adherence, based on the results of a number of similar primary studies. Subjects and Method: This study is a systematic review and meta-analysis research. Article search was carried out based on the eligibility criteria of the PICO model including: P= Tuberculosis patient; I= drug side effects, smoking and alcohol consumption; C= no drug side effects, no smoking and no alcohol consumption; O= Tuberculosis treatment adherence. Articles were collected from Google scholar, PubMed, Science Direct, and Springerlink. Keywords using “drug side effects” OR “tobacco smoking” OR “alcohol consumption” OR “tuberculosis” AND “medication adherence” AND “cross sectional” AND “adjusted odds ratio”. Inclusion criteria in this study included articles with a cross-sectional study design, the relationship size used was the adjusted Odds Ratio (aOR), articles published in the 2009 to 2022 range. Selected articles were tested for eligibility using CEBM and analyzed using the PRISMA diagram and the Review Manager 5.3 application. Results: 14 Cross-sectional studies were selected for the meta-analysis of 8 studies with 2,045 TB patients showed that drug side effects reduced TB treatment adherence by 0.26 times than no drug side effects (aOR= 0.26; 95% CI= 0.14 to 0.49; p< 0.001). 7 studies with 2,966 TB patients showed that alcohol consumption decreased TB treatment adherence by 0.61 times than not consuming alcohol (aOR= 0.61; 95% CI= 0.32 to 1.16; p= 0.130). Study 6 with 1,748 TB patients showed that smoking decreased TB treatment adherence by 0.86 times than non-smokers (aOR= 0.86; 95% CI= 0.17 to 4.37; p= 0.850). Conclusion: Side effects of drugs, alcohol, and smoking reduce treatment adherence in tuberculosis patients. Keywords: drug side effects, alcohol consumption, smoking, treatment adherence Correspondence: Aem Ismail. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: aem.ismail80@gmail.com. Mobile: +6282133114822.

High-performance Liquid Chromatography based Methods for Determination of Antitubercular Drugs in Urine Samples: A Scoping Review

Introduction: Tuberculosis (TB) is a contagious disease and is one of the leading causes of death worldwide. TB is primarily caused by Mycobacterium Tuberculosis (MTB) and the percentage of Multi-Drug Resistance TB (MDR-TB) and Extensively Drug Resistance TB (XDR-TB) is increasing daily in many developing countries. Aim: To summarise different High-performance Liquid Chromatography (HPLC)-based methods for checking treatment adherence and drug monitoring of patients by estimating the amount of Anti-tubercular (Anti-TB) drugs in urine samples. Materials and Methods: The authors conducted a search and screened various databases (PubMed, Scopus, Web of Science, Google Scholar) using different keywords between April 2023 and June 2023. The authors included original research articles, clinical trials, and observational studies that focused on estimating anti-TB drugs in urine samples using HPLC. The authors excluded articles that employed methods other than HPLC for drug estimation in urine samples. A total of 13 articles were included in this review. Results: The authors identified 296 articles from different electronic databases and four articles from other sources (Google Scholar, ResearchGate, etc.). Ultimately, 13 articles were included describing HPLC-based methods for determining anti-TB drugs in urine samples. Data was extracted focusing on mobile phases and sample preparation/extraction procedures. Two articles of 2004 and 2014 reported simple mobile phases and sample preparation methods for estimating rifampicin and isoniazid. Additionally, articles published in the last five years have employed simple mobile phases with minimal or no extraction procedures. Conclusion: The present review summarises various HPLCbased methods reported in the literature, as it is considered the gold standard method for checking treatment adherence in TB patients. Urine samples were chosen for ease of collection, particularly from patients of different age groups, including the paediatric population. This review highlights the need for more HPLC-based methods with simple mobile phases and extraction procedures for early detection of anti-TB drugs in resource-poor settings.

Economy, Service Distance and Physical Impairment as the Main Factors of Non-Adherence of Tuberculosis Patients in Districts/Cities

Increased treatment adherence in tuberculosis patients can control and reduce the incidence of tuberculosis, thereby improving the quality of life of the community. TB control must be carried out jointly by involving all levels of society, including health workers, community organizations, religious organizations, government, and the private sector. Compliance of pulmonary tuberculosis patients in taking medication is the key to successful tuberculosis treatment. This study aimed to explore the main indicators causing non-compliance of tuberculosis patients in taking the medication regularly. This research is a qualitative study with a phenomenological approach. Data were collected using in-depth interviews and then analyzed with Atlas. ti. The informants in this study consisted of fifteen people consisting of five people with tuberculosis, five patients' families, and five health workers. The results of this study found three themes, namely (1) Economy, (2) Distance of service, and (3) Impact of disease. It was concluded that these three indicators are the most important things that cause patients to finally decide to stop taking medicine even though they are basically willing to comply and routinely take medicine every day. It is suggested that there should be good cooperation between Puskesmas officers, village midwives, and village officials to facilitate this problem indicator.

Treatment adherence in outpatient Tuberculosis patientsatHa Tinh Lung hospital in 2022 and some associatedfactors

Background: Treatment adherence is considered as important and pivotal in the treatment andmanagement of Tuberculosis (TB) patients. This is still a big challenge of VietnamNationalTuberculosisControl Program, especially in the newcontext of the prolongedCOVID-19pandemic.Objectives: To describe the status of adherence to treatment and to identify some factorsaৼectingto the treatment adherence of TB patients. Methods: Cross-sectional study design using quantitative combined with qualitativemethodswasapplied. All 109 TB patients were selected for interviews with a structured questionnaireand23 in-depth interviews were conducted with TB patients, patients' family members andhealthworkers. Evaluation of electronic information through assessment of adherence tomedicationuse,compliance with follow-up visits and compliance with periodic testing. Results: The study collected information from 109 TB patients, 10 patients' family membersand03health workers involved in the outpatient TB management process. Adherence rate of TBpatientswas 45.9%. Some factors aৼecting the treatment adherence of TB patients include: educationlevel, average income, other comorbidities, Tuberculosis knowledge and understandingof TBtreatment adherence, family and relatives' help and support; supportive social organizations;patients aৼected by the COVID-19 epidemic; the supervision and support of healthworkers, theform of reminders of medication time and follow-up visits; undesirable eৼects of anti-tuberculosisdrugs, patients are provided with information about TB by health workers andTBinformationcenters, and patients' satisfaction with the provision of medical services. Conclusions: The rate of adherence to treatment of TB patients is still low. It is necessarytohavesolutionsto enhance treatment adherence of TB patients, thereby improving the eৼectiveness of treatment.

Meta-Analysis: The Effect of Social Support on Medication Treatment Adherence in Tuberculosis Patients

Background: Tuberculosis is a disease that can be cured by various methods of treatment. How­ever, tuberculosis treatment is often not carried out properly and completely. The importance of medication adherence as a top priority in the effectiveness of treatment of tuberculosis patients through social support. The purpose of this study was to analyze the effect of social support on medication adherence in tuberculosis patients. Subjects and Method : This meta-analysis study used the PRISMA flowchart guideline with PICO, Population= Tuberculosis patients. Intervention= social support. Comparison= without social support. Outcome= medication adherence. The search process was carried out between 2017 and 2022 using Google Scholar, PubMed, Sci-Hub, and Science Direct databases. The keywords used were "Medication Adherence" OR "Drug Adherence" OR "Adherence" OR " treatment adhe­rence" AND "Tuberculosis" OR "multidrug resistant tuberculosis*" OR "Mycobacterium tuber­culosis Infection" AND "Social Support" OR "Social Support System" OR "Psychosocial Support System" OR "Support System". Based on the database, there are 10 articles that fulfill the inclusion criteria. Study analysis was using review manager 5.3 software. Results: There were 10 articles from the continents of Asia and Africa selected in this meta-analysis, the results showed that the presence of social support has the possibility to increase adherence to anti-tuberculosis treatment compared to without social support in tuberculosis patients and it was statistically significant (aOR= 2.10; CI 95%= 1.76 to 2.52; p< 0.001). Conclusion: Tuberculosis patients who have strong social support about tuberculosis adherence are more likely to adhere to anti-tuberculosis treatment. Keywords: tuberculosis, social support, medication adherence, meta-analysis. Correspondence: Lily Nabillah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: lilynabillah09@gmail.com. Mobile: +62 821-1135-6435. Journal of Health Promotion and Behavior (2022), 07(03): 250-261 DOI: https://doi.org/10.26911/thejhpb.2022.07.03.07

Family Function and Treatment Adherence of People Infected with tuberculosis in Peru: A Multicenter Observational Study

<h3>Background</h3> Tuberculosis (TB) is a major public health problem in Peru. There is limited research about the effect of family function on treatment adherence in South America, and no published Peruvian studies. The purpose of this study was to 1) Report the treatment adherence of TB patients, and 2) Evaluate the effect of family function on treatment adherence. <h3>Methods</h3> This was a cross-sectional instrument study conducted in an integrated network of 16 primary care centers in Lima (Peru). An a priori power analysis indicated a 160 sample to detect a significant result. A three-part instrument (15-items) was used for data collection: Sociodemographic (6-items); Family APGAR (5-items) for family function; and Medication Adherence Questionnaire (4-items) for treatment adherence; all valid and reliable Spanish versions previously used in Peru. <h3>Results</h3> A total of 189 (81%) participants with drug-sensitive TB completed the survey. Very few participants (10%) reported treatment adherence. Participants in a relationship more frequently reported adherence (42.1%; p < 0.05), single participants more frequently reported nonadherence (55.3%; p < 0.05), while nonadherent participants more often reported moderate family dysfunction (38.8%; p=0.002). In multivariate analysis, family function was a risk factor for nonadherence, more pronounced with moderate dysfunction (OR=12.8; CI 95% 2.90-56.70). The risk decreased in the direction of good family function (OR=7.58; CI 95% 1.36-42.09) compared to the severe dysfunction, but not linearly. In the adjusted model, the same behavior was observed as the relation between moderate dysfunction and nonadherence remained statistical significance with an OR of 9.89 (CI95% 1.89-51.66) adjusted for the sociodemographic variables. <h3>Conclusions</h3> The participants reported very low treatment adherence in comparison to previous government estimates and other South American studies. The findings suggest treatment adherence is associated with family function. Further qualitative research may be important to explain the low treatment adherence and to further explore the relationship with family function.

Using a Mobile Health Intervention (DOT Selfie) With Transfer of Social Bundle Incentives to Increase Treatment Adherence in Tuberculosis Patients in Uganda: Protocol for a Randomized Controlled Trial.

BackgroundThe World Health Organization’s End TB Strategy envisions a world free of tuberculosis (TB)—free of deaths, disease, and suffering due to TB—by 2035. Nonadherence reduces cure rates, prolongs infectiousness, and contributes to the emergence of multidrug-resistant TB (MDR-TB). Moreover, MDR-TB is a growing, complex, and costly problem that presents a major obstacle to TB control. Directly observed therapy (DOT) for treatment adherence monitoring is the recommended standard; however, it is challenging to implement at scale because it is labor-intensive. Mobile health interventions can facilitate remote adherence monitoring and minimize the costs and inconveniences associated with standard DOT.ObjectiveThe study aims to evaluate the effectiveness of using video directly observed therapy (VDOT) plus incentives to improve medication adherence in TB treatment versus usual-care DOT in an African context.MethodsThe DOT Selfie study is an open-label, randomized controlled trial (RCT) with 2 parallel groups, in which 144 adult patients with TB aged 18-65 years will be randomly assigned to receive the usual-care DOT monitoring or VDOT as the intervention. The intervention will consist of a smartphone app, a weekly internet subscription, translated text message reminders, and incentives for those who adhere. The participant will use a smartphone to record and send time-stamped encrypted videos showing their daily medication ingestion. This video component will directly substitute the need for daily face-to-face meetings between the health provider and patients. We hypothesize that the VDOT intervention will be more effective because it allows patients to swallow their pills anywhere, anytime. Moreover, patients will receive mobile-phone–based “social bundle” incentives to motivate adherence to continued daily submission of videos to the health system. The health providers will log into a secured computer system to verify treatment adherence, document missed doses, investigate the reasons for missed doses, and follow prespecified protocol measures to re-establish medication adherence. The primary endpoint is the adherence level as measured by the fraction of expected doses observed over the treatment period. The main secondary outcome will be time-to-treatment completion in both groups.ResultsThis study was funded in 2019. Enrollment began in July and is expected to be completed by November 2020. Data collection and follow-up are expected to be completed by June 2021. Results from the analyses based on the primary endpoint are expected to be submitted for publication by December 2021.ConclusionsThis random control trial will be among the first to evaluate the effectiveness of VDOT within an African setting. The results will provide robust scientific evidence on the implementation and adoption of mobile health (mHealth) tools, coupled with incentives to motivate TB medication adherence. If successful, VDOT will apply to other low-income settings and a range of chronic diseases with lifelong treatment, such as HIV/AIDs.Trial RegistrationClinicalTrials.gov NCT04134689; http://clinicaltrials.gov/ct2/show/NCT04134689International Registered Report Identifier (IRRID)DERR1-10.2196/18029

Barriers to treatment adherence of tuberculosis patients: A qualitative study in West Bengal, India

Background: Defaulter (loss to follow-up) tuberculosis (TB) patients present a challenge to TB program by increasing drug resistance and transmission. Knowing factors contributing to non-adherence to TB treatment might help the program implementers to develop appropriate strategies to tackle the problem. Objectives: The objectives of this study were to explore factors contributing to non-adherence among defaulter TB patients and to delve into the perceived barriers to adherence according to directly observed treatment, short-course (DOTS) providers and staffs of TB unit (TU) at Burdwan Municipality. Materials and Methods: A total of 14 in-depth interviews of defaulter TB patients, 4 focus group discussions with 30 DOTS provider, and 4 key informant interviews with staffs of TU were conducted from May to November 2017 at Burdwan Municipality, West Bengal. The analysis of free list and pile sort data obtained was undertaken using Anthropac 4.98.1/X Software. Results: Key reasons contributing to default appeared to be addiction, improvement and non-improvement of symptoms, side effect and pill burden with long regime of the drugs, loss of daily wages, lack of awareness, stigma, poverty, non-referral by private practitioner, familial problem, negative counseling by friends, and perceptions of government medicines are bad. Conclusion: Triangulation of the response from patients, DOTS providers, TB health visitors, and senior treatment supervisor divulged certain contributing factors for non-adherence to TB treatment in the municipality such as addiction and side effect of the drug. Policymakers may consider inclusion of causality analysis and psychological counseling in the program for assessing true burden of drug-related adverse effects and for fighting the effect of addiction, respectively.

Digitalization Leverages Notification and Treatment Adherence of Tuberculosis Patients in Private Sector: Pilot Study From India

Digitalization Leverages Notification and Treatment Adherence of Tuberculosis Patients in Private Sector: Pilot Study From India

Treatment Adherence of Tuberculosis Patients Attending Two Reference Units in Equatorial Guinea.

Equatorial Guinea has one of the highest burden of tuberculosis (TB) in Africa. Incomplete adherence to TB treatment has been identified as one of the most serious remaining problem in tuberculosis control. The following study is aimed at determining the adherence to anti-tuberculosis treatment in Equatorial Guinea and its determinants, as well as at assessing the knowledge of the people about the disease. In this cross-sectional study, participants were recruited by non-probabilistic consecutive sampling amongst patients who attended the reference units for TB in Bata and Malabo between March and July 2015. Socio-demographic and clinical data were collected. Adherence to treatment and knowledge about TB were assessed by Morisky-Green-Levine and Batalla tests and a questionnaire on adherence related factors specifically prepared for this research. Descriptive statistics were computed to summarize the data and bivariate analyses by adherence profile were performed with χ2 test for categorical data. A total of 98 patients with TB were interviewed. 63.27% of interviewees had good knowledge about TB (Batalla test) while 78.57% of respondents were adherent according to the Morisky-Green-Levine test. A low educational level, lack of family support and lack of medical advice about the disease were significantly associated to lower adherence level. Patients with re-infection (due to relapse or treatment failure) and those who have suffered from drug shortages were also less adherents. The National Programme for TB Control should consider improving the early diagnosis and follow-up of TB cases, as well as the implementation of all components of DOTS (Directly observed Treatment, short-course) strategy all over the country.

Study of streptomycin-induced ototoxicity: protocol for a longitudinal study

Hearing impairment is due to various causes including ototoxicity from aminoglycosides. The susceptibility to aminoglycosides increases in the presence of certain mitochondria gene mutations. There is unrestrained use of aminoglycosides in many developing nations which may worsen the burden of hearing impairment in these countries but there is lack of data to drive required policy changes. Streptomycin (an aminoglycoside) is part of the drug regimen in re-treatment of tuberculosis. Exploring the impact of streptomycin ototoxicity in tuberculosis patients provides a unique opportunity to study aminoglycoside ototoxicity within the population thus providing data that can inform policy. Also, since streptomycin ototoxicity could adversely affect treatment adherence in tuberculosis patients this study could enable better pre-treatment counseling with subsequent better treatment adherence. Patients on tuberculosis re-treatment will be recruited longitudinally from Direct Observation Therapy-Short course centers. A baseline full audiologic assessment will be done before commencement of treatment and after completion of treatment. Early detection of ototoxicity will be determined using the American Speech and Hearing Association criteria and genetic analysis to determine relevant mitochondria gene mutations will be done. The incidence of ototoxicity in the cohort will be analyzed. Both Kaplan–Meier survival curve and Cox proportional hazards tests will be utilized to determine factors associated with development of ototoxicity and to examine association between genotype status and ototoxicity. This study will provide data on the burden and associated predictors of developing aminoglycoside induced ototoxicity. This will inform public health strategies to regulate aminoglycoside usage and optimization of treatment adherence and the management of drug-induced ototoxicity among TB patients. Furthermore the study will describe mitochondrial gene mutations associated with ototoxicity in the African population.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2429-5) contains supplementary material, which is available to authorized users.

Effects of motivational interviewing on the treatment adherence of Tuberculosis patients

Effects of motivational interviewing on the treatment adherence of Tuberculosis patients

Factors that influence treatment adherence of tuberculosis patients living in Java, Indonesia

Due to nonadherence of tuberculosis (TB) patients to treatment, complications may arise and if remaining infectious, these patients may infect other people with TB. To obtain information about factors associated with nonadherence, we performed a study comparing adherent and nonadherent TB patients. Adherent and nonadherent patients randomly selected from hospital records in one urban and two rural districts were interviewed using semi-structured questionnaires. Key informant interviews were done with TB nurses and doctors. The most frequently mentioned reason for nonadherence to treatment was feeling better. Although the drugs were given free of charge, many patients were nonadherent because of lack of money. Social support was considered very important for adherence. The study indicated that some patients had a negative image about the health care staff, treatment, and quality of medication. Treatment adherence of TB patients receiving treatment in hospitals in Central Java might be improved by providing health education about treatment duration and side effects, facilitating procedures for receiving treatment free of charge and reducing costs of transportation and consultation. Qualified friendly health care staff able to motivate patients might further improve adherence.

Impact of socio-psychological factors on treatment adherence of TB patients in Russia

The aim of this study was to assess the impact of social and psychological factors on treatment adherence of patients with tuberculosis (TB). To this end a cross-sectional questionnaire-based study was conducted among TB patients in four Russian regions (Orel, Vladimir, Belgorod oblasts, and Republic of Mari-El) from 01/04/2004 to 31/03/2005. A total of 87 non-adherent and 1302 adherent patients were interviewed. Compared to adherents, non-adherents were significantly more likely to be male, unemployed, have a technical college education, have a history of imprisonment, have a negative emotional status, consider themselves "not sick", not know the treatment period, have negative feelings and distrust for medical staff, not believe they will fully recover, and not want to continue treatment. Patients at highest risk for non-adherence should be identified at the start of treatment, and offered the services of a psychologist. A case management and patient-centered approach should be applied.

FACTORS AFFECTING TREATMENT ADHERENCE OF TUBERCULOSIS PATIENTS AT SAMITIVEJ SRINAKARIN HOSPITAL

PURPOSE: To determine treatment completeness and social factors affecting treatment adherence of tuberculosis patients at Samitivej Srinakarin Hospital.