Tuberculosis Treatment Adherence Research Articles

Global Research Trends on Factors Affecting Tuberculosis (TB) Adherence and Dropout: A Bibliometric Study

ABSTRACT Tuberculosis (TB) remains one of the significant global health challenges, especially in resource-limited countries. Adherence to TB treatment is key to successful therapy and preventing the emergence of drug resistance. However, dropout rates or discontinuation of treatment before completion remains a major problem that needs to be addressed. This study aims to analyze global trends in research focusing on factors affecting TB treatment adherence and dropout through a bibliometric approach. Using the Publish or Perish application, relevant scientific articles with keywords such as treatment adherence, tuberculosis, treatment dropout, and influencing factors were searched from 2017 to 2024. A total of 50 articles from Google Scholar were further analyzed to identify by publication year, country, publisher, citation, and article type. The data was then processed using VOSviewer to visualize the relationship between keywords and research trends through Network Visualization, Overlay Visualization, and Density Visualization. The results of the analysis showed that Indonesia is the country with the highest number of publications, demonstrating a great commitment in addressing the TB challenge. Articles published in reputable journals, especially those adopting systematic and meta-analysis approaches, show great impact with a high number of citations. Bibliometric visualizations reveal that the focus of research lies on factors such as treatment, adherence, health workers, and access. In addition, family and community support was also found to be an important element in ensuring treatment adherence. In conclusion, this study emphasizes the need for a comprehensive and collaborative approach in improving TB treatment adherence and preventing dropouts. Further research in this area is needed to address existing gaps and develop more effective strategies in the fight against TB. Keywords: Treatment Adherence, Tuberculosis, Dropout, Influencing Factors, Health Worker

Sociodemographic factors affecting knowledge levels of tuberculosis patients in New Delhi

ABSTRACT Background: Sociodemographic factors can significantly influence the knowledge level of tuberculosis (TB) patients, affecting the overall health outcomes. Due to lack of awareness and the stigma associated with TB, Indian TB elimination efforts are facing challenges. Patients with less information are more likely to experience delays in diagnosis and proper care. Method: A cross-sectional study was conducted in New Delhi across 26 operational National TB Elimination Program districts, involving 200 adult pulmonary TB patients receiving treatment from April to August 2020. A structured questionnaire guided the interviews, followed with bivariate analysis and descriptive statistics used for analysis. Results: Predominantly, residents of semiurban regions accounted for the highest proportion (70.5%), followed by urban areas (20.5%), with rural areas/slums comprising a minority (9%). Notably, a significant majority (94.5%) reported residing in individually owned dwellings, with shared accommodations limited to a minority (5.5%). Sanitary facilities varied, with 77% possessing personal toilets, 18.5% utilizing private facilities, and only 4.5% relying on public toilets. Awareness levels about TB reflected moderate awareness among 56% of participants, good knowledge among 41%, and minimal awareness (poor knowledge) among only 3% of respondents. Conclusion: Age, sex, socioeconomic level, kind of lodgings, malnutrition, and personal cleanliness should all be taken into account for TB treatment adherence. A new set of frameworks should be developed to enhance the living circumstances of high-risk populations and patients who are living in crowded locations since sharing a room or a house in a populated region increases the risk of TB transmission.

Evaluating the Effectiveness of “I LIKE VST” Digital Technology in Enhancing Tuberculosis Treatment Adherence in Moldova

This study assessed the acceptance and feasibility of the implementation of Video Supported Treatment (VST) “I LIKE VST” digital application as an approach to increase tuberculosis (TB) treatment adherence in the Republic of Moldova. It employed mixed quantitative and qualitative method among TB patients and healthcare providers. The analysis encompasses socio-demographic factors, adherence levels, technological accessibility, and user experiences with the VST app. Results indicate that VST app method is acceptable and feasible to implement for people who find it convenient, regardless of their level of education. Adherence data from the I LIKE VST system shows that 75% of participants have over 90% adherence rate, due to VST app’s digital nature offering convenience and flexibility. No cases of less than 50% adherence were found. Challenges include technological, financial barriers and the need for patient-centric customization. Less than 2% of TB patients have their own phones which support the app work. Moreover, 13.3% of TB patients and 19.7% medical staff stated that they did not have own resources to cover mobile internet costs, until they were covered by the project. This study demonstrates the effectiveness of digital health interventions in resource-limited settings. The findings are particularly relevant for policymakers and health practitioners aiming to innovate TB treatment adherence strategies.

Knowledge, attitude and perceived barriers related to directly observed treatment, short-course among patients and caregivers attending tuberculosis clinics: a cross-sectional survey.

Tuberculosis (TB) is a major worldwide health problem, particularly in India, where it accounts for a quarter of infections. Adherence to the directly observed treatment, short-course (DOTS), which is necessary for TB treatment, is difficult in resource-limited circumstances. This study addressed the knowledge, attitude, and perceived barriers related to TB and DOTS adherence among patients and caregivers. A cross-sectional survey was undertaken at the selected TB clinics between November 2023 and March 2024. Purposive sample yielded 180 patients and 217 caregivers. Data were obtained using validated, self-structured questionnaires that assessed knowledge, attitude, and perceived barriers to TB and DOTS adherence. Statistical analysis was carried out with IBM SPSS version 23.0. The study found that caregivers had considerably greater TB knowledge than patients (p<0.05). Many patients misunderstood the cause of TB (50.6%) and embraced various misconceptions about the disease, such as TB spreading by shaking hands or sharing food, swimming in a holy river to cure diseases, and TB being the result of sin or karmic retribution. Distance to treatment facilities (95.6%), the necessity to take time off from work (91.7%), and social stigma (65.0%) were identified as the top three barriers to DOTS adherence. The study highlighted considerable gaps in knowledge, distant healthcare facilities, busy work schedules, and social stigma as barriers to TB treatment adherence in Deoghar, Jharkhand. Addressing these challenges via focused education and support activities is essential for enhancing DOTS adherence and TB treatment outcomes.

Enhancing Tuberculosis Treatment Adherence: Evaluating the Efficacy of the Support for Treatment Adherence and Medication Protocols (STAMP) Device for Automatic Dispensing and Real-Time Medication Monitoring.

Tuberculosis (TB) remains a significant global health challenge, necessitating strict adherence to medication for successful treatment and prevention of drug resistance. Adherence to a regular medication regimen is crucial in TB management, yet achieving high adherence rates among patients proves challenging due to various factors including forgetfulness, complexity of treatment schedules, and socioeconomic barriers. This study explores the potential of an automatic medicine dispenser (AMD) anchored system to improve medication adherence among TB patients and evaluates its impact through monitoring and feedback mechanisms. The AMD integrates advanced technology to dispense medications at scheduled times, thereby reducing reliance on patient memory and manual adherence tracking. This device is complemented by a monitoring system where healthcare mentors oversee adherence data in real-time via a web-linked dashboard. Such real-time monitoring enables mentors to promptly intervene in cases of non-adherence, offering personalized support and guidance tailored to individual patient needs. The study employs a mixed-methods approach, combining quantitative analysis of adherence rates derived from the AMD anchored system with qualitative data from patient surveys. These surveys gather insights into patient experiences and perceptions regarding the use of the AMD anchored system, including feedback on the accuracy of medication intake recorded by the device. Data obtained from the surveys are analyzed alongside adherence metrics from the dashboard to elucidate factors influencing adherence behavior and the device's effectiveness in fostering sustained treatment adherence. Preliminary findings indicate promising outcomes associated with the AMD anchored system intervention. High rates of adherence are observed among patients utilizing the device, attributed to the device's automated dispensing mechanism and the supportive role of healthcare mentors. Challenges such as technical malfunctions and patient acceptance are also identified, prompting continuous refinement of the AMD and mentorship strategies. In conclusion, the integration of an AMD coupled with real-time monitoring through a web-linked dashboard represents a significant advancement in TB treatment adherence management. Future research should focus on the scalability and sustainability of this technology-augmented, holistic approach across diverse healthcare settings to maximize its impact on global TB management strategies.

Improving Pulmonary Tuberculosis Treatment Adherence: The role of patient knowledge in Cirebon, West Java, Indonesia

Background: With 10 million cases around the world, pulmonary tuberculosis (TB) has been classified as a highly contagious disease and mostly affecting low and middle countries. Having the second highest incident cases in West Java of Indonesia, Cirebon becomes a challenging city in order to reduce the number of TB cases in the country. Aims: This study aims to identify the patients’ knowledge and treatment phases, and how the two factors encourage patients to comply with their medication. Methods : This cross-sectional observational study was conducted among 91 new pulmonary tuberculosis patients at the Cirebon City Community Lung Health Centre, selected using random sampling. Not only respondent characteristics, but also data on the patients' knowledge levels, treatment phases, and medication adherence were collected using a questionnaire and medical records. To assess the relationship between these variables, the collected data was then analyzed using the Spearman Correlation test. Ethical clearance was obtained from the Health Research Ethics Commission, and informed consent was gathered from all participants. Results: This study reveals the most updated characteristics of the Tuberculosis patients at the Cirebon City Community Lung Health Center aged 15-64 years old with treatment duration ranged 1-6 months. The majority have insufficient knowledge about tuberculosis (45.1%), and 75.8% of patients adhered to their prescribed medication regimen, regardless of their knowledge level. The data indicates a significant positive correlation between knowledge level and medication adherence (p = 0.015), with 95% of patients with good knowledge adhering to treatment compared to only 34% with poor knowledge. Furthermore, there is a significant relationship between adherence and treatment duration (p = 0.002), as 85% of patients who adhered to treatment did so for more than two months. Conclusion: The study shows that patients with better knowledge of tuberculosis are more likely to stick to their medication, which also leads to longer treatment durations. Given the high incidence of TB in the region, these findings suggest the need for targeted educational programs to enhance patients' understanding of TB, thereby improving adherence to treatment protocols. Received: 20 May 2024, Reviewed: 09 June 2024, Revised: 26 August 2024, Accepted: 30 August 2024.

Adherence to treatment in pulmonary tuberculosis: Rodgers' evolutionary concept analysis.

Adherence to treatment is essential for the management of pulmonary tuberculosis. Nurses and healthcare professionals play a significant role in promoting adherence behavior among this population. Nevertheless, defining adherence to treatment within this particular population remains complex. This study aimed to explore and clarify the concept of adherence to treatment among individuals with pulmonary tuberculosis. Rodgers' evolutionary concept analysis was employed in this study. A literature search was conducted in the PubMed and Scopus databases to identify relevant studies published between July 2013 and July 2023. The attributes of adherence to treatment in pulmonary tuberculosis consist of multiple components: biological, individual, social, health service, and policy-making processes. Antecedents include various patient-related factors as well as factors associated with clinical conditions and patient-health professional engagement. Three consequences of the concept have emerged: enhanced treatment efficacy, increased commitment to tuberculosis treatment adherence, and improved health service quality. This study provides a comprehensive operational definition of adherence to tuberculosis treatment, including its attributes, antecedents, and consequences. This framework will assist nurses in evaluating adherence more effectively. However, further research into the experiences of individuals adhering to tuberculosis treatment is needed to confirm and enhance these strategies.

Hubungan Dukungan Sosial terhadap Kepatuhan Pengobatan Pada Pasien Tuberkulosis di Asia: Tinjauan Naratif

Introduction: Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis and continues to be a global health concern, particularly in Asian countries. Objective: This narrative review aims to identify the importance of social support in relation to treatment adherence among TB patients in Asia. Methods: The method employed is a narrative review, utilizing the Scopus and Proquest databases from 2017 to 2023 with the same keywords and BOOLEAN operators such as "AND" and "OR." Articles related to adherence, social support, adult TB patients, and research conducted in Asia are included in the study. Results: The results reveal 15 articles related to the relationship between social support and adherence included in this narrative review. Various instruments were used, with some employing existing questionnaires, while others were developed by the researchers themselves. Additionally, some studies did not specifically report the instruments used. Forms of social support provided were utilized as reinforcement in treatment adherence. Conclusion: The forms of social supports, such as emotional, instrumental, and informational support, primarily from family, play a crucial role in TB treatment adherence in Asia.

Health literacy and tuberculosis control: systematic review and meta-analysis.

To identify literature on health literacy levels and examine its association with tuberculosis treatment adherence and treatment outcomes. Two authors independently searched Pubmed®, Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus and ScienceDirect for articles reporting on health literacy levels and tuberculosis that were published between January 2000 and September 2023. We defined limited health literacy as a person's inability to understand, process, and make decisions from information obtained concerning their own health. Methodological quality and the risk of bias was assessed using the JBI critical appraisal tools. We used a random effects model to assess the pooled proportion of limited health literacy, the association between health literacy and treatment adherence, and the relationship between health literacy and tuberculosis-related knowledge. Among 5813 records reviewed, 22 studies met the inclusion criteria. The meta-analysis revealed that 51.2% (95% confidence interval, CI: 48.0-54.3) of tuberculosis patients exhibit limited health literacy. Based on four studies, patients with lower health literacy levels were less likely to adhere to tuberculosis treatment regimens (pooled odds ratio: 1.95; 95% CI: 1.37-2.78). Three studies showed a significant relationship between low health literacy and inadequate knowledge about tuberculosis (pooled correlation coefficient: 0.79; 95% CI: 0.32-0.94). Health literacy is associated with tuberculosis treatment adherence and care quality. Lower health literacy might hamper patients' ability to follow treatment protocols. Improving health literacy is crucial for enhancing treatment outcomes and is a key strategy in the fight against tuberculosis.

EduTB as an Effort to Improve Tuberculosis Treatment Adherence

EduTB as an Effort to Improve Tuberculosis Treatment Adherence

Machine learning algorithms using national registry data to predict loss to follow-up during tuberculosis treatment

BackgroundIdentifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN).MethodsWe performed a retrospective study of all TB cases reported to SINAN between 2015 and 2022; excluding children (< 18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we splitted our data into training (~ 80% data) and test (~ 20%) sets, and then compared the model metrics using the test data set.ResultsOf the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring systems exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity and sensitivity. A user-friendly web calculator app was developed (https://tbprediction.herokuapp.com/) to facilitate implementation.ConclusionsOur nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement utilizing schooling level, sex, age, prior TB status, and substance use (drug, alcohol, and/or tobacco). This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence.

Revolutionizing Tuberculosis Treatment Adherence through a Web-Based Reminder System

This research develops a website-based reminder system using the Waterfall Method and WhatsApp for message notifications, aiming to improve patient adherence to treatment plans, particularly for conditions like Tuberculosis (TB) that require strict medication schedules. The study evaluates the system's functionality and user satisfaction, with positive feedback indicating strong agreement (56.5%) and agreement (39.1%) among respondents regarding the system's effectiveness. Key advantages include 24/7 active server support, technical assistance via instant messaging, flexible usage, and fast delivery of notifications, showcasing its potential in enhancing healthcare communication and treatment compliance. Highlight: Website reminder system for treatment adherence with Waterfall Method. Patient satisfaction and communication improvement through WhatsApp integration. 24/7 server support, fast notifications, and enhanced patient engagement. Keyword: Reminder system, Waterfall Method, Patient adherence, Healthcare communication, Treatment compliance

Health service providers’ perspective on barriers and strategies to tuberculosis treatment adherence in Obuasi Municipal and Obuasi East District in the Ashanti region, Ghana: a qualitative study

Abstract Background Despite the substantial improvement in treatment success rate over the past two decades in Ghana, some districts in the country still record high rates of tuberculosis (TB) deaths and lost-to-follow-up. The high incidence of these adverse outcomes suggests that the TB programme is not performing well in these districts which could be due to some barriers in the programme implementation. This paper explored the perspectives of healthcare providers on the barriers to TB treatment adherence and the potential strategies to address them in two high-burden districts in the Ashanti Region of Ghana. Methods This study utilised an explorative qualitative study design among 16 purposively selected healthcare providers directly involved in TB care in the Obuasi Municipal and Obuasi East District. Key informant interviews were used to collect data, which were audio-recorded and transcribed word-for-word. The transcriptions were then imported into Atlas.ti version 8.4 software for thematic content analysis. Results Findings from this study revealed significant socioeconomic and individual barriers to TB treatment adherence. Key socioeconomic barriers included income insecurity, transportation cost, food insecurity, lack of public education on TB and frequent shortage of TB diagnostic tools. The individual barriers identified were misconception of TB causation, perceived full recovery after intensive phase treatment, inadequate patient privacy and noncompliance to treatment transfer protocol. The strategies recommended by healthcare providers to address these barriers were home-based treatment, provision of food incentives, frequent education on TB, and usage of reminder systems for follow-ups. Conclusion The barriers to TB treatment adherence from the healthcare providers’ perspective were mainly socioeconomic and individual. The suggested strategies offer actionable steps towards addressing these barriers. Thus, it is recommended that the TB programme and other supporting stakeholders take into account these barriers and adopt these strategies when planning for TB control to enhance treatment adherence and improve patient health outcomes.

Exploring Caregivers’ Perceptions on the Impact of Nyaope and Alcohol Use on Tuberculosis Treatment Adherence in Limpopo Province, South Africa: A Qualitative Investigation

Exploring Caregivers’ Perceptions on the Impact of Nyaope and Alcohol Use on Tuberculosis Treatment Adherence in Limpopo Province, South Africa: A Qualitative Investigation

Non-adherence to anti-tuberculosis treatment and associated factors among TB patients in public health facilities of Hossana town, Southern Ethiopia, 2022.

Non-adherence to anti-tuberculosis treatment is one of the crucial challenges to improving TB treatment outcomes and reducing healthcare costs. The prevalence of non-adherence to anti-tuberculosis treatment is not well documented in the study context. Therefore, this study was aimed at estimating the prevalence of non-adherence to anti-tuberculosis treatment and associated factors among TB patients attending TB clinics in Hosanna town, Southern Ethiopia, in 2022. An institution-based cross-sectional study was conducted from April to May 2022. A systematic random sampling technique was employed to select a sample of 233 study subjects from all four public health facilities. According to the order of arrival, every second person was interviewed. Data were collected using a structured questionnaire that was created using several works of literature. A multivariable binary logistic regression analysis was used to identify factors associated with non-adherence to anti-TB drugs. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated. The study included 233 tuberculosis (TB) patients with a response rate of 100%. The prevalence of non-adherence was 18% (95% CI: 15.39, 21.82). Being in the continuation phase (AOR = 3.09, 95% CI: 1.16, 8.23), not attending formal education (AOR = 2.47, 95% CI: 1.12, 5.42), not disclosing TB status to their family (AOR = 2.36, 95% CI: 0.11, 5.04) and having poor TB knowledge (AOR = 3.09, 95% CI: 1.48, 6.48) were significantly associated with non-adherence to TB treatment. Among TB patients, there was a significant prevalence of non-adherence to anti-TB medications. Interventions that target patients with low education status, are in the continuation phase, and do not disclose their TB status to their families are required to improve TB treatment adherence. In addition, improving health education is important to enhance TB knowledge, which has an impact on TB treatment adherence. The need for good drug adherence should be emphasized while counseling TB patients.

Interventions to improve latent and active tuberculosis treatment completion rates in underserved groups in low incidence countries: a scoping review

BackgroundPeople in underserved groups have higher rates of tuberculosis (TB) and poorer treatment outcomes compared with people with no social risk factors.ObjectivesThis scoping review aimed to identify interventions that improve...

Identifying adolescents at risk for suboptimal adherence to tuberculosis treatment: A prospective cohort study.

Adolescents account for an estimated 800,000 incident tuberculosis (TB) cases annually and are at risk for suboptimal adherence to TB treatment. Most studies of adolescent TB treatment adherence have used surveillance data with limited psychosocial information. This prospective cohort study aimed to identify risk factors for suboptimal adherence to rifampicin-susceptible TB treatment among adolescents (10-19 years old) in Lima, Peru. We collected psychosocial data using self-administered surveys and clinical data via medical record abstraction. Applying k-means cluster analysis, we grouped participants by psychosocial characteristics hypothesized to impact adherence. Then, we conducted mixed effects regression to compare suboptimal adherence-defined as <90% (missing >10% of doses)-between clusters. Treatment setting (facility vs. home) and drug formulation (single drug vs. fixed dose combination) were interaction terms. Of 249 participants, 90 (36.1%) were female. Median age was 17 (IQR: 15, 16.6) years. We identified three clusters-A, B, and C-of participants based on psychosocial characteristics. Cluster C had the lowest support from caregivers, other family members, and friends; had the weakest motivation to complete TB treatment; were least likely to live with their mothers; and had experienced the most childhood adversity. Among the 118 (47.4%) participants who received facility-based treatment with single drug formulations, adherence did not differ between Clusters A and B, but Cluster C had six-fold odds of suboptimal adherence compared to Cluster A. In Clusters B and C, adherence worsened over time, but only in Cluster C did mean adherence fall below 90% within six months. Our findings have implications for the care of adolescents with TB. When caring for adolescents with low social support and other risk factors, clinicians should take extra measures to reinforce adherence, such as identifying a community health worker or peer to provide treatment support. Implementing newly recommended shorter regimens also may facilitate adherence.

Enhancing tuberculosis treatment adherence and motivation through gamified real-time mobile app utilization: a single-arm intervention study

BackgroundFinding innovative methods to enhance Tuberculosis treatment adherence in Malaysia is imperative, given the rising trend of non-adhere TB patients. Direct Observed Therapy (DOTS) has been used to ensure Tuberculosis (TB) drug compliance worldwide. However, due to its inconvenience, digitalizing this system into a virtual monitoring system via a mobile app can help deliver a more efficient tuberculosis management system. A gamified video-observed therapy is developed that connects three users the patient, supervisor, and administrator, allowing drug monitoring and patient loss to follow up with the patient tracking system. Thus, the objective of this study is to determine the impact of Gamified Real-time Video Observed Therapy (GRVOTS) mobile apps on patient medication adherence rates and motivation.Methods71 patients from 18 facilities participated in the 8-week single-arm intervention study. GRVOTS mobile apps were installed in their mobile apps, and patients were expected to fulfill tasks such as providing Video Direct Observe Therapy (VDOTS) daily as well as side effect reporting. At 3-time intervals of baseline,1-month, and 2-month intervals, the number of VDOT taken, the Malaysian Medication Adherence Assessment Tool (MyMAAT), and the Intrinsic Motivation Inventory (IMI) questionnaire were collected. One-sample t-test was conducted comparing the VDOT video adherence to the standard rate of 80%. RM ANOVA was used to analyze any significant differences in MyMAAT and IMI scores across three-time intervals.ResultsThis study involved 71 numbers of patients from 18 healthcare facilities who showed a significantly higher treatment adherence score of 90.87% than a standard score of 80% with a mean difference of 10.87(95% CI: 7.29,14.46; p < 0.001). The participants’ MyMAAT and IMI scores significantly increased over 3-time intervals with the IMI Interest domain showing the highest mean difference 19.76 (95% CI: 16.37, 21.152: p < 0.001).ConclusionsBy utilizing GRVOTS, a mobile application based on gamification and real-time features, we can enhance motivation and medication adherence among TB patients, while also addressing the limitations of physical DOTS.Trial registrationIRCT20230308057657N1, Registered on (15/03/23).

Doctor Patient Type of Language Used and Tuberculosis Treatment Adherence in Kibera Informal Settlement in Nairobi County, Kenya

Purpose: To explore the type of language used on tuberculosis treatment adherence in an informal settlement in Nairobi County, Kenya.&#x0D; Methodology: This was by a descriptive qualitative research design. The sample size was 67 and comprised 10 healthcare workers and 57 TB patients. Purposive sampling technique was used to sample the participants. The study conducted 37 unstructured in-depth interviews and 3 focus group discussions. Data analysis was conducted by first translating the data, then transcribing the verbatim of the in-depth unstructured interviews and focus group discussions. The transcribed data was later analyzed using thematic analysis. Data was presented using tables, bar charts and pie charts.&#x0D; Findings: The findings of the study indicated that majority of the tuberculosis patients found that the type of language used by the healthcare workers when communicating with them determined whether they would adhere to treatment or not. If the language used was not well understood by the patient or if the healthcare worker used complex language, then the patient was not likely to adhere to treatment. The findings further indicated that more than half of the patients were fluent in Swahili language while the remaining patients only had basic knowledge of the language. Sixty percent that is 34 of the participants were fluent in Swahili language whereas thirty- eight percent that is 22 patients had basic knowledge of the language, and one did not understand the language and opted to communicate with the help of an interpreter. Seventy percent that is 40 of the patients indicated that when the healthcare workers communicated with them in simple language they were more likely to adhere to TB treatment. Findings from the healthcare workers indicated that Swahili was the preferred language used by both the healthcare workers and the tuberculosis patients. If a patient did not understand Swahili language, the healthcare workers would look for an interpreter who would then translate to the patient the required information. The use of complex medical language was only used when the healthcare workers were communicating amongst themselves.&#x0D; Unique Contribution to Theory and Practice and Policy: The constructs of the theories informed the study in terms of treatment adherence by emphasizing the benefits of seeking healthcare early. On practice, healthcare workers needed to be aware of type of language used when interacting with their patients as they are likely to affect their patients’ adherence to treatment. Based on these findings, policymakers should ensure that all healthcare workers should use simple language that is, the use of plain common words to make it easier for the patients to understand. In addition, any health messages, appointment cards or any other TB information whether spoken or written meant for the patients, should be designed in a language that is simple for the patient to comprehend.

Costs of Digital Adherence Technologies for Tuberculosis Treatment Support, 2018-2021.

Digital adherence technologies are increasingly used to support tuberculosis (TB) treatment adherence. Using microcosting, we estimated healthcare system costs (in 2022 US dollars) of 2 digital adherence technologies, 99DOTS medication sleeves and video-observed therapy (VOT), implemented in demonstration projects during 2018-2021. We also obtained cost estimates for standard directly observed therapy (DOT). Estimated per-person costs of 99DOTS for drug-sensitive TB were $98 in Bangladesh (n = 719), $119 in the Philippines (n = 396), and $174 in Tanzania (n = 976). Estimated per-person costs of VOT were $1,154 in Haiti (87 drug-sensitive), $304 in Moldova (173 drug-sensitive), $452 in Moldova (135 drug-resistant), and $661 in the Philippines (110 drug-resistant). 99DOTS costs may be similar to or less expensive than standard DOT. VOT is more expensive, although in some settings, labor cost offsets or economies of scale may yield savings. 99DOTS and VOT may yield savings to local programs if donors cover infrastructure costs.