Tuberculosis Treatment Adherence Research Articles

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.

Acceptability of hair harvest as a method of tuberculosis therapeutic drug monitoring among adult pulmonary TB patients: a qualitative study

Background: The current six months regimen for drug-susceptible tuberculosis (TB) is long, complex, and requires adherence monitoring. TB hair drug level assay is one innovative approach to monitor TB treatment adherence however, its acceptability in the context of African multi-cultural settings is not known.Objective: To determine the acceptability of hair harvest and testing as a TB therapeutic drug monitoring method.Methods: The study explored perceptions, and lived experiences among TB patients with regard to using hair harvest and testing as a method of tuberculosis therapeutic drug monitoring in the context of their cultural beliefs, and faith. We used a descriptive phenomenological approach.Results: Four main themes emerged namely: participants’ perceptions about the cultural meaning of their body parts; perceptions about hair having any medical value or meaning; perceptions about hospitals starting to use hair harvest and testing for routine hospital TB treatment adherence monitoring; and perceived advantages and disadvantages of using hair for treatment adherence monitoring. Overall, we found that using hair to monitor adherence was acceptable to TB patients provided the hair was harvested and tested by a medical worker.Conclusion: Hair harvest for medical testing is acceptable to TB patients on the condition that it is conducted by a medical worker.

A qualitative assessment on the acceptability of providing cash transfers and social health insurance for tuberculosis-affected families in Ho Chi Minh City, Vietnam.

To achieve the Sustainable Development Goal's targets of universal health coverage (UHC) and poverty reduction, interventions are required that strengthen and harmonize both UHC and social protection. Vietnam is committed to achieving financial protection and over 90% of the general population has enrolled in its social health insurance (SHI) scheme. However, an estimated 63% of tuberculosis (TB)-affected households in Vietnam still face catastrophic costs and little is known about the optimal strategies to mitigate the costs of TB care for vulnerable families. This study assessed the acceptability of a social protection package containing cash transfers and SHI using individual interviews (n = 19) and focus group discussions (n = 3 groups). Interviews were analyzed through framework analysis. The study's main finding indicated that both conditional and unconditional cash transfers paired with SHI were acceptable, across six dimensions of acceptability. Cash transfers were considered beneficial for mitigating out-of-pocket expenditure, increasing TB treatment adherence, and improving mental health and general well-being, but the value provided was inadequate to fully alleviate the economic burden of the illness. The conditionality of the cash transfers was not viewed by participants as inappropriate, but it increased the workload of the TB program, which brought into question the feasibility of scale-up. SHI was viewed as a necessity by almost all participants, but people with TB questioned the quality of care received when utilizing it for auxiliary TB services. Access to multiple sources of social protection was deemed necessary to fully offset the costs of TB care. Additional research is needed to assess the impact of cash transfer interventions on health and economic outcomes in order to create an enabling policy environment for scale-up.

Digital Health Interventions to Enhance Tuberculosis Treatment Adherence: Scoping Review.

Digital health technologies are widely used for disease management, with their computing platforms, software, and sensors being used for health care. These technologies are developed to manage chronic diseases and infectious bacterial diseases, including tuberculosis (TB). This study aims to comprehensively review the literature on the use of digital health interventions (DHIs) for enhancing TB treatment adherence and identify major strategies for their adoption. We conducted a literature search in the PubMed, Cochrane Library, Ovid Embase, and Scopus databases for relevant studies published between January 2012 and March 2022. Studies that focused on web-based or mobile phone-based interventions, medication adherence, digital health, randomized controlled trials, digital interventions, or mobile health and ubiquitous health technology for TB treatment and related health outcomes were included. We identified 27 relevant studies and classified them according to the intervention method, a significant difference in treatment success, and health outcomes. The following interventions were emphasized: SMS text messaging interventions (8/27, 30%), medicine reminders (6/27, 22%), and web-based direct observation therapy (9/27, 33%). Digital health technology significantly promoted disease management among individuals and health care professionals. However, only a few studies addressed 2-way communication therapies, such as interactive SMS text messaging and feedback systems. This scoping review classified studies on DHIs for patients with TB and demonstrated their potential for the self-management of TB. DHIs are still being developed, and evidence on the impact of digital technologies on enhancing TB treatment adherence remains limited. However, it is necessary to encourage patients' participation in TB treatment and self-management through bidirectional communication. We emphasize the importance of developing a communication system.

Adherence to tuberculosis treatment among patients attending national tuberculosis elimination centre in tertiary care hospital, Bangalore

Background: Annually ten million cases of tuberculosis (TB) and 1.8 million mortalities are recorded. Adherence to TB treatment not only reduces death outcomes but prevents prolonged sickness, transmission to others and development of multi drug resistant TB. This study was aimed at determining the rate of treatment adherence and possible factors influencing adherence to TB treatment in the NTEP Centre at Rajarajeswari medical college and hospital, Bangalore. Methods: It was a cross sectional study design. A validated 8 item Morisky medication adherence scale was used to obtain data from respondents. Adherence to TB treatment was assessed. Chi square test was used to determine the variables that were associated with treatment adherence. Results: Out of 60 patients, majority i.e. 18 (30%) were in the age group 25-34 years, males were more compared to females. Majority i.e. 21 (35%) were studied up to post high school diploma, 31(51.67%) were unemployed, majority i.e. 48 (80.00%) were married, 42 (70.00%) were from nuclear family. Out of 60 patients, majority 54 (90.00%) were Hindus 24 (40.00%) were from lower middle class. Conclusions: The adherence rate for TB treatment in this study was 68.33%. There was no significant association between socio demographic variables, personal habits, health status, current TB status, type of TB, and common symptom with treatment adherence. An intensified health education on the adherence of TB treatment therefore recommended.

Doctor Patient Nonverbal Communication and Tuberculosis Treatment Adherence in Kibera Informal Settlement in Nairobi County, Kenya

Purpose: To establish the effect of nonverbal communication 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.&#x0D; Findings: The findings of the study reported that less than half of the patients in the in-depth interviews reported that some healthcare workers avoided eye contact with them when they are in the consultation room and kept writing down notes. About a half of the patients indicated that majority of the healthcare workers expressed positive non-verbal cues which motivated them to adhere to treatment. The findings further showed that non-verbal communication by the healthcare workers in terms of body language could determine a TB patient’s adherence to treatment. This nonverbal communication entailed factors like rate of speech, volume of speech, facial expressions and gestures. A higher adherence rate by the patients when healthcare workers exhibited positive non-verbal communication was also reported.&#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 their non-verbal cues when interacting with their patients as they are likely to affect their patients’ adherence to treatment. In addition, policy laws on doctor-patient communication nonverbal communication should guide when dealing with patients. The laws should anchor the aspect of non-verbal cues during the healthcare workers’ interaction with patients.

Acceptability of using the medication monitor and experience of a differentiated care approach for TB treatment adherence among people living with TB in South Africa.

The introduction of digital adherence technologies (DATs) such as medication monitors in tuberculosis (TB) programmes supports treatment adherence among people with tuberculosis (PWTB). We evaluated the acceptability of using medication monitors (Wisepill evriMED) prompting a stepwise differentiated care approach (DCA), involving short message service (SMS), phone calls, home visits and motivational counselling, among PWTB in South Africa. We conducted 62 in-depth interviews with participants in local languages across three provinces (January-October 2020), purposively selected by treatment month, adherence history and gender. Interviews were audio recorded, transcribed verbatim and translated. Using a deductive approach and the Theoretical Framework for Acceptability (TFA), we explored acceptability across the sample attributes. PWTB across adherence histories showed a positive attitude to using the evriMED device and receiving the DCA support. PWTB described the SMS reminders and phone calls as effective reminders, though home visits were less acceptable, due to perceived stigma. Despite willingness to participate in the intervention, the large size of the monitor and sound of the alarm drew attention, potentially causing embarrassment and stigma. Due to perceived stigma, some PWTB adapted the intervention by leaving the monitor at home after removing the pills to ensure that someone else tracked usage, while the PWTB used alternative reminders such as cell phones to take their medication. Although PWTB showed a positive attitude towards the intervention, perceived stigma contributed to participants adapting their lifestyle to meet treatment adherence requirements without using the monitor. However, the medication monitor was a tool that seemed to prompt this personal change in behaviour. Achieving people-centered TB care, including the introduction of DATs, will require that TB programmes incorporate PWTB insights to maximize their use and effectiveness.

Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review.

Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence. The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB. Databases, including PubMed, Embase (Ovid), Web of Science, and Scopus, were comprehensively reviewed to identify relevant studies reporting the impacts of nutritional support on TB treatment adherence. Two authors independently screened the title, abstracts, and full article texts to identify eligible studies and assess the risk of bias. Observational and interventional studies were included. A narrative synthesis approach was used to summarize the findings qualitatively. From the search, 3059 publications were identified; of these, 8 studies were included in this systematic review. Three types of nutritional interventions were identified: food baskets (eg, energy, micronutrient- or macronutrient-enriched food support), nutritional advice and guidance, and incentives for buying foods. Although 5 studies reported that nutritional support significantly improved treatment adherence in patients with TB, 3 studies showed that nutritional support had no effect on TB treatment adherence. Providing nutritional support may improve adherence to TB treatment. However, more well-powered, high-quality trials are warranted to demonstrate the effect of nutrition support on cost-effectively improving adherence to TB treatment. PROSPERO registration no. CRD42023392162.

Clayton copula for survival data with dependent censoring: An application to a tuberculosis treatment adherence data.

Ignoring the presence of dependent censoring in data analysis can lead to biased estimates, for example, not considering the effect of abandonment of the tuberculosis treatment may influence inferences about the cure probability. In order to assess the relationship between cure and abandonment outcomes, we propose a copula Bayesian approach. Therefore, the main objective of this work is to introduce a Bayesian survival regression model, capable of taking into account the dependent censoring in the adjustment. So, this proposed approach is based on Clayton's copula, to provide the relation between survival and dependent censoring times. In addition, the Weibull and the piecewise exponential marginal distributions are considered in order to fit the times. A simulation study is carried out to perform comparisons between different scenarios of dependence, different specifications of prior distributions, and comparisons with the maximum likelihood inference. Finally, we apply the proposed approach to a tuberculosis treatment adherence dataset of an HIV cohort from Alvorada-RS, Brazil. Results show that cure and abandonment outcomes are negatively correlated, that is, as long as the chance of abandoning the treatment increases, the chance of tuberculosis cure decreases.

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&lt; 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.

Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective

BackgroundDespite having an effective community-based Directly Observed Therapy Short-course (DOTS) strategy for tuberculosis (TB) care, treatment adherence has been a major challenge in many developing countries including Ghana. Poor adherence results in discontinuity of treatment and leads to adverse treatment outcomes which pose an increased risk of drug resistance. This study explored barriers to TB treatment adherence and recommended potential patient-centered strategies to improve treatment adherence in two high-burden TB settings in the Ashanti region of Ghana.MethodsThe study was conducted among TB patients who defaulted on treatment in the Obuasi Municipal and Obuasi East districts in the Ashanti region. A qualitative phenomenology approach was used to explore the barriers to TB treatment adherence. Purposive sampling was adopted to select study participants with different sociodemographic backgrounds and experiences with TB care. Eligible participants were selected by reviewing the medical records of patients from health facility TB registers (2019–2021). Sixty-one (61) TB patients met the eligibility criteria and were contacted via phone call. Out of the 61 patients, 20 were successfully reached and consented to participate. In-depth interviews were conducted with participants using a semi-structured interview guide. All interviews were audio recorded and transcribed verbatim. The transcripts were imported into Atlas.ti version 8.4 software and analyzed using thematic content analysis.ResultsFood insecurity, cost of transportation to the treatment center, lack of family support, income insecurity, long distance to the treatment center, insufficient knowledge about TB, side effect of drugs, improvement in health after the intensive phase of the treatment regimen, and difficulty in accessing public transportation were the main co-occurring barriers to treatment adherence among the TB patients.ConclusionThe main barriers to TB treatment adherence identified in this study reveal major implementation gaps in the TB programme including gaps related to social support, food security, income security, knowledge, and proximity to treatment centers. Hence, to improve treatment adherence there is a need for the government and the National Tuberculosis Programme (NTP) to collaborate with different sectors to provide comprehensive health education, social and financial support as well as food aid to TB patients.

Factors associated with tuberculosis treatment adherence among tuberculosis patients in the Kumasi metropolis in the Ashanti Region of Ghana; A cross-sectional study

Factors associated with tuberculosis treatment adherence among tuberculosis patients in the Kumasi metropolis in the Ashanti Region of Ghana; A cross-sectional study

Digital devices for tuberculosis treatment adherence

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of digital devices (feature phone‐based and smartphone‐based technologies, digital pillboxes, ingestible sensors, and other devices) for improving tuberculosis treatment adherence.