Nonadherence to tuberculosis treatment and associated factors among patients using directly observed treatment short-course in north-west Nigeria: A cross-sectional study

Influence of the new dispersible fixed-dose combination anti-Tuberculosis drug on treatment adherence among children with Tuberculosis in Osun State, Nigeria

BACKGROUND

The dispersible fixed-dose combination drug has been recommended as the mainstay of treatment for TB in children. However, more needs to be known about its effect on treatment. This study aimed to assess the effectiveness of the formulation on treatment adherence among children with TB.

METHODS

A historical cohort design was used to assess and compare adherences of old loose non-dispersible and new dispersible fixed-dose anti-TB drugs, using a convergent parallel mixed-method approach for data collection. Determinants of treatment adherence were assessed using binary logistic regression.

RESULTS

The proportion of children with good treatment adherence was higher in the new dispersible formulation group (82 [64.6%]) relative to the proportion among the loose non-dispersible formulation group (29 [23.4%]). Reports of forgetfulness, travelling and pill burden were significantly higher among those with poor adherence in the loose non-dispersible formulation group. Significant predictors of treatment adherence were acceptability (adjusted OR [AOR]=4.1, p=0.013, 95% CI 1.342 to 12.756), travelling from treatment areas (AOR=8.9, p=0.002, 95% CI 2.211 to 35.771) and forgetfulness (AOR=74.0, p<0.001, 95% CI 23.319 to 234.725).

CONCLUSIONS

The determinants of treatment adherence are multifactorial. In addition to ensuring universal access to the drug, flexible referral in case of travelling and ensuring treatment partners' participation to minimise forgetfulness to take pills, are essential.

Medication-related burden and its association with medication adherence among elderly tuberculosis patients in Guizhou, China: a cross-sectional study

Introduction

Tuberculosis (TB) morbidity and mortality are significantly increasing in the elderly worldwide. Their optimal health outcomes are hampered by medication related burden (MRB) and poor treatment adherence. Understanding th e MRB status from patients' perspectives and its association with adherence among elderly TB patients will help achieve the End TB targets. Thus, we aimed to identify the incidence of MRB and nonadherence among elderly TB patients in Guizhou, and determine their association.

Methods

A cross-sectional study was conducted in three prefectures with high TB notifications in Guizhou in 2022. The data were collected via face-to-face structured interviews. MRB was measured using the Living with Medicines Questionnaire version 3 (LMQ-3), which consists of eight domains. Nonadherence was assessed by treatment interruption, which was defined as any interruption lasting at least 1 day at any time within the last 3 months. A binary unconditional logistic regression model was used to determine the association between variables.

Results

Of the 405 elderly TB patients enrolled, 49.4% and 42.7% of the respondents perceived suffering from moderate and high MRB, respectively. The incidence of nonadherence among patients was 33.6%. Patients with higher scores in domain 2 (practical difficulties) [OR adj = 1.19; 95% CI (1.11-1.28)] and domain 4 (side effects burden of prescribed medications) [OR adj = 1.16; 95% CI (1.06-1.27)] were more likely to experience nonadherence. But, patients with higher scores in domain 8 (control/autonomy of medicine use) [OR adj = 0.70; 95% CI (0.61, 0.81)] were more likely to occur adherence. Patients with a high education level [OR adj = 0.29; 95% CI (0.08, 0.92)] had a decreased risk of nonadherence, but those with a living expense from a retirement salary [OR adj = 2.55; 95% CI (1.16, 5.71)] had an increased risk of nonadherence.

Discussion

The incidence of MRB and medication nonadherence is high among elderly TB patients in Guizhou. The significant associations between the three domains of MRB and nonadherence highlight that measuring MRB in multiple dimensions using the LMQ-3 in elderly TB patients could assist clinicians in providing patient-centered care, and multifaceted interventions targeting the identified problems should be implemented to reduce MRB and nonadherence among elderly TB patients in Guizhou.

Medication nonadherence and associated factors in patients with tuberculosis in Wau, South Sudan: a cross- sectional study using the world health organization multidimensional adherence model

BACKGROUND

Tuberculosis medication nonadherence is a multi-dimensional public health problem with serious consequences worldwide. There is little information available for medication nonadherence in South Sudan. This study assessed the proportion, reasons, and associated factors for nonadherence among patients with TB in Wau Municipality, South Sudan.

METHODS

A health facility based cross-sectional study was conducted among 234 tuberculosis (TB) patients receiving first line anti-TB regimen in Wau Municipality. Urine isoniazid metabolite testing (IsoScreen®) was used to determine nonadherence (visualized by negative test results) and a questionnaire was used to describe the reasons for nonadherence. Modified poisson regression with robust standard errors was performed since the proportion of nonadherence was < 10%, to identify nonadherence associated factors using the WHO Multidimensional adherence model.

RESULTS

Out of 234 participants, 24.8% (95% CI, 19.2 - 30.3) were nonadherent to the TB treatment regimen. At multivariate analysis, nonadherence was significantly associated with: relief of symptoms (APR 1.93, 95% CI 1.12 - 3.34, p = 0.018), alcohol use (APR 2.12, 95% CI 1.33 - 3.96, p = 0.019) and waiting time to receive drugs (APR 1.77, 95% CI 1.11 - 2.83, p = 0.017).

CONCLUSION

Tuberculosis medication nonadherence was high, and it's associated with patients' relived of symptoms, alcohol use, and prolonged waiting time at health facility. Hence, addressing these barriers and the use of multifaceted interventions e.g. counseling, health education and improve appointments are crucial to reduce nonadherence among patients with TB in South Sudan.

Challenges of Screening and Investigations of Contacts of Patients with Tuberculosis in Oyo and Osun States, Nigeria

Tuberculosis (TB) remains a significant public health challenge in Nigeria, with high rates of transmission and low case detection rates. This paper presents the challenges of screening and investigation of contacts of patients with TB in Oyo and Osun State, Nigeria. This descriptive-qualitative study was conducted in eight Local Government Areas with high TB burdens. Twenty-four focus group discussions and 30 key informant interviews were conducted among TB patients, household TB contacts, and government TB staff, among others. Respondents ages ranged from 17-85 years with a mean of 42.08 ± 14.9 years, and (4.0%) had a postgraduate degree. This study identified that the majority of TB contacts who tested negative for TB were unwilling to be placed on TB preventive therapy because of the belief that only a sick person should take drugs. Also, hostility from the TB contacts to the contact tracers during the house-to-house screening of presumptive TB cases due to community stigma associated with TB was another existing gap reported in TB contact investigations. The findings emphasise the importance of tailored approaches in TB prevention and control, addressing challenges in testing and contact investigations; this necessitates investments in community engagement strategies to enhance the cooperation of TB contacts.

Identification of the health education targeted susceptible population of tuberculosis in Ningxia, Northwest China

Knowledge, Attitude, and Practice (KAP) survey, as an effective measure tool, is of practical significance for identifying the susceptible population in high-incidence regions of tuberculosis (TB). We aim to identify the health education targeted susceptible population of TB and discuss the acting pathway of KAP in Ningxia. A multistage random sampling method was used to conduct a face-to-face questionnaire survey for residents. The latent class analysis (LCA) model was used to classify susceptible populations of TB, and the structural equation modeling (SEM) model was also employed to investigate the interaction mechanisms of KAP (mediation analysis). We further applied the ordered logistic regression model to explore the associated factors. A total of 973 residents were enrolled, 70.6% were male, aged from 16 to 89. The LCA analysis demonstrated that 3 categories of susceptible populations of TB ("overall good", "positive attitude" and "overall poor") have optimal goodness of fit (BIC = 7889.5, Entropy = 0.923). SEM model indicated that the attitude plays a significant mediation effect from knowledge to practice toward TB (an indirect effect of 0.038, and a direct effect of 0.138). The ordered logistic regression results found that age, sex, marital status, education level, occupation, family income, self-perceived health status, having a family member or friend with TB, and knowing the DOTS strategy were significantly associated with classifications of KAP level towards TB. Based on the LCA model, we accurately classified the susceptible population of TB into 3 groups with different degrees of KAP. We found that TB attitude plays a mediating role between knowledge and practice. Therefore, we should pay more attention and carry out targeted health education in the community to these populations with overall poor KAP towards TB, and develop effective strategies and measures to realize the End TB Plan.

Towards comprehensive clinical trials for new tuberculosis drug regimens: policy recommendations from a stakeholder analysis

BACKGROUND

Research and development (R&D) of new drugs and regimens against tuberculosis (TB) is evolving to meet new challenges and face limited investments in the sector. To effectively improve and fill existing gaps, researchers and trialists should engage a broad spectrum of stakeholders. With this study, we aim to map the interests in TB R&D raised by the main stakeholders in the TB field.

METHODS

We conducted semistructured, short interviews to gather insight and viewpoints on innovation on TB drugs and regimens R&D of policy-makers, national TB programme officers, donors, funders, non-governmental organisations and research institutions.A composite measure of the relevance of topics that emerged was computed by implementing different models considering the importance for researchers and the urgency to implement those changes during the trial, the number of citations each topic received, and the maximum value of the influence of stakeholders who had raised the topic.

RESULTS

50 stakeholders, out of 56 identified, were interviewed and almost half were policy-makers and governmental institutions. Several stakeholders highlighted the importance of disseminating information about clinical trials' methodology and emerging preliminary results, followed by the need to pursue early discussion around access and pricing of safe and effective TB innovations, although different categories of stakeholders prioritised different topics. Using different methods for ranking topics, the results remained almost unchanged. Notably, post-trial operational research ranked higher in models with higher weight for the parameter considering the number of citations.

CONCLUSION

Researchers and research consortia embarking on phase 2 and 3 clinical trials should consider a broad set of elements when planning and designing trials' protocols, all aiming at lowering the price and improving access to emerging TB innovations, besides meeting regulatory criteria. This can only be achieved by consulting and engaging relevant stakeholders in the discussion.

Drug adherence to anti-tubercular treatment during COVID-19 lockdown in Haldwani block of Nainital district

Background: India saw one of the stringent lockdowns during the COVID-19 pandemic. In the wake of this period, the normal functioning of medical services was affected. People were reluctant to seek medical attention and notification of Tuberculosis dipped. The aim of the study was to estimate the proportion of non-adherence to anti-tubercular treatment and to identify the factors affecting the non-adherence to treatment. Methods: A retrospective community-based study was conducted among 284 tuberculosis patients. They were interviewed using a pre-designed questionnaire consisting of WHO dimensions of non-adherence and lockdown related questions. Results: The proportion of non-adherence to treatment was found to be 5.3%. Factors like chronic diseases, depression, without knowledge on how the disease is transmitted and that medication can be discontinued once the symptoms subsided, alcohol consumption, and trouble accessing medicine were found to be the determining factors in non-adherence to the treatment. Conclusions: Non-adherence to anti-tuberculosis treatment in our study was low but the various dimensions of adherence along with lockdown related factors had significant impact on it. To further minimize non-adherence during emergency like the lockdown due to COVID-19 pandemic, corrective measures must be explored and implemented.

FACTORS CONTRIBUTING TO PULMONARY TB TREATMENT LOST TO FOLLOW-UP IN DEVELOPING COUNTRIES: AN OVERVIEW

Background

Despite the available treatment options, pulmonary tuberculosis (TB) remains a leading cause of disease-related deaths worldwide. Treatment non-adherence/lost to follow-up (LTFU), particularly in developing countries, is a continuous concern. LTFU prolongs TB infectiousness and contributes to TB treatment failure, relapse, and death. Furthermore, LTFU also delays global TB eradication by promoting TB spread and drug-resistant TB strain development.[1] The purpose of this paper is to give an overview of the commonly observed risk factors associated with TB treatment LTFU in developing countries.

Materials and Methods

A literature survey was done of studies published in the past decade, which evaluated the risk factors for LTFU in TB patients, specifically in developing countries. Furthermore, some prospective TB treatment adherence initiatives and the feasibility of these initiatives within developing countries were assessed.[3].

Results

Several variables, including socio-demographic, patient-related, TB disease and other health-related-factors, healthcare and system determinants, as well as treatment-related factors, were identified to increase the risk of TB treatment LTFU. More recently applied adherence interventions in developing countries, show potential for implementation on a larger scale.

Conclusion

Successful TB treatment is contingent on treatment adherence, and by addressing these persisting LTFU risk factors, treatment adherence in developing countries may be improved.

Effectiveness of education intervention of tuberculosis treatment adherence in Khartoum State: A study protocol for a randomized control trial

BACKGROUND

Treatment failure and disease relapse among tuberculosis (TB) patients are commonly caused by non-adherence. It can lead to prolonged infection, increased transmission, drug resistance, and loss of life. Even though the causative microorganism of TB has been identified for more than a century, the disease is still a substantial public health problem worldwide. This research aims to devise, implement, and assess an educational intervention to improve adherence to TB treatment.

METHODS AND FINDINGS

A randomised clinical trial involving 146 Sudanese TB patients will be conducted at the Abu Anga hospital in Khartoum. The participants will be randomly assigned to the intervention and control groups. A 2-hour session will be offered to the intervention group in a one-day TB educational intervention course. The same educational materials will also be provided to the control group after the randomised controlled trial (RCT). Data will be collected at baseline, one month, and four months after the intervention. The primary outcome of interest is TB treatment adherence, while secondary outcomes include quality of life score, tuberculosis knowledge, and health belief domains. Generalised estimating equations (GEE) in SPSS software version 25.0 will be utilised to evaluate the changes over time.

CONCLUSIONS

This trial will provide information that could be used in improving TB control strategies to achieve better results in the adherence of healthcare services to the norms of the National Program and patient adherence to the disease treatment and cure.

TRIAL REGISTRATION

This study is registered at TCTR: (TCTR20210607006).

Between Curing and Torturing: Burden of Adverse Reaction in Drug-Resistant Tuberculosis Therapy

Drug-resistant tuberculosis (DR-TB) requires prolonged and complex therapy which is associated with several adverse drug reactions (ADR). The burden of ADR can affect the quality of life (QoL) of patients that consists of physical, mental, and social well-being, and influences the beliefs and behaviors of patient related to treatment. This article reviews the burden of ADR and its association with QoL and adherence. We used PubMed to retrieve the relevant original research articles written in English from 2011 to 2021. We combined the following keywords: "tuberculosis," "Drug-resistant tuberculosis," "Side Effect," "Adverse Drug Reactions," "Adverse Event," "Quality of Life," "Adherence," "Non-adherence," "Default," and "Loss to follow-up." Article selection process was unsystematic. We included 12 relevant main articles and summarized into two main topics, namely, 1) ADR and QoL (3 articles), and 2) ADR and therapy adherence (9 articles). The result showed that patients with ADR tend to have low QoL, even in the end of treatment. Although it was torturing, the presence of ADR does not always result in non-adherence. It is probably because the perception about the benefit of the treatment dominates the perceived barrier. In conclusion, burden of ADR generally tends to degrade QoL of patients and potentially influence the adherence. A comprehensive support from family, community, and healthcare provider is required to help patients in coping with the burden of ADR. Nevertheless, the regimen safety and efficacy improvement are highly needed.