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Mukora R, Ahumah B, Maraba N, Orrell C, Jennings L, Naidoo P, Fielding KL, Velen K, Charalambous S, Chetty-Makkan CM. 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. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001885. [PMID: 37889875 PMCID: PMC10610070 DOI: 10.1371/journal.pgph.0001885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Rachel Mukora
- The Aurum Institute, Aurum House, Parktown, Johannesburg, South Africa
- University of Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Barack Ahumah
- University of Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Noriah Maraba
- The Aurum Institute, Aurum House, Parktown, Johannesburg, South Africa
| | - Catherine Orrell
- Department of Medicine, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Desmond Tutu Health Foundation, Cape Town, South Africa
| | | | - Pren Naidoo
- Stellenbosch University, Stellenbosch, South Africa
| | - Katherine L. Fielding
- University of Witwatersrand, School of Public Health, Johannesburg, South Africa
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kavindhran Velen
- The Aurum Institute, Aurum House, Parktown, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Aurum House, Parktown, Johannesburg, South Africa
- University of Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Candice M. Chetty-Makkan
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
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Tok PSK, Wong LP, Liew SM, Razali A, Mahmood MI, Chinnayah T, Kawatsu L, Toha HR, Mohd Yusof K, Abd Rahman R, Che Mat Din SNA, Loganathan T. A qualitative exploration of tuberculosis patients who were lost to follow-up in Malaysia. PLoS One 2023; 18:e0289222. [PMID: 37676902 PMCID: PMC10484432 DOI: 10.1371/journal.pone.0289222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/14/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Loss to follow-up (LTFU) is an unsuccessful treatment outcome for tuberculosis (TB) patients. In Malaysia, LTFU affects around 1 in 20 TB patients. Integration of qualitative research methods and evidence will provide a better understanding of LTFU and its underlying issues. In this study, we qualitatively explored TB patients' experiences in receiving treatment and their reasons for leaving TB care. METHOD In-depth interviews of 15 patients with a history of LTFU were conducted from January to September 2020. Interview guides were developed to explore TB patients' experiences while receiving treatment, including challenges faced and reasons for treatment interruption. Data were thematically analysed using the framework method. RESULTS We identified 11 emerging themes that occurred at four levels of interaction with TB patients. First, at the patient personal level, TB beliefs referring to patients' perception of illness and wellness, patients' perceived role of traditional and complementary medicine, and substance abuse were important. Second, the healthcare system and treatment factors that were highlighted included the organisation of care and treatment, interaction with healthcare professionals, particularly in communication and counselling, and TB medications' side effects. Third, structural factors including financial burden, logistical and transportation issues and work-related factors were identified to be barriers to treatment continuation. Fourth, the interpersonal level interaction of patients should not be neglected; this includes family relationships and support as well as peer influence. CONCLUSION Study findings put forth issues and challenges faced by TB patients while receiving treatment and underscore areas where actions can be taken. This will contribute to informing the development and implementation of future TB control strategies that are responsive to TB patients' needs and concerns, to effectively address LTFU and ensure better treatment completion rates among TB patients in Malaysia.
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Affiliation(s)
- Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Asmah Razali
- Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohd Ihsani Mahmood
- Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Thilaka Chinnayah
- Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Lisa Kawatsu
- Department of Epidemiology and Clinical Research, the Research Institute of Tuberculosis, Japan Anti-tuberculosis Association (RIT/JATA), Tokyo, Japan
| | - Haidar Rizal Toha
- Johor State Health Department, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
| | - Khalijah Mohd Yusof
- Johor State Health Department, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
| | - Rozanah Abd Rahman
- Respiratory Medicine Department, Hospital Sultanah Aminah, Ministry of Health Malaysia, Johor Bahru, Johor, Malaysia
| | | | - Tharani Loganathan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Mukora R, Maraba N, Orrell C, Jennings L, Naidoo P, Mbatha MT, Velen K, Fielding K, Charalambous S, Chetty-Makkan CM. Qualitative study exploring the feasibility of using medication monitors and a differentiated care approach to support adherence among people receiving TB treatment in South Africa. BMJ Open 2023; 13:e065202. [PMID: 36868589 PMCID: PMC9990642 DOI: 10.1136/bmjopen-2022-065202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES The tuberculosis (TB) MATE study evaluated whether a differentiated care approach (DCA) based on tablet-taking data from Wisepill evriMED digital adherence technology could improve TB treatment adherence. The DCA entailed a stepwise increase in adherence support starting from short message service (SMS) to phone calls, followed by home visits and motivational counselling. We explored feasibility of this approach with providers in implementing clinics. DESIGN Between June 2020 and February 2021, in-depth interviews were conducted in the provider's preferred language, audiorecorded, transcribed verbatim and translated. The interview guide included three categories: feasibility, system-level challenges and sustainability of the intervention. We assessed saturation and used thematic analysis. SETTING Primary healthcare clinics in three provinces of South Africa. PARTICIPANTS We conducted 25 interviews with 18 staff and 7 stakeholders. RESULTS Three major themes emerged: First, providers were supportive of the intervention being integrated into the TB programme and were eager to be trained on the device as it helped to monitor treatment adherence. Second, there were challenges in the adoption system such as shortage of human resources which could serve as a barrier to information provision once the intervention is scaled up. Healthcare workers reported that some patients received incorrect SMS's due to delays in the system that contributed to distrust. Third, DCA was considered as a key aspect of the intervention by some staff and stakeholders since it allowed for support based on individual needs. CONCLUSIONS It was feasible to monitor TB treatment adherence using the evriMED device and DCA. To ensure successful scale-up of the adherence support system, emphasis will need to be placed on ensuring that the device and the network operate optimally and continued support on adhering to treatment which will enable people with TB to take ownership of their treatment journey and help overcome TB-related stigma. TRIAL REGISTRATION NUMBER Pan African Trial Registry PACTR201902681157721.
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Affiliation(s)
- Rachel Mukora
- The Aurum Institute, Implementation Research Division, Johannesburg, South Africa
- University of Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Noriah Maraba
- The Aurum Institute, Implementation Research Division, Johannesburg, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lauren Jennings
- Desmond Tutu HIV Foundation, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Pren Naidoo
- University of Stellenbosch, Stellenbosch, South Africa
| | - M Thulani Mbatha
- Interactive Research and Development, Johannesburg, South Africa
| | - Kavindhran Velen
- The Aurum Institute, Implementation Research Division, Johannesburg, South Africa
| | | | - Salome Charalambous
- The Aurum Institute, Implementation Research Division, Johannesburg, South Africa
- University of Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Candice Maylene Chetty-Makkan
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Zago PTN, Maffacciolli R, Mattioni FC, Dalla-Nora CR, Rocha CMF. Nursing actions promoting adherence to tuberculosis treatment: scoping review. Rev Esc Enferm USP 2021; 55:e20200300. [PMID: 34435609 DOI: 10.1590/1980-220x-reeusp-2020-0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze actions promoting adherence to tuberculosis treatment that are being carried out by nurses in different countries. METHOD Scoping review with selection of articles on the subject in LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science, and Scopus databases. RESULTS Forty studies, published between 2009 and 2020, allowed the identification of nursing actions in two thematic categories. In the category "Nursing care: TB patients' specific needs to promote adherence to treatment", actions involving clinical aspects, professionals' knowledge and skills, educational and relational processes were identified. In the category "The role of nursing in coping with the social determinants of health to promote adherence to treatment", interventions related to the strengthening of family and community support, the inclusion of socioeconomic issues in care plans, and respect for cultural differences were highlighted. CONCLUSION Nursing work directed to the adherence to disease treatment requires the development of technical, ethical and, above all, political skills, aiming to increase the success of the actions carried out by these professionals.
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Affiliation(s)
- Priscila Tadei Nakata Zago
- Secretaria Estadual da Saúde do Rio Grande do Sul, Hospital Sanatório Partenon, Porto Alegre, RS, Brazil
| | - Rosana Maffacciolli
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Fernanda Carlise Mattioni
- Grupo Hospitalar Conceição, Serviço de Saúde Comunitária, Escola de Saúde Pública/SES, Porto Alegre, RS, Brazil
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Nwagu EN, Abugu LI, Yohanna W, Eze DN, Ononuju AH, Obayi AN. Behaviour change communication for control of tuberculosis by healthcare workers in DOTS facilities in Nigeria. Pan Afr Med J 2020; 36:306. [PMID: 33282089 PMCID: PMC7687482 DOI: 10.11604/pamj.2020.36.306.21640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/14/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction prevention and control of tuberculosis (TB) should be behaviour-centred to facilitate change of unhealthy behaviours that encourage the spread of the infective agent. This study aimed to ascertain the knowledge, beliefs and practices of Behavior Change Communication (BCC) in the control of TB by healthcare workers in DOTS in Nigeria. Methods using the qualitative research approach, we interviewed 38 healthcare workers from two states in Nigeria. The interview questions consisted of 13 open-ended questions framed to elicit information about the health workers' knowledge, beliefs and practices of BCC in the control of TB. Analysis was done using the conventional content analysis. Results the following themes emerged: lack of knowledge and understanding about BCC; BCC believed to be important in the control of TB; lack of adequate skills for BCC; some aspects of BCC practiced; BCC was mainly done in health facilities; and lack of adequate system for maintaining long term change. Conclusion the BCC training needs of healthcare workers in the area of study have been revealed. These should form the basis for effective BCC capacity building programme for healthcare workers in the prevention and control of TB. We recommended that BCC should go beyond interpersonal communication to community-wide campaign through mass media to produce a massive change in behaviour that will enable the elimination of TB.
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Affiliation(s)
- Evelyn Nwanebe Nwagu
- University of Nigeria Nsukka, Department of Human Kinetics and Health Education, Nsukka, Nigeria
| | - Lawreta Ijeoma Abugu
- University of Nigeria Nsukka, Department of Human Kinetics and Health Education, Nsukka, Nigeria
| | - Wamanyi Yohanna
- University of Nigeria Nsukka, Department of Human Kinetics and Health Education, Nsukka, Nigeria.,Adamawa State College of Health Technology, Department of Community Health, Michika, Nigeria
| | - Dorothy Nwakaego Eze
- University of Nigeria Nsukka, Department of Human Kinetics and Health Education, Nsukka, Nigeria.,Nsukka Health Centre, Nsukka, Enugu state, Nigeria
| | - Amaka Harry Ononuju
- University of Nigeria Nsukka, Department of Human Kinetics and Health Education, Nsukka, Nigeria
| | - Agatha Nneka Obayi
- University of Nigeria Nsukka, Department of Human Kinetics and Health Education, Nsukka, Nigeria
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Margineanu I, Louka C, Vincenti-Gonzalez M, Saktiawati AMI, Schierle J, Abass KM, Akkerman O, Alffenaar JW, Ranchor AV, Stienstra Y. Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework. JMIR Mhealth Uhealth 2020; 8:e18156. [PMID: 33136052 PMCID: PMC7669445 DOI: 10.2196/18156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/20/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background Digitally delivering healthcare services is very attractive for tuberculosis (TB) management as this disease has a complex diagnosis and lengthy management and involves multiple medical and nonmedical specialists. Especially in low- and middle-income countries, eHealth could potentially offer cost-effective solutions to bridge financial, social, time, and distance challenges. Objective The goal of the research is to understand what would make eHealth globally applicable and gain insight into different TB situations, opportunities, and challenges. Methods We performed focus group interviews with TB experts and patients from 6 different countries on 4 different continents. The focus group interviews followed the theory of planned behavior framework to offer structured recommendations for a versatile eHealth solution. The focus group interviews were preceded by a general demographic and technology use questionnaire. Questionnaire results were analyzed using basic statistics in Excel (Microsoft Corporation). Focus group interview data were analyzed using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH) by assigning codes to quotations and grouping codes into the 5 domains within the framework. Results A total of 29 patients and 32 medical staff members were included in our study. All medical staff had used the internet, whereas 31% (9/61) of patients had never been online. The codes with the most quotations were information in relation to eHealth (144 quotations) and communication (67 quotations). The consensus among all participants from all countries is that there are important communication and information gaps that could be bridged by an eHealth app. Participants from different countries also highlighted different challenges, such as a majority of asylum-seeker patients or lack of infrastructure that could be addressed with an eHealth app. Conclusions Within the 6 countries interviewed, there is high enthusiasm toward eHealth in TB. A potential app could first target information and communication gaps in TB, with additional modules aimed at setting-specific challenges.
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Affiliation(s)
- Ioana Margineanu
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Pneumology Hospital Iasi, Iasi, Romania
| | - Christina Louka
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Maria Vincenti-Gonzalez
- Department of Medical Microbiology and Infection Prevention, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Antonia Morita Iswari Saktiawati
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Johannes Schierle
- University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Kabiru Mohammed Abass
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,Agogo Presbyterian Hospital, Agogo, Ghana
| | - Onno Akkerman
- Department of Pulmonary Diseases and Tuberculosis, Tuberculosis Centrum Beatrixoord, University Medical Centrum Groningen, University of Groningen, Haren, Netherlands
| | - Jan-Willem Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands.,University of Sydney, Camperdown, Australia.,Westmead Hospital, Sydney, Australia.,Marie Bashir Institute of Infectious Diseases, University of Sydney, Sydney, Australia
| | - Adelita V Ranchor
- Health Psychology Section, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine, University Medical Centrum Groningen, University of Groningen, Groningen, Netherlands
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Manyazewal T, Woldeamanuel Y, Holland DP, Fekadu A, Blumberg HM, Marconi VC. Electronic pillbox-enabled self-administered therapy versus standard directly observed therapy for tuberculosis medication adherence and treatment outcomes in Ethiopia (SELFTB): protocol for a multicenter randomized controlled trial. Trials 2020; 21:383. [PMID: 32370774 PMCID: PMC7201596 DOI: 10.1186/s13063-020-04324-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To address the multifaceted challenges associated with tuberculosis (TB) in-person directly observed therapy (DOT), the World Health Organization recently recommended that countries maximize the use of digital adherence technologies. Sub-Saharan Africa needs to investigate the effectiveness of such technologies in local contexts and proactively contribute to global decisions around patient-centered TB care. This study aims to evaluate the effectiveness of pillbox-enabled self-administered therapy (SAT) compared to standard DOT on adherence to TB medication and treatment outcomes in Ethiopia. It also aims to assess the usability, acceptability, and cost-effectiveness of the intervention from the patient and provider perspectives. METHODS This is a multicenter, randomized, controlled, open-label, superiority, effectiveness-implementation hybrid, mixed-methods, two-arm trial. The study is designed to enroll 144 outpatients with new or previously treated, bacteriologically confirmed, drug-sensitive pulmonary TB who are eligible to start the standard 6-month first-line anti-TB regimen. Participants in the intervention arm (n = 72) will receive 15 days of HRZE-isoniazid, rifampicin, pyrazinamide, and ethambutol-fixed-dose combination therapy in the evriMED500 medication event reminder monitor device for self-administration. When returned, providers will count any remaining tablets in the device, download the pill-taking data, and refill based on preset criteria. Participants can consult the provider in cases of illness or adverse events outside of scheduled visits. Providers will handle participants in the control arm (n = 72) according to the standard in-person DOT. Both arms will be followed up throughout the 2-month intensive phase. The primary outcomes will be medication adherence and sputum conversion. Adherence to medication will be calculated as the proportion of patients who missed doses in the intervention (pill count) versus DOT (direct observation) arms, confirmed further by IsoScreen urine isoniazid test and a self-report of adherence on eight-item Morisky Medication Adherence Scale. Sputum conversion is defined as the proportion of patients with smear conversion following the intensive phase in intervention versus DOT arms, confirmed further by pre-post intensive phase BACTEC MGIT TB liquid culture. Pre-post treatment MGIT drug susceptibility testing will determine whether resistance to anti-TB drugs could have impacted culture conversion. Secondary outcomes will include other clinical outcomes (treatment not completed, death, or loss to follow-up), cost-effectiveness-individual and societal costs with quality-adjusted life years-and acceptability and usability of the intervention by patients and providers. DISCUSSION This study will be the first in Ethiopia, and of the first three in sub-Saharan Africa, to determine whether electronic pillbox-enabled SAT improves adherence to TB medication and treatment outcomes, all without affecting the inherent dignity and economic wellbeing of patients with TB. TRIAL REGISTRATION ClinicalTrials.gov, NCT04216420. Registered on 2 January 2020.
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Affiliation(s)
- Tsegahun Manyazewal
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, P.O. Box 9086, Addis Ababa, Ethiopia
| | - David P. Holland
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30322 USA
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Henry M. Blumberg
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30322 USA
| | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30322 USA
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Bhatnagar H. User-experience and patient satisfaction with quality of tuberculosis care in India: A mixed-methods literature review. J Clin Tuberc Other Mycobact Dis 2019; 17:100127. [PMID: 31788569 PMCID: PMC6880015 DOI: 10.1016/j.jctube.2019.100127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tuberculosis affected 2.7 million people in India in 2017. The Revised National TB Control Programme has achieved milestones in coverage, however quality of TB care remains highly variable and often poor, with significant gaps in provider knowledge, practices, and patients consistently lost to follow-up. These quality gaps are largely informed by studies on provider practices or objective chart abstractions and case data. Per the knowledge of the author, no review has been conducted on first-hand patient perspectives on the quality of TB care they receive. This mixed-methods literature review aims to synthesize evidence on user-experience and patient satisfaction with TB care in India and inform areas for service quality improvement. METHODS Five medical databases, including PubMed, EMBASE, Global Health (Ovid), Web of Science, and CINAHL were searched for empirical studies on patient perspectives on TB health services published between January 1st, 2000 to December 31st, 2017. Studies in English with adult patients with any form of TB in the public or private health system were included. Studies prior to entering the health system, on distance to health facilities and cost were excluded. Seven Indian journals were hand searched and a grey literature search was conducted in GoogleScholar. Studies were assessed for methodological quality and thematic analysis was conducted by categorizing data using NVivo 12. RESULTS A total of 498 studies were screened, of which 23 met the inclusion criteria. 16 supplementary studies were identified from Indian journals and grey literature. Of the 39 total studies included most were quantitative (29; 74%), based in South India (17; 44%) and focused on drug-sensitive TB patients (19; 49%) within the public health system (25; 64%). Data collection methods were highly heterogenous which limited synthesis and comparisons across population demographics, health sectors, or regions. Overall quantitative patient satisfaction measured in seven studies was high. Two major themes identified were provider-related factors (n = 26 studies) and convenience (n = 25), and six minor themes were supplies and equipment availability (n = 12), confidence (n = 10), information and communication (n = 10), waiting time (n = 8), stigma (n = 4), and confidentiality (n = 4). Each reported positive and negative user-experiences. Most significantly, DOTS did not fit the daily needs and obligations of many patients, particularly due to conflicts with employment and frequency of visits; while positive provider support, information, and flexibility helped patients adhere to treatment. CONCLUSION Although quantitative patient satisfaction was found to be high, data were not collected using robust, validated tools. Qualitative and quantitative user-experiences in each theme were variable, making them both barriers and facilitators of good quality TB care. Poor user-experiences were often responsible for patients interrupting treatment or dropping out of TB care. Patient-centeredness, or user-friendliness of TB care can be improved by introducing individualized or flexible DOTS that is responsive to user circumstances and needs. User-experience data should be systematically collected using a standardized, national tool for identification of specific bottlenecks and successes in quality of TB care from the patients' perspective.
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