46% of persistently nonadherent patients were homeless, 81% had drug or alcohol abuse, and 28% had mental illness.
Further improvements in the care of persistently nonadherent patients may require more psychosocial services, appropriate facilities for civil detention, and detaining patients long enough to assure completion of treatment.
The rate of compliance with antituberculosis regimen under directly observed therapy was found to be high (73%). DOT improves the rate of compliance. The only factor that significantly influenced rate of compliance was proximity to the chest clinic. Also, psychopathology could have adversely affected the rate of compliance.
Locating chest units in the existing primary health care facilities will improve the rate of compliance with antituberculosis therapy. More attention should be paid to behavioral aspect of tuberculosis control. Health workers involved in the management of these patients should develop a higher index of suspicion for possible psychopathology.
Factors associated with adherence to treatment: patient related factors, provider characteristics, clinic facilities, characteristics of treatment regimens, and disease characteristics.
Adherence to treatment for latent tuberculosis infection: a manual for healthcare providers
Factors impacting adherence include: social and economic recourses prior to the onset and during the course of the disease, the causal attributions assigned to TB, the social, cultural, economic, disease related, and psychological challenges faced as a consequence of having TB, quality of health care received, use of traditional healing systems and feelings of helplessness, depression, and lack of social support.
Advocate a more holistic approach to health care programs with the inclusion of mental health services.
Structural factors: poverty, gender, and discrimination. Patient factors: motivation, knowledge, beliefs, and attitudes and interpretations of illness and wellness. Social context. health care service factors.
More patient-centred interventions, and far greater attention to structural barriers, are needed to improve treatment adherence and reduce the global disease burden attributable to TB.
Gelmanova, 2007
Substance abuse was identified as the only factor that was strongly associated with nonadherence.
Few TB programmes that have explicitly offered patients treatment for substance abuse generally have demonstrated better outcomes than “unexpanded” DOTS programmes.
Factors were classified into 7 categories; factors related to disbelief and/or prejudice for diagnosis and/or treatment (except factors related to drug adverse effects) were observed in 51.8%, factors related to economical problem in 24.1%, factors related to job or studies in 23.4%, factors related to drug adverse effects in 22.6%, factors related to visiting out-patients departments in 6.6%, psychiatric disease and/or drug abuse in 4.4%, others in 9.5%.
To improve the quality of tuberculosis medical care and services including good and sufficient explanations on TB and how to cure it and proper managements for drug adverse effects and then to expand public economical support for the costs of medicine and travel expenses to medical facilities and to make accessible time and place of the tuberculosis outpatient clinic more convenient and flexible for patients.
The factors contributing to noncompliance can be grouped into three categories, namely, patient related, health care, and community and treatment factors.
Develop and implement patient-centred interventions that encourage shared decision-making regarding treatment. Provide ongoing (in-service) training to health staff to improve and upgrade their competencies with regard to health education and communication skills. Strengthen patient support and community advocacy programmes aimed at eradicating the stigma associated with the disease. Emphasise the particular needs of individual patients and tailor the role of support systems to their needs. Plan interventions to reduce the influence of poverty and gender on patients and their treatment adherence
Lack of knowledge about TB, nonsustainability of educational campaigns, side effects of drugs, hunger and lack of family support, stigma attached to TB, and health-related factors such as the attitude of health care providers and the long delay in obtaining a diagnosis.
Recommendations are made for the instigation of enhanced education programmes focusing on patients, the community, and health care providers.
16% of patients among patients receiving DOTS treatment were nonadherent to the anti-TB therapy. Smoking during treatment and travel-related cost factors were significantly associated with nonadherence in the newly diagnosed patients, while alcohol consumption and shortage of drugs were significant in the residual groups.
Targeting easier access to drugs, an ensured drug supply, effective solutions for travel-related concerns, and modification of smoking and alcohol-related behaviors are essential for treatment adherence.
Factors related to the patient (lack of means, being a migrant worker, distance to treatment site, poor understanding of treatment, drug use, and mental illness), medical team (high patient load, low motivation, and lack of resources for tracking defaulters), treatment organization (poor communication between treatment sites, no systematic strategy for patient education or tracking, and incomplete record keeping), and health care system and society.
Interventions to enhance TB treatment completion should take into account the local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.
Nine factors conceptually associated with medication adherence in TB patients: (1) communication with healthcare providers, (2) personal traits, (3) confidence in curing TB, (4) social support, (5) mood disorders, (6) lifestyle and habits, (7) coping style, (8) access to healthcare, and (9) forgetfulness.
A 30-item TB medication adherence scale (TBMAS) with a positive predictive value of 65.5% and sensitivity of 82.9% was developed and incorporated the latest research in TB specific medication adherence, where predictors for adherence such as patient behavior and patient-provider interaction in TB treatment have been explored. The resulting tool will help TB medical professionals identify not only TB patients with poor adherence but also potential reasons for nonadherence and help them to design and implement targeted interventions to improve adherence.
