Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study

Abstract

BackgroundTuberculosis is a major public health problem in Ethiopia, and a high number of TB patients are co-infected with HIV. There is a need for more knowledge about factors influencing treatment adherence in co-infected patients on concomitant treatment. The aim of the present study is to explore patients' and health care professionals' views about barriers and facilitators to TB treatment adherence in TB/HIV co-infected patients on concomitant treatment for TB and HIV.MethodsQualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients.ResultsWe found that interplay of factors is involved in the decision making about medication intake. Factors that influenced adherence to TB treatment positively were beliefs in the curability of TB, beliefs in the severity of TB in the presence of HIV infection and support from families and health professionals. Barriers to treatment adherence were experiencing side effects, pill burden, economic constraints, lack of food, stigma with lack of disclosure, and lack of adequate communication with health professionals.ConclusionHealth professionals and policy makers should be aware of factors influencing TB treatment in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Our results suggest that provision of food and minimal financial support might facilitate adherence. Counseling might also facilitate adherence, in particular for those who start ART in the early phases of TB treatment, and beliefs related to side-effects and pill burden should be addressed. Information to the public may reduce TB and HIV related stigma.

‘Ghost’ stories: sociocultural factors influencing tuberculosis treatment adherence in Ghana

“…Good support received by patients during treatment made the patients feel loved and it promoted adherence to treatment and this is confirmed by Gebremariam et al (2010). Their study indicated that good family support affected adherence to treatment positively.…”

“…This was particularly reported by participants who had defaulted earlier, and now on re-treatment. Other studies report that patients are likely to default after the intensive phase of the drugs which is, 2-3 months (Ananthakrishnan et al, 2012;Atkins 2010;Dodor & Kelly, 2010;Gebremariam et al, 2010).…”

The Enabling Effect of Food Assistance in Improving Adherence and/or Treatment Completion for Antiretroviral Therapy and Tuberculosis Treatment: A Literature Review

“…Food insecurity is one of the multiple barriers that individuals face in initiating and adhering to long-term medical therapies such as ART and DOTS, especially in resourcelimited settings [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Other patient-related barriers include the complexity of the medication regimen [18], emotional distress [7], illness costs to households [19], stigma [20], health beliefs and poverty [4], limited knowledge of the disease [21], difficulty remembering [22], intentional non-adherence due to adverse drug reactions [23] and harmful use of alcohol [24].…”

“…Other patient-related barriers include the complexity of the medication regimen [18], emotional distress [7], illness costs to households [19], stigma [20], health beliefs and poverty [4], limited knowledge of the disease [21], difficulty remembering [22], intentional non-adherence due to adverse drug reactions [23] and harmful use of alcohol [24].…”

“…In addition to being an enabler to start and continue treatment, it can together with the pharmacological treatment contribute Table 1 Overview of studies among PLHIV or TB patients that assessed impact of food or vouchers for food on adherence and/or completion of treatment (n = ART adherence, survival, CD4 count, nutritional status 98 % of food assisted and 77. 4 to the treatment of malnutrition, provided that the foods provided are of appropriate nutritional quality [26]. In the context of limited health care and programme resources, and especially in areas of widespread food insecurity, there is considerable interest in knowing the effectiveness of food interventions in improving adherence to ART and DOTS.…”