Determinants of tuberculosis treatment interruption among patients in Vihiga County, Kenya

Abstract

Background Despite robust Tuberculosis (TB) program with effective chemotherapy and high coverage, treatment interruption remains a serious problem. Interrupting TB treatment means that patients remain infectious for longer time and are at risk of developing drug resistance and death. This study was conducted to identify and describe predictors of TB treatment interruption. Methods A cohort of 291 notified TB patients from 20 selected health facilities in Vihiga County were enrolled in to the study and followed up until the end of treatment. Patient characteristics that potentially predict treatment interruption were recorded during treatment initiation using structured questionnaires. Patients who interrupted treatment were traced and reasons for stoppage of treatment recorded. Kaplan Meier method was used to estimate probabilities of treatment interruption by patient characteristics and determine time intervals. The Log rank test for the equality of survival distributions analyzed significance of survival differences among categorical variables. For multivariable analysis, Cox proportional hazard model, was fitted to identify predictors of TB treatment interruption through calculation of hazard ratios with 95% Confidence Intervals (CIs). For variable analysis, statistical significance was set at P ≤ 0.05. Reasons for treatment interruption were categorized according to most recurrent behavioral or experiential characteristics. Results Participants’ median age was 40 years (IQR = 32–53) and 72% were male. Of the 291 patients, 11% (n = 32) interrupted treatment. Incidences of treatment interruption significantly occurred during intensive phase of treatment. Independent predictors of treatment interruption included alcohol consumption (HR = 9.2, 95% CI; 2.6–32.5, p < 0.001), being female (HR = 5.01, 95% CI; 1.68–15.0, p = 0.004), having primary or lower education level (HR = 3.09, 95% CI; 1.13–8.49, p < 0.029) and having a treatment supporter (HR = 0.33, 95% CI; 0.14–0.76, p = 0.009). Reasons for interrupting treatment were categorized as: alcoholism, feeling better after treatment initiation, associated TB stigma, long distance to health facility, lack of food, perception of not having TB and pill burden. Conclusion TB treatment interruption was high and largely associated with patients’ socio-demographic and behavioral characteristics. These multidimensional factors suggest the need for interventions that not only target individual patients but also environment in which they live and receive healthcare services.

Treatment Outcomes and Risk Factors of Multidrug-Resistant Tuberculosis Patients in Xi’an China, a Retrospective Cohort Study

“…To reduce loss to follow-up in male patients, measures should be taken to improve their knowledge of tuberculosis, as well as improve family and economic support. 21,22 It was reported in many studies that aging was a risk factor for an unfavorable outcome of MDR-TB treatment; 13,16,21,23 it is due to older people may combine other diseases and suffer more from drug side effects or death. 24 In this study, 40% of the patients were older than 40 years old, indicating that a considerable number of patients are at risk of unfavorable outcomes.…”

“…There were also some limitations in our study. Some studies showed that smoking and drinking were risk factors for unfavorable outcomes, 21,22,32 but we did not involve these factors. China is a country with a high burden of tuberculosis and HIV, but there were only 2 HIV-positive cases in our study.…”

Factors of medication adherence among adult patients with tuberculosis: A literature review

“…We found 7 studies showed low income and experienced loss of job as a significant factor of adherence (12,16,(23)(24)(25)(26)(27), 6 studies for comorbidities (16,(28)(29)(30)(31), and 2 studies for age/ elderly (25,28), and 2 studies for the level of education (16,32). TB patients with low income have difficulty paying for transportation costs to health services and also face a lack of food during treatment (12,13,27,32). TB patients with comorbidities such as depression, diabetes mellitus, and HIV are more noncompliant with TB medication.…”

“…The sociodemographic of individual factors found that low income, comorbidities, age, and education level impact TB medication compliance. We found 7 studies showed low income and experienced loss of job as a significant factor of adherence (12,16,(23)(24)(25)(26)(27), 6 studies for comorbidities (16,(28)(29)(30)(31), and 2 studies for age/ elderly (25,28), and 2 studies for the level of education (16,32). TB patients with low income have difficulty paying for transportation costs to health services and also face a lack of food during treatment (12,13,27,32).…”

“…Seven studies confirmed that relationship factors had supporters from social or family and patient-health provider relationships. There were six studies on the patient-health provider relationship (13,16,23,24,29,34) and two studies on support from social and family (32,34). Medication supporters from social and family lead to successful TB therapy.…”