Levels of Tuberculosis Treatment Adherence among Sputum Smear Positive Pulmonary Tuberculosis Patients Attending Care at Zomba Central Hospital, Southern Malawi, 2007–2008

Abstract

BackgroundDespite great efforts to control Tuberculosis (TB), progress is compromised by low adherence to medication, leading to prolonged duration of infectiousness and continued transmission. Investigating low adherence is of high importance from TB programmatic perspective. Though data on actual days of missed treatment exist, the effect of such on TB cure rates has not been investigated.MethodsTB operational research data were extracted for smear-positive pulmonary TB patients registered at Zomba Central hospital, Malawi from January 2007 to December 2008.ResultsOf the 524 patients, 302 (57.6%) were males and 340 (64.9%) fully adhered to treatment. Excluding 5 individuals with missing data on cure, four hundred and eighty-one (92.7%) were cured of TB, and of these 162 (33.7%) missed at least one day of treatment. Respectively, 49/64 (76.6%) and 71/76 (93.4%) of those who missed treatment in the intensive and continuation phases were cured of TB (p = 0.005). The adjusted logistic regression analysis showed that those who missed 15–29 days of treatment (OR = 0.04, 95% CI: 0.01, 0.14) were less likely to be cured of TB compared with those who fully adhered.ConclusionTreatment non-adherence was high and was observed even within the first 2 months of treatment. Thus, even at an earlier critical stage of treatment, simple algorithms need to be developed to identify and monitor patients at higher risk of non-adherence. Efforts on treatment compliance counselling should focus on enhanced counselling to improve adherence during the intensive treatment phase.

Health-related quality of life and its association with medication adherence in active pulmonary tuberculosis– a systematic review of global literature with focus on South Africa

“…Medication adherence is a complex, multi-dimensional, dynamic phenomenon comprising patient behavior with regard to the prescribed interval, dose and dosing regimen as well as appropriateness of how the medication is taken [ 49 , 50 ]. In the absence of drug resistance, TB is a curable disease with a six month treatment of antibiotics [ 51 ]. Medication adherence is a key factor for treatment success [ 52 ], and might have a greater impact on a population’s health than any improvement in specific medical treatments [ 53 ].…”

“…Medication adherence is a key factor for treatment success [ 52 ], and might have a greater impact on a population’s health than any improvement in specific medical treatments [ 53 ]. Adherence during the intensive treatment phase (first two months) increases the chance for cure in newly diagnosed patients [ 51 ]. In contrast, non-adherence leads to spread of free TB bacteria in the community; this may impact the patient by resulting in disability, drug resistance, relapse and risk of death and the community by increased health costs [ 51 , 52 , 54 , 55 ].…”

“… After treatment 27 % of TB patients have moderate to severe pulmonary function impairment. HIV -positive status was significantly associated with worse HRQOL Reference Study Objective Study Setting Population Comparator Group Adherence Measure Application time point of Adherence Measure Overall Outcome in Adherence Specific Outcome in Adherence Chirwa et al 2013 [ 51 ] To estimate cure rates, and their association with adherence to TB treatment Malawi n = 524 TB patients None Retrospective counting of missing days during treatment Retrospective review of records Adherence to TB treatment had a significant effect on cure of TB Overall, 35.1 % of patients did not fully adhere to TB treatment. Of these, 86.4 % missed < 15 days and 23.4 % missed at least 1 day of treatment Overall, 92.7 % of patients were cured from TB and 33.7 % of these missed at least 1 day of treatment.…”

Quality of life in Korean tuberculosis patients: A longitudinal study

“…HRQoL is important to consider at three critical points in treatment: at the start of TB treatment, during the intensive treatment phase (first 2 months), and at treatment completion (Chirwa et al, 2013). HRQoL has been found to improve with treatment (Louw, Mabaso, & Peltzer, 2016) although the specific factors (e.g., physical symptoms and self-esteem) associated with HRQoL improvements over the treatment course have been rarely studied (Louw et al, 2016).…”

IMPACT study on intervening with a manualised package to achieve treatment adherence in people with tuberculosis: protocol paper for a mixed-methods study, including a pilot randomised controlled trial

“…This seeks to reduce TB incidence, decrease health inequalities and ultimately contribute to international efforts to eliminate TB as a public health problem. Ensuring that people can take all of their medication as prescribed is one of the strategy’s priorities, as poor adherence to treatment for TB is a driver of worse patient outcomes,2–9 increases the risk of transmission (due to delayed sputum culture conversion)10 and can promote the development of drug resistance 3 11–16. Subsequent National Institute for Health and Care Excellence (NICE) guidance noted the lack of robust TB research in this area 17…”