Patients’ perspectives of tuberculosis treatment challenges and barriers to treatment adherence in Ukraine: a qualitative study

Abstract

ObjectivesTo understand the challenges faced by patients with tuberculosis (TB) and factors that influence TB treatment adherence in Ukraine.DesignQualitative study.SettingTB treatment facilities in Kyiv Oblast, Ukraine.ParticipantsSixty adults who had undergone treatment for drug-sensitive TB between June 2012 and August 2015.MethodsWe conducted semistructured, in-depth, individual interviews among a purposively selected clinical sample of patients previously treated for drug-sensitive TB. Interview content encompassed WHO’s framework for barriers to adherence to long-term therapies and included questions about patient preferences and motivators concerning treatment adherence. We examined treatment experience across strata defined by previously identified risk correlates of non-adherence.ResultsAmong 60 participants, 19 (32.8%) were HIV positive, 12 (20.3%) had substance use disorder and 9 (15.0%) had not completed TB treatment. Respondents discussed the psychological distress associated with hospital-based TB care, as well as perceived unsupportive, antagonistic interactions with TB providers as major challenges to treatment adherence. An additional barrier to successful treatment completion included the financial toll of lost income during TB treatment, which was exacerbated by the additional costs of ancillary medications and transportation to ambulatory TB clinics. The high pill burden of TB treatment also undermined adherence. These challenges were endorsed among participants with and without major risk factors for non-adherence.ConclusionsOur findings highlight important barriers to TB treatment adherence in this study population and suggest specific interventions that may be beneficial in mitigating high rates of poor treatment outcomes for TB in Ukraine.

Lived experiences of tuberculosis patients and their implications for early tuberculosis case identification and management in pastoralist community setting: a qualitative study in Borena zone, Oromia region of Ethiopia

“…Three of the eight hospital patients were on DRTB treatment. Age the patients' ranges from 22 to 62 years with a median and inter quartile range of 31 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42) years. From the analysis of interview transcriptions, 62 codes and five categories emanated which were finally organized into three themes.…”

“…The other challenges, experienced by TB patients in the pastoralist community, where economic burden that may expose families of the patients to catastrophic cost [ 10 ]. Due to the inaccessibility of TB service providing health facilities, patients suffer from direct non-medical costs such as transportation cost which can lead to lost to follow up from treatment, [ 27 , 33 ] poor adherence and hence development of DR TB, [ 23 , 34 ] and discourages other patients from seeking care for similar signs and symptoms [ 25 , 26 ]. These challenges can be minimized using different innovative and patient centered approaches such as the use of community treatment supporters [ 28 , 35 – 37 ], modified self administered treatment methods [ 38 ].…”

Medical Compliance Determinants for Tuberculosis Patients in Palembang

“…This is due to the lack of public knowledge, support from family and health workers as well as the treatment process which takes a long time, so it can increase the risk of transmission by those who have not yet recovered and the possibility of MDR TB in patients who do not adhere to taking medication. The highlight important barriers to TB treatment adherence in this study population and suggest specific interventions that may be beneficial in mitigating high rates of poor treatment 7.…”

Development and Psychometric Testing of the Supportive Care Needs Scale for Patients with Tuberculosis (SCN-TB)

“…12,13 In recent years, although efforts have been made to promote TB care, many patients are still not accessing appropriate health services timely to address their needs. 14 TB patients who experience unmet SCN are more likely to suffer prolonged infection, relapse and even drug resistance. 5,10,11 Additionally, increased evidence has demonstrated that unmet SCN can also lead to a heavy financial burden for TB patients and a waste of medical resources.…”