Background
Methods
Study design
Study setting and participants
Sample size and sampling techniques
Data collection tools and procedures
Data analysis
Results
Socio-demographic and economic characteristics of participants
Characteristics | n (%) |
---|---|
Age | |
Below 25 | 84 (27.4) |
25–34 | 110 (35.8) |
35–44 | 60 (19.5) |
45+ | 53 (17.3) |
Sex | |
Male | 178 (58.0) |
Female | 129 (42.0) |
Marital status | |
Single | 142 (46.2) |
Married | 119 (38.8) |
Divorced | 34 (11.1) |
Widowed | 12 (3.9) |
Religion | |
Orthodox | 285 (92.8) |
Muslim | 20 (6.5) |
Others | 2 (.7) |
Residence | |
Urban | 220 (71.7) |
Rural | 87 (28.3) |
Educational level | |
Can’t read and write | 101 (32.9) |
Informally educated | 37 (12.1) |
Primary | 73 (23.8) |
Secondary | 56 (18.2) |
Higher | 40 (13.0) |
Partner’s educational level | |
Can’t read and write | 47 (39.5) |
Informally educated | 10 (8.4) |
Primary | 33 (27.7) |
Secondary | 17 (14.3) |
Higher | 12 (10.1) |
Type of facility enrolled for treatment | |
Health Center | 267 (86.9) |
Hospital | 40 (13.1) |
Family wealth quantile | |
Lowest | 62 (20.2) |
Second | 61 (19.9) |
Middle | 62 (20.2) |
Fourth | 61 (19.9) |
Highest | 61 (19.9) |
Own a mobile phone | |
Yes, smartphone | 55 (17.9) |
Yes, basic phone | 130 (42.4) |
Not at all | 122 (39.7) |
Adherence to TB treatment
Characteristics | Adherent to TB treatment | |
---|---|---|
Yes | No | |
Type of TB | ||
Pulmonary TB | 122 (65.2%) | 65 (34.8%) |
Extra pulmonary TB | 75 (62.5%) | 45 (37.5%) |
Treatment category | ||
New | 184 (64.1%) | 103 (35.9%) |
Relapse | 13 (65.0%) | 7 (35.0%) |
Disclosed TB status to family | ||
Yes | 189 (64.3%) | 105 (35.7%) |
No | 8 (61.5%) | 5 (38.5) |
TB/HIV co-infected | ||
Yes | 14 (53.9%) | 12 (46.2%) |
No | 183 (65.1%) | 98 (34.9%) |
Overall adherence | 197 (64.2%) | 110 (33.3) |
“… when patients enrolled in the continuation phase, they often get reluctant to their pills. Let alone daily medication, they even miss weekly refilling appointments, however, during the intensive phase, they come to take their pills on time”
Determinants of adherence to TB treatment during continuation phase
Variables | Adherent | COR(95%CI) | AOR(95%CI) | |
---|---|---|---|---|
Yes | No | |||
Patient age | ||||
24 years and below | 58 | 26 | 2.317 (1.139–4.712)* | 1.533 (.642–3.661) |
25–34 years | 81 | 29 | 2.901 (1.461–5.757)* | 2.123 (.937–4.813) |
35–44 years | 32 | 28 | 1.187 (.566–2.487) | .879 (.378–2.043) |
45+ years | 26 | 27 | 1 | 1 |
Sex | ||||
Male | 113 | 65 | 1 | 1 |
Female | 84 | 45 | 1.074 (.669–1.724) | 1.251 (.707–2.214) |
Residence | ||||
Urban | 146 | 74 | 1.393 (.836–2.320) | .764 (.374–1.559) |
Rural | 51 | 36 | 1 | 1 |
Educational level | ||||
No education | 53 | 48 | 1 | 1 |
Informal education | 20 | 17 | 1.065 (.501–2.268) | .729 (.299–1.773) |
Primary | 45 | 28 | 1.456 (.789–2.685) | 1.057 (.501–2.231) |
Secondary | 46 | 10 | 4.166 (1.895–9.157)* | 4.138 (1.594–10.74)* |
Higher | 33 | 7 | 4.27 (1.728–10.55)* | 2.795 (.970–8.052) |
Distance to the health facility | ||||
Less than 5 km | 72 | 156 | 2.708 (1.206–6.081)* | 2.275 (.877–5.903) |
5-10 km | 23 | 29 | 1.576 (.618–4.018)* | 1.672 (.589–4.746) |
Greater than 10 km | 15 | 12 | 1 | 1 |
Treatment supporter assigned | ||||
Yes | 74 | 123 | 1 | 1 |
No | 36 | 73 | 1.22 (.746–1.996) | 1.375 (.769–2.457) |
Disclosed TB status to family | ||||
Yes | 105 | 189 | 1.125 (.359–3.527) | .744 (.191–2.902) |
No | 5 | 8 | 1 | 1 |
Provider-patient relationship | ||||
Good | 112 | 45 | 1.903 (1.186–3.055)* | 1.863 (1.014–3.423)* |
Poor | 85 | 65 | 1 | 1 |
Knowledge on TB treatment | ||||
Good | 157 | 72 | 2.072 (1.226–3.5)* | 1.845 (1.012–3.362)* |
Poor | 40 | 38 | 1 | 1 |
Attitude on TB treatment | ||||
Favorable | 121 | 59 | 1.376 (.858–2.206) | 1.272 (.702–2.305) |
Unfavorable | 76 | 51 | 1 | |
Family wealth index | ||||
Poor | 54 | 49 | 1 | 1 |
Middle | 71 | 31 | 2.078 (1.173–3.683)* | 2.646 (1.360–5.148)* |
Rich | 72 | 30 | 2.178 (1.225–3.871)* | 1.949 (.957–3.968) |
In the key-informant interview, the majority of TB focal providers also exemplified that patients with low income tend to miss and/or interrupt refilling due to transportation and related costs. Besides, relapse cases tend to default treatments. A female TB focal healthcare provider replied that“During the continuation phase, we do not have daily contact with patients as we do on intensive phase. Even, weekly attendance was not easy. Some patients did not come, they send their supporter/family member to the clinic for refilling, and they were busy with family matters, social events like a funeral.”
Participants also mentioned that relapsing cases tend to lost-to-follow-up. Another female focal healthcare provider added that:“TB patients on continuation phase often miss refilling and from my experience, their reasons are mainly related to transportation cost and unintended social events”.
Political unrest and security problems were among the challenges for the patient, the health facility, and central drug suppliers (hubs for supplying drugs based on the health facilities’ need). A male TB focal healthcare provider replied that“This year alone we lost two patients due to relapse of the case [TB]. One female insisted not to take the pills anymore and decided to go to Monastery. Similarly, one male patient lost from treatment follow-up …”
Respondents were also asked their opinion on whether the assigned treatment supporters were helpful during the continuation treatment phase. Seven of nine participants replied that they were not helpful as intended, and (2/9) reported as helpful. The problem begins with assigning treatment supporters. A male TB focal healthcare provider reported that:“Our community was victimized with frequent political turmoil and security problems which results in lost-to-follow due to massive displacement, migration of healthcare providers, and interruption of drug supply from the center.”
In addition, the commitment of treatment supporters was confronted by their income level and their prior commitments as reported by the respondents. A male TB focal healthcare provider mentioned that:“During assigning treatment supporters, patients often choose educated relatives without considering the distance away from their home: mostly, they choose their relatives in urban while the patient living in rural.”
Another male TB focal healthcare provider also added that:“Treatment supporters very rarely accompany patients during refilling, they mention transportation cost, own family, and social commitments.”
“During the continuation phase, we assign treatment supporters but in practice, most did not follow and most focal providers lack skills to influence patients to take their pills at home”