Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania

Abstract

BackgroundNon-adherence to tuberculosis (TB) treatment is the leading contributor to the selection of drug-resistant strains of Mycobacterium tuberculosis and subsequent treatment failure. Tanzania introduced a TB Patient Centred Treatment (PCT) approach which gives new TB patients the choice between home-based treatment supervised by a treatment supporter of their own choice, and health facility–based treatment observed by a medical professional. The aim of this study was to assess the extent and determinants of adherence to anti-TB therapy in patients opting for home-based treatment under the novel PCT approach.MethodsIn this cross-sectional study, the primary outcome was the percentage of patients adherent to TB therapy as detected by the presence of isoniazid in urine (IsoScreen assay). The primary analysis followed a non-inferiority approach in which adherence could not be lower than 75%. Logistic regression was used to examine the influence of potentially predictive factors.ResultsA total of 651 new TB patients were included. Of these, 645 (99.1%) provided urine for testing and 617 patients (95.7%; 90%CI 94.3–96.9) showed a positive result. This result was statistically non-inferior to the postulated adherence level of 75% (p<0.001).ConclusionsAdherence to TB therapy under home-based Directly Observed Treatment can be ensured in programmatic settings. A reliable supply of medication and the careful selection of treatment supporters, who preferably live very close to the patient, are crucial success factors. Finally, we recommend a cohort study to assess the rate of adherence throughout the full course of TB treatment.

Adherence to Drug Medications amongst Tuberculosis Patients in a Tertiary Health Institution in South East Nigeria

“…This contrasts with the findings of a prior study conducted in China which reported more male TB patients 69.5%, than females 30.5% [15]. Another study on adherence to anti-tuberculosis drugs done in Tanzania reported higher percentage of 57.2% for male patients, than 42.8% for female patients [16]. The higher percentage of female patients in this study may be because of the general attitude of men in this environment whereby they don't access healthcare until their health deteriorates to the extent that they can't carry out their daily activities effectively.…”

“…This study has demonstrated that 74.7% of the patients were adherent to their drugs. This adherence rate is lower than that seen in prior studies among TB patients in Tanzania and India which reported adherence rates of 95.7% and 84% respectively [16] [19]. A higher rate of 92.6% was reported in Atlanta, Georgia USA [20].…”

Non-Adherence to Anti-TB Drugs and Its Predictors among TB/HIV Co- Infected Patients in Mekelle, Ethiopia

“…In this study, gender of the patient did not significantly affect nonadherence to treatment like other studies [6,11,12]. However, some studies have shown an association between non-adherence and gender of the patients [9,13].…”

Non-Compliance among Tuberculosis Patients on SelfAdministration of Drugs in Ogbomoso Local Government Area of Oyo State. Nigeria.

“…A recent investigation has demonstrated the suitability of using isoniazid as a maker to monitor the regularity of self-administration of other drugs and the sensitivity is such that reliably positive results are obtainable for only about 12 hours after the ingestion of isoniazid (23,24).…”