Alcohol intervention strategy among tuberculosis patients: a pilot study from South India

Thomas, Beena; Watson, Basilea; Senthil, E K; A, Deepalakshmi; Balaji, G.; Chandra, Shalini; Manogaran, Chelvadurai; Nagarajan, K.; Ovung, Senthanro; Jayabal, Lavanya; Swaminathan, Soumya

doi:10.5588/ijtld.16.0693

Cited by 25 publications

(18 citation statements)

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“…Alcohol use was particularly common and has been previously described as a barrier to TB care in Chennai 38. Interventions to address alcohol use have been associated with improvements in treatment success 39. Family-related and society-related barriers also included lack of social support and TB-related stigma.…”

Section: Discussionmentioning

confidence: 99%

Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

et al. 2020

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IntroductionPretreatment loss to follow-up (PTLFU)—dropout of patients after diagnosis but before treatment registration—is a major gap in tuberculosis (TB) care in India and globally. Patient and healthcare worker (HCW) perspectives are critical for developing interventions to reduce PTLFU.MethodsWe tracked smear-positive TB patients diagnosed via sputum microscopy from 22 diagnostic centres in Chennai, one of India’s largest cities. Patients who did not start therapy within 14 days, or who died or were lost to follow-up before official treatment registration, were classified as PTLFU cases. We conducted qualitative interviews with trackable patients, or family members of patients who had died. We conducted focus group discussions (FGDs) with HCWs involved in TB care. Interview and FGD transcripts were coded and analysed with Dedoose software to identify key themes. We created categories into which themes clustered and identified relationships among thematic categories to develop an explanatory model for PTLFU.ResultsWe conducted six FGDs comprising 53 HCWs and 33 individual patient or family member interviews. Themes clustered into five categories. Examining relationships among categories revealed two pathways leading to PTLFU as part of an explanatory model. In the first pathway, administrative and organisational health system barriers—including the complexity of navigating the system, healthcare worker absenteeism and infrastructure failures—resulted in patients feeling frustration or resignation, leading to disengagement from care. In turn, HCWs faced work constraints that contributed to many of these health system barriers for patients. In the second pathway, negative HCW attitudes and behaviours contributed to patients distrusting the health system, resulting in refusal of care.ConclusionHealth system barriers contribute to PTLFU directly and by amplifying patient-related challenges to engaging in care. Interventions should focus on removing administrative hurdles patients face in the health system, improving quality of the HCW-patient interaction and alleviating constraints preventing HCWs from providing patient-centred care.

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Section: Discussionmentioning

confidence: 99%

Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

et al. 2020

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“…Examples of adherence intervention packages that leverage DAT dosing histories exist for other diseases, such as HIV. 21 These packages of care could screen for and address common causes of non-adherence in each setting, which may include poor treatment literacy, 84 TB medication toxicities, 5 depression, 5 85 86 substance use disorders, 4 financial burdens 7 or difficulties travelling to health facilities. 7 By triaging patients, DATs may allow HCPs to focus more time and attention on a smaller group of high-risk patients, and ancillary personnel, such as dedicated counsellors or psychologists, could potentially help address their more intensive needs.…”

Section: Research Priorities and Existing Evidencementioning

confidence: 99%

“…Causes of medication non-adherence are complex and include psychosocial (eg, alcohol use, 4 depression, 5 stigma 6 ), structural (eg, distance from clinics, medication costs), therapy-related (eg, toxicities 5 ) and health system–related barriers (eg, lack of counselling, poor user-experience with the health system). 7 8 Directly observed therapy (DOT) was designed to reduce non-adherence; however, concerns have been raised that some DOT approaches may impinge on patient autonomy 9 and have minimal efficacy for improving treatment outcomes, as compared with self-administered therapy.…”

Section: Introductionmentioning

confidence: 99%

Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities

Subbaraman¹,

et al. 2018

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Poor medication adherence may increase rates of loss to follow-up, disease relapse and drug resistance for individuals with active tuberculosis (TB). While TB programmes have historically used directly observed therapy (DOT) to address adherence, concerns have been raised about the patient burden, ethical limitations, effectiveness in improving treatment outcomes and long-term feasibility of DOT for health systems. Digital adherence technologies (DATs)—which include feature phone–based and smartphone-based technologies, digital pillboxes and ingestible sensors—may facilitate more patient-centric approaches for monitoring adherence, though available data are limited. Depending on the specific technology, DATs may help to remind patients to take their medications, facilitate digital observation of pill-taking, compile dosing histories and triage patients based on their level of adherence, which can facilitate provision of individualised care by TB programmes to patients with varied levels of risk. Research is needed to understand whether DATs are acceptable to patients and healthcare providers, accurate for measuring adherence, effective in improving treatment outcomes and impactful in improving health system efficiency. In this article, we describe the landscape of DATs that are being used in research or clinical practice by TB programmes and highlight priorities for research.

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“…39 Interventions to address alcohol use have been associated with promising improvements in treatment success. 40 Family- and society-related barriers also included lack of social support and TB-related stigma—which were particularly a problem for women who had difficulties traveling to health facilities if not accompanied by a family member. Some patients had advanced TB disease at the time of diagnosis, which made it more difficult to navigate the health system and also resulted in some patients dying before official registration.…”

Section: Discussionmentioning

confidence: 99%

Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

Thomas

Chandra

Jayabal

et al. 2019

Preprint

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Introduction: Pretreatment loss to follow-up (PTLFU)--dropout of patients after diagnosis but before registration in treatment--is a major gap in TB care delivery in India and globally. Patient and healthcare worker (HCW) perspectives are critical for developing interventions to address this problem. Methods: We prospectively tracked newly diagnosed smear-positive TB patients from 22 TB diagnostic centers in Chennai, one of the largest cities in India. Patients who did not start therapy within 14 days, or who died or were lost to follow-up before official registration in treatment, were classified as PTLFU cases. We conducted qualitative interviews with all trackable PTLFU patients, or family members of patients who had died. We conducted focus group discussions (FGDs) with three types of HCWs involved in TB care. Interview and FGD recordings were transcribed, coded, and analyzed with the support of Dedoose 8.0.35 software to identify key themes. We created categories into which these themes clustered, identified relationships among thematic categories, and assembled findings into a broader explanatory model for PTLFU. Results: We conducted six FGDs comprising 53 HCWs and 33 individual patient or family member interviews. Themes clustered into five categories. Examining relationships among these categories revealed two pathways leading to PTLFU as part of a broader explanatory model. In the first pathway, administrative and organizational health system barriers--including the complexity of navigating the system, healthcare worker absenteeism, and infrastructure failures--resulted in patients feeling frustration or resignation, leading to disengagement from care. Health system barriers experienced by patients were in turn shaped by constraints that made it difficult for HCWs to do their jobs effectively. In the second pathway, negative or judgmental HCW attitudes and behaviors towards patients contributed to patient distrust of the health system, resulting in refusal of further care. Conclusion: Health system barriers contribute substantially to PTLFU directly and by amplifying patient-related challenges to engaging in care. Interventions should focus on removing administrative hurdles patients face in the health system, improving the quality of the HCW-patient interaction, and alleviating constraints HCWs face in being able to provide optimal patient-centered care.

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Alcohol intervention strategy among tuberculosis patients: a pilot study from South India

Cited by 25 publications

References 0 publications

Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities

Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

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