Assessment of adherence to anti tuberculosis medication for successful implementation of revised national tuberculosis programme at a tertiary care hospital, Shimoga: a cross-sectional observational study

Abstract

Background:This study assessed level of non-adherence to anti tuberculosis (TB) therapy among pulmonary TB patients, compares various factors among adherent and non-adherent TB patients, stressing on reasons for non-adherence at a tertiary care hospital. Methods: This institution based observational and cross-sectional study was conducted interviewing patients with pulmonary TB and assessed using Moriskys medication adherence scale-8 (MMAS-8), a pre-tested structured questionnaire based scoring system of patients treated for pulmonary TB at district TB centre SIMS, Shimoga. Descriptive statistics were employed. Results: Among 70 cases analysed, 57 were males and 13 females, with mean age group of 41.32±8.63 and mean MMAS score of 2.23±1.87. 53.33% patients were on continuous phase of treatment. The level of non-adherence were as follows, high= 18%, medium= 38% and low= 44%. The common cause for nonadherence was forgetfulness (66%) reasons being: betterment of symptoms (54%), sickness after taking medication (31%), distance of travel: far (15%). Many were labourers (62%), with low literacy rate, also chronic alcoholics (72%) and smokers (73%). Female with moderate literacy and not addicted to alcohol/smoking showed high adherence compared to males (p<0.05%). Conclusions:As prevalence of non-adherence is high, especially Patients on continuous phase of TB treatment, there arises immense need for continuous and effective health education to patients' and their family regarding the adverse effects and the need for high level of adherence to treatment for the complete cure of disease. Patients who are addicted to alcohol/smoking should be targeted with interventions to quit the same, provide free transport facility to RNTCP centres and prompt treatment of ADR, will improve adherence to medication.

Factors Associated with Treatment Adherence among Tuberculosis Patients in Gandaki Province of Nepal

“…Very low adherence was shown by study participants having alcohol habit, tobacco consumption with treatment adherence. This was similarly observed in other studies where lifestyles behaviour such as alcohol and tobacco consumption were well-known risk factors for non-adherence [14,18,19] . Those TB patients who don't consume alcohol have good communication with health services providers and also found to be effectively adhered to their treatment regimen.…”

Drug adherence to anti-tubercular treatment during COVID-19 lockdown in Haldwani block of Nainital district

“…( 21) Alcohol consumption and addiction to drugs are well known risk factor and a barrier to medical treatment which may lead to non-adherence. (21,28) Findings from our study also reflects that alcohol consumption and drug addiction are risk factors, where the rate of nonadherence to treatment due to these factors were as high as 15% and 6.7% respectively. Stigmatization towards tuberculosis and those suffering from TB is an old issue which discourages the patient to come forward for the treatment or may also lead to early stoppage of the treatment.…”

“…which was also similar to the findings from around the world. (18,(20)(21)(22) Even though the setting and the condition/situation of the study were different, as our study focused during the lockdown brought about by the pandemic, the findings remained the same. This shows that the socio-demographic factors of the patients play an important role in non-adherence to drugs therapy.…”

“…Contrary to our findings, many studies reported that the compliance depended on distance from the centre and route difficulties. (18,21,23,24) The low prevalence from our study in spite of the stringent lockdown may be due to the relaxation placed for health sector and those seeking medical help. (1) Anti-TB medication is required to be taken for a long duration, which is another important factor in the nonadherence of the treatment which was also corroborated by Cylia Nkechi Iweama et al (25) The other factors were Diabetes and HIV, which are chronic diseases, such diseases also require a tenacious medication for a long duration or lifelong.…”