Factors Influencing Treatment Adherence Among Drug-Sensitive Tuberculosis (DS-TB) Patients in Armenia: A Qualitative Study

Abstract

Purpose Despite the availability of effective treatment, tuberculosis (TB) is still one of the leading causes of mortality around the globe. Poor adherence to treatment challenges TB management both globally and locally. Proper adherence to treatment contributes to successful outcomes and prevents the development of drug-resistant forms of TB. Patients and Methods We conducted a qualitative study to identify and describe the factors that facilitated treatment adherence among drug-sensitive TB (DS-TB) patients in Armenia. Sixteen in-depth interviews (IDIs) with former DS-TB patients, two IDIs with family members of former DS-TB patients, and a focus group discussion with healthcare providers who manage DS-TB patients were conducted. The educational and ecological assessment component of the PRECEDE-PROCEED model was applied as a conceptual framework to guide the interview content and data analysis. Results Former patients’ awareness of TB and its treatment, beliefs about TB, trust in TB healthcare providers, and a sense of responsibility were the most common factors that predisposed them to complete the treatment. Support received from providers, family, and friends, a desire to avoid TB-associated stigma, and good tolerance of TB medications were the main reinforcing factors. Enabling factors included a relatively simple regimen of TB treatment and accessibility and affordability of TB services. Conclusion The findings of the study provide new perspectives on factors that facilitate adherence to long-term therapies, such as TB. Interventions that aim to invoke a patient’s sense of responsibility and positive beliefs about TB as well as engage families might promote the successful completion of treatment.

A systematic review of interventions to improve medication adherence in family medicine patients

“…Adherence to medication regimens is crucial to the successful management of a variety of medical illnesses [26][27][28]. Many patients, however, struggle to adhere to their recommended pharmaceutical regimens, resulting in unsatisfactory treatment outcomes [29,30]. This systematic study sought to assess the efficacy of several approaches for enhancing medication adherence.…”

The influence of the quality of Tuberculosis services with adherence to taking Anti-tuberculosis drugs

“…Patients' understanding of TB disease and its treatment, beliefs about TB, trusted TB healthcare facilities, and their responsibilities in completing treatment are the most common factors influencing patients to complete treatment. The main driving factors were the support received from health facilities, family, and friends, the desire to avoid TB-related stigma, and good tolerance for TB drugs (Grigoryan et al, 2022). Research conducted at an integrated health home hospital revealed that TB patients' perception of their disease, *Correspondence: adibahzahra0626@gmail.com…”

O estigma como fonte da construção social do conceito de tuberculose pulmonar: perspectiva dos enfermeiros

“…O sucesso do seu tratamento depende de diversos fatores que se interrelacionam entre si e têm como fator chave, a adesão ao regime medicamentoso. Uma abordagem centrada na pessoa é um dos fatores que potencializa a adesão ao tratamento e reduz o risco de abandono (7)(8)(9) . Doença fortemente influenciada por determinantes sociais e também pelo estigma social relacionado à doença, que na tuberculose é descrito como indicador de grande importância nessa relação e que tem grande impacto na não adesão ao tratamento medicamentoso (1,2,7-8-11).…”

“…Enquanto fenômeno social, no que se refere a tuberculose pulmonar, o estigma interfere na qualidade de vida e bem-estar das pessoas doentes, fomenta a vergonha, o medo de rejeição, o isolamento e a exclusão social (11-12-15). É ainda descrito como um importante fator que influencia a adesão e o resultado do tratamento (7)(8)(10)(11)16,23). O estudo teve como objetivo descrever a construção social do conceito social da tuberculose pulmonar que, na perspectiva dos enfermeiros, emerge de conceitos alicerçados no estigma.…”

“…O estigma social na tuberculose pulmonar associa-se à construção social do conceito da doença e relaciona-se com uma marca ou atributo depreciativo que causa medo, vergonha, discriminação, isolamento social. Origina sofrimento físico e moral, potencializa o abandono do tratamento e o retardamento na procura de cuidados de saúde (13)(14)16,23). Este artigo apresenta a análise de conteúdo como técnica de tratamento de dados em pesquisa qualitativa na perspetiva de Laurence Bardin (20) , prevendo as três fases fundamentais segundo a autora: pré-análise, exploração do material e tratamento dos resultados -a inferência e a interpretação.…”