Qualitative study of perceived causes of tuberculosis treatment default among health care workers in Morocco

Abstract

Interventions to enhance TB treatment completion should take into account the local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.

Treatment Default amongst Patients with Tuberculosis in Urban Morocco: Predicting and Explaining Default and Post-Default Sputum Smear and Drug Susceptibility Results

“…On the other hand, strategies aimed at factors related to TB treatment organization, such as patient reminders or strategies for timely discovery and recovery of patients who default, have shown positive effects [36], including when practiced by clinicians at some of our study sites [15]. Patient-centered interventions that involve both patient-related and health-system determinants of default are most likely to be successful [11].…”

“…In a parallel qualitative study, doctors and nurses who provided care to patients with TB were aware of most of the risk factors found via quantitative analysis of patient questionnaire data and patient interviews, with the exception of personal and family problems. Clinicians also described health systems factors that were unknown to patients but were important contributors to default and delays in recovery of patients who had defaulted, including lack of time for patient education because of staff shortages, lack of appointment registers, and insufficient communication between pulmonary specialists and primary care providers [15].…”

“…Medical professionals frequently cited markers of low socio-economic status (SES), such as poverty, illiteracy, alcohol and drug use as important causes of default [15]. However, although these factors were associated with default in bivariate analysis, they were not mentioned by patients and not found to be independent predictors of default in multivariate regression.…”

“…Results of the quantitative analysis were compared to patients’ responses and to perspectives of local health care workers with extensive experience caring for patients with TB collected in a parallel study [15]. This mixed methods approach was used to explain and extend the results of the quantitative analysis [21], [22].…”

“…In a previous qualitative study, we explored treatment default from the point of view of healthcare professionals who provide care to patients with TB in Morocco [15]. In this paper, we present results of a concurrent study of risk factors for TB treatment default based on patient interviews and compare these findings to responses given by healthcare providers.…”