The social determinants of tuberculosis treatment adherence in a remote region of Papua New Guinea

Abstract

BackgroundPapua New Guinea (PNG) is a diverse and culturally-rich country with severe infrastructural and health problems. Tuberculosis (TB) is widespread, and the number of cases with drug resistance is rising. Treatment adherence is known to be important for both effective treatment and limiting the emergence of drug resistance. The aim of this study was to construct a matrix of the factors that act as facilitators or barriers to TB treatment adherence in a remote region of PNG.MethodsThe study was based in the Balimo region of the Western Province. People known to have undergone TB treatment, as well as staff involved in managing people with TB, were asked to participate in an in-depth interview about their experiences. Purposive sampling was used to identify a diverse range of participants, from different geographic locations, social backgrounds, and with successful and unsuccessful treatment outcomes. The interview data was analysed based on grounded theory methodology.ResultsThe study identified a range of factors that influence TB treatment adherence, with these being classified as personal, systems, and sociocultural. These factors are presented along with suggested recommendations for adaptations to DOTS-based treatment in this region. Barriers included the challenges associated with travel to treatment sites, and the difficulties of undertaking treatment alongside the daily need to maintain subsistence food production. However, facilitators were also identified, including the positive influence of religious beliefs, and high confidence in the ability of DOTS-based treatment to cure TB.ConclusionsDocumenting the wide range of factors that influence treatment adherence in a severely affected remote population will assist in improving TB control. These results provide impetus for further community-based efforts aimed at improving access to TB diagnosis and treatment, and maintaining successful treatment outcomes in the face of emerging drug resistance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3935-7) contains supplementary material, which is available to authorized users.

The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea

“…Treatment outcomes were unknown for just over 25% of patients who completed treatment at least 6 months before the end of the study period. This proportion may reflect the flexibility with which DOTS is often administered in the region, where patients may take their treatment packs back to their home village for the duration of treatment [6]. In this study, the only factor found to be significantly associated with poorer treatment outcomes was the LLG area in which a patient resided, with poorer outcomes more likely in the rural LLGs.…”

Epidemiology of tuberculosis in Papua New Guinea: analysis of case notification and treatment-outcome data, 2008–2016

“…To improve treatment outcomes, further action is needed to strengthen patient support, including daily treatment, monitoring, counselling and continued efforts to strengthen the health system and address socioeconomic and physical barriers to accessing TB services. ( 17 ) Family DOT and self-administration are currently practised in Papua New Guinea but have not led to improved treatment success rates. Revisiting the care modality by strengthening community involvement and using an informal health workforce for treatment support is warranted.…”

Tuberculosis Treatment Completion for Tribal Patients in Kerala: Needs Constant Push!

“…They were awareness about TB, motivation, employment, treatment duration, family, community and government support, stigma and discrimination and belief systems. Similar studies were conducted and concluded that patient adherence to their medication regimens was influenced by the interaction of personal and social factors [6] [11].…”

“…The study results reflected the influence of traditional beliefs that resulted in delayed seeking care and showed the importance of communication and lack of stigma in the care of TB. A large number of patients had no stigma because of caste and TB [11] [14] [15].…”

“…The treatment adherence mechanisms under RNTCP have a spectrum of activities for patients and health care providers which include training programs, health education, a routine reminder for patients to consume drugs and follow-up examination, financial incentives and reimbursements to patients direct or indirect costs, peer assistance, directly observed treatment and loss to retrieval actions. But still, the treatment adherence continues to be a challenge in tribal areas due to the geographic and social milieu of tribal population [10] [11]. Though many studies have been conducted globally on adherence among TB patients there is sparse literature from Kerala, India to understand the multifaceted dimensions and determinants of treatment adherence among the tribal population in a state which has remarkably performed well in health and development indicators over the years.…”