Adherence to TB treatment remains low during continuation phase among adult patients in Northwest Ethiopia

BackgroundPatients' failure to adhere to TB treatment was a major challenge that leads to poor treatment outcomes. In Ethiopia, TB treatment success was low as compared with the global threshold. Despite various studies done in TB treatment adherence, little was known specifically in continuation phase where TB treatment is mainly patient-centered. This study aimed to determine adherence to TB treatment and its determinants among adult patients during continuation phase.MethodsWe deployed a facility-based cross-sectional study design supplemented with qualitative data to explore perspectives of focal healthcare providers. The study population was all adult (>= 18years) TB patients enrolled in the continuation phase and focal healthcare workers in TB clinics. The study included 307TB patients from 22 health facilities and nine TB focal healthcare providers purposively selected as key-informant. A short (11 questions) version Adherence to Refill and Medication Scale (ARMS) was used for measuring adherence. Data was collected using an interviewer-administered questionnaire and in-depth interview for qualitative data. Binary logistic regression was applied to identify factors associated with patient adherence. We followed a thematic analysis for the qualitative data. The audio data was transcribed, coded and categorized into themes using OpenCode software.ResultsAmong 307 participants, 64.2% (95% CI (58.6-69.4%) were adherent to TB treatment during continuation phase. A multi-variable analysis shown that secondary education (AOR=4.138, 95% CI; 1.594-10.74); good provider-patient relationship (AOR=1.863, 95% CI; 1.014-3.423); good knowledge on TB treatment (AOR=1.845, 95% CI; 1.012-3.362) and middle family wealth (AOR=2.646, 95% CI; 1.360-5.148) were significantly associated with adherence to TB treatment. The majority (58%) of patients mentioned forgetfulness, and followed by 17.3% of them traveling away from home without pills as major reasons for non-adherence to TB treatment.ConclusionsThe study indicated that patients' adherence to TB treatment remains low during continuation phase. The patient's education level, knowledge, family wealth, and provider-patient relationship were found positively associated with patient adherence. Forgetfulness, traveling away, and feeling sick were major reasons for non-adherence to TB treatment. Interventional studies are needed on those factors to improve patient adherence to TB treatment during continuation phase.

Automated summary

The study found that patients' adherence to TB treatment remains low during the continuation phase, with forgetfulness, travel away, and feeling sick being major reasons for non-adherence. Factors positively associated with patient adherence include education level, knowledge, family wealth, and provider-patient relationship. Interventional studies on these factors are needed to improve patient adherence to TB treatment during the continuation phase.