Background: Treatment non-adherence poses significant risks to
health outcomes and impedes the health system’s efficiency, hence curtailing
progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite
interventions to address TB treatment non-adherence, Kenya still reports high
TB treatment non-adherence rates of 35% and consequently poor treatment outcome
rates. Health Care Workers (HCWs) play a critical role in linking the
population to health services, yet little is known of their influence on
patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in
Kisumu East Sub-County. Methods:Health facility-based analytical cross-sectional mixed-method study. A Semi-structured
questionnaire on treatment adherence and patients’ perceptions of HCWs
during the clinic visit was administered to 102 consenting adult (out of a
total census of 107 adults) drug-susceptible TB patients. 12 purposively
selected HCWs by rank from 6 health facilities participated in Key Informant
Interview sessions. Medication adherence was measured using the Morisky
Medication Adherence Scale and then expressed as a dichotomous variable.
Quantitative analysis utilized STATA version 15.1 while qualitative deductive
thematic analysis was done using NVIVO version 14.
References
[1]
WHO: World Health Organization (2022) Global Tuberculosis Report 2022. Geneva. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022
[2]
MOH: Ministry of Health (2019) National Strategic Plan for Leprosy and Lung Health 2019-2023. https://nltp.co.ke/wp-content/uploads/2020/12/National-Strategic-Plan-2019-2023.pdf
[3]
NTLD-P (2018) Factors Associated with Non-Adherence to Tuberculosis Treatment in Kenya. https://nltp.co.ke/wp-content/uploads/2020/10/TB-Adherence-Report-Final.pdf
[4]
Castelnuovo, B. (2010) A Review of Compliance to Anti Tuberculosis Treatment and Risk Factors for Defaulting Treatment in Sub Saharan Africa. African Health Sciences, 10, 320-324.
[5]
MOH: Ministry of Health (2021) Integrated Guideline for Tuberculosis, Leprosy and Lung Disease. https://www.nltp.co.ke/wp-content/uploads/2022/02/Integrated-Guideline.pdf? _gl=1*3h2d82*_ga*MjA0MTIyMTE5MS4xNjkxMTM4MzU4*_ga_G9ERE53M0B*MTcwOTU1NTIxNi4xMS4xLjE3MDk1NTUyNDQuMC 4wLjA.*_ga_KCX8FFTHSP*MTcwOTU1NTIxNy4xMS4xLjE3MDk1NTUyNDQuMC4wLjA.&_ga=2.238928713.896767185.1709555217 -2041221191.1691138358
[6]
MOH: Ministry of Health (2021) Annual Report. National Tuberculosis NTLD-P. https://www.nltp.co.ke/wp-content/uploads/2022/07/DNTLDP_AnnualReport_2021_compressed.pdf
[7]
TIBU (2023) TIBU Patient Management System.
[8]
Gitonga, C.M., Nyamari, J. and Mugo, J. (2020) Adherence to Pulmonary Tuberculosis Treatment in Murang’a County, Kenya. International Journal of Current Aspects, 4, 49-63. https://doi.org/10.35942/ijcab.v4i1.114
[9]
Pablos-Méndez, A., Knirsch, C.A., Barr, R.G., Lerner, B.H. and Frieden, T.R. (1997) Nonadherence in Tuberculosis Treatment: Predictors and Consequences in New York City. The American Journal of Medicine, 102, 164-170. https://doi.org/10.1016/S0002-9343(96)00402-0
[10]
Jimmy, B. and Jose, J. (2011) Patient Medication Adherence: Measures in Daily Practice. Oman Medical Journal, 26, 155-159. https://doi.org/10.5001/omj.2011.38
[11]
CDC (2017) Drug Resistant TB: U.S. Department of Health & Human Services. https://www.cdc.gov/tb/topic/drtb/default.htm#:~:text= The%20average%20cost%20of%20treating,the%20disease%20(XDR%20TB)
[12]
Arap Sang, R.K., Obwoge, R.O., Kangethe, S., Ayiro, L.P. and Changeiywo, J.M. (2017) Patient Factors which Contribute to Non-Adherence to TB Treatment in Kericho and Nakuru Counties of Kenya. Science Journal of Public Health, 5, 329-334.
[13]
Muture, B.N., Keraka, M.N., Kimuu, P.K., Kabiru, E.W., Ombeka, V.O. and Oguya, F. (2011) Factors Associated with Default from Treatment among Tuberculosis Patients in Nairobi Province, Kenya: A Case Control Study. BMC Public Health, 11, Article No. 696. https://doi.org/10.1186/1471-2458-11-696
[14]
Obwoge, R.O., Sang, R.A. and Wakube, A. (2016) Factors Associated to Non-Adherence in Tuberculosis Treatment, Baringo County, Kenya. International Journal of Innovative Science and Research Technology, 3, Article 85.
[15]
MOH: Ministry of Health (2021) Guidelines for Management of Tuberculosis and Leprosy in Kenya. https://www.nltp.co.ke/wp-content/uploads/2022/02/Integrated-Guideline.pdf? _gl=1*53v0hj*_ga*MjA0MTIyMTE5MS4xNjkxMTM4MzU4*_ga_G9ERE53M0B*MTcwOTU1NTIxNi4xMS4xLjE3MDk1NTY3OTcuMC 4wLjA.*_ga_KCX8FFTHSP*MTcwOTU1NTIxNy4xMS4xLjE3MDk1NTY3OTguMC4wLjA.&_ga=2.129106757.896767185.1709555217 -2041221191.1691138358
[16]
IHME (2022) Kisumu, Kenya. https://www.healthdata.org/kenya-kisumu
Sim, J., Saunders, B., Waterfield, J. and Kingstone, T. (2018) Can Sample Size in Qualitative Research Be Determined a Priori? International Journal of Social Research Methodology, 21, 619-634. https://doi.org/10.1080/13645579.2018.1454643
[19]
MOH: Ministry of Health (2020) Kenya Latent Tuberculosis Infection Policy. https://nltp.co.ke/wp-content/uploads/2020/10/Kenya-LTBI_-Policy_Final.pdf
[20]
Nili, M., Mohamed, R. and Kelly, K.M. (2020) A Systematic Review of Interventions Using Health Behavioral Theories to Improve Medication Adherence among Patients with Hypertension. Translational Behavioral Medicine, 10, 1177-1186. https://doi.org/10.1093/tbm/ibaa020
[21]
Salifu, Y., Eliason, C. and Mensah, G. (2018) Health Service Factors That Affect Adherence to Tuberculosis Treatment in Ghana. Primary Health Care, 28, 27-33. https://doi.org/10.7748/phc.2018.e1312
[22]
Finlay, A., Lancaster, J., Holtz, T.H., Weyer, K., Miranda, A. and Van Der Walt, M. (2012) Patient- and Provider-Level Risk Factors Associated with Default from Tuberculosis Treatment, South Africa, 2002: A Case-Control Study. BMC Public Health, 12, Article No. 56. https://doi.org/10.1186/1471-2458-12-56
[23]
Adane, A.A., Alene, K.A., Koye, D.N. and Zeleke, B.M. (2013) Non-Adherence to Anti-Tuberculosis Treatment and Determinant Factors among Patients with Tuberculosis in Northwest Ethiopia. PLOS ONE, 8, e78791. https://doi.org/10.1371/journal.pone.0078791
[24]
Boru, C.G., Shimels, T. and Bilal, A.I. (2017) Factors Contributing to Non-Adherence with Treatment among TB Patients in Sodo Woreda, Gurage Zone, Southern Ethiopia: A Qualitative Study. Journal of Infection and Public Health, 10, 527-533. https://doi.org/10.1016/j.jiph.2016.11.018
[25]
Ibrahim, L.M., Hadjia, I.S., Nguku, P., Waziri, N.E., Akhimien, M.O., Patrobas, P., et al. (2014) Health Care Workers’ Knowledge and Attitude towards TB Patients under Direct Observation of Treatment in Plateau State Nigeria, 2011. The Pan African Medical Journal, 18, Article No. 8. https://doi.org/10.11604/pamj.supp.2014.18.1.3408
[26]
Mburu, G., Restoy, E., Kibuchi, E., Holland, P. and Harries, A.D. (2016) Detention of People Lost to Follow-Up on TB Treatment in Kenya: The Need for Human Rights-Based Alternatives. Health and Human Rights, 18, 43-54.
[27]
Huque, R., Al Azdi, Z., Ebenso, B., Nasreen, S., Chowdhury, A.A., Elsey, H., et al. (2021) Patient Feedback Systems at the Primary Level of Health Care Centres in Bangladesh: A Mixed Methods Study. SAGE Open, 11. https://doi.org/10.1177/21582440211011458
[28]
Nezenega, Z.S., Gacho, Y.H. and Tafere, T.E. (2013) Patient Satisfaction on Tuberculosis Treatment Service and Adherence to Treatment in Public Health Facilities of Sidama Zone, South Ethiopia. BMC Health Services Research, 13, Article No. 110. https://doi.org/10.1186/1472-6963-13-110
[29]
Tadesse, S. (2016) Stigma against Tuberculosis Patients in Addis Ababa, Ethiopia. PLOS ONE, 11, e0152900. https://doi.org/10.1371/journal.pone.0152900
[30]
Tola, H.H., Azar, T., Shojaeizadeh, D. and Garmaroudi, G. (2015) Tuberculosis Treatment Non-Adherence and Lost to Follow up among TB Patients with or without HIV in Developing Countries: A Systematic Review. Iranian Journal of Public Health, 44, 1-11.
[31]
Sabaté, E. (2003) Adherence to Long-Term Therapies: Evidence for Action. World Health Organization. https://books.google.co.ke/books?hl=en&lr=&id=kcYUTH8rPiwC&oi=fnd&pg=PR5&dq=%5B31%5D+Sabat%C3%A9,+E.+ (2003)+Adherence+to+Long-Term+Therapies:+Evidence+for+Action.+World+Health+Organization&ots=tD-Rjt 4ir-&sig=dJXP7P82Y7wl8uewxiUEpTHn9XE&redir_esc=y#v=onepage&q=training%20of%20health%20care%20workers&f=false
[32]
Steyn, M., Van Der Merwe, N., Dick, J., Borcherds, R. and Wilding, R. (1997) Communication with TB Patients; A Neglected Dimension of Effective Treatment? Curationis, 20, 53-56.
[33]
Adefolalu, A.O. (2018) Cognitive-Behavioural Theories and Adherence: Application and Relevance in Antiretroviral Therapy. Southern African Journal of HIV Medicine, 19, a762. https://doi.org/10.4102/sajhivmed.v19i1.762
