Patients' experiences and perceptions on associates of TB treatment adherence: a qualitative study on DOTS service in public health centers in Addis Ababa, Ethiopia

Effect of COVID-19 on paediatric TB service delivery and patients' comfort receiving TB services in Cameroon and Kenya during COVID: a qualitative assessment

BACKGROUND

The outbreak of COVID-19 has caused a setback to the gains achieved in tuberculosis (TB) control by impairing TB diagnosis, delaying treatment initiation and aggravating TB deaths. This study explored the effect of COVID-19 on paediatric TB services provided through the Catalysing Paediatric TB Innovations (CaP-TB) project among caregivers of children receiving TB services and healthcare workers (HCWs) providing TB services in Cameroon and Kenya.

METHODS

From March to September 2021, in-depth interviews (44) were conducted with caregivers whose children under 5 years had gone through TB services and programme managers (10) overseeing the CaP-TB project. Focus group discussions were conducted with HCWs (07) and community health workers (04) supporting TB care services. Transcripts were coded and analysed by using MAXQDA V.12.

RESULTS

The COVID-19 pandemic has caused fear and anxiety among HCWs and caregivers. This fear was motivated by stigma related to COVID-19 and affected the ability to screen patients for TB due to the similarity of symptoms with COVID-19. The health-seeking behaviour of patients was affected, as many caregivers avoided hospitals and those accessing the facilities concealed their sickness due to fear of testing positive or being vaccinated. In addition, COVID-19 mitigation strategies implemented by both government and health facilities to curb the spread of the virus limited patient access to paediatric healthcare services. These included temporary closure of health facilities due to COVID-19 infections among staff, transfer of services to other spaces, spacing out patient appointments and reduced time spent with patients.

CONCLUSIONS

The outbreak of COVID-19 has induced fear and stigma that affected patients' health-seeking behaviour and provider attitudes towards paediatric TB service delivery. In addition, facility and governmental measures put in place to mitigate COVID-19 impact negatively affected paediatric service delivery. Training for health personnel, timely provision of personal protective equipments and appropriate communication strategies could help mitigate COVID-19 impact on paediatric TB service delivery.

Evaluating tuberculosis treatment outcomes in Haiti from 2018 to 2019: A competing risk analysis

Objectives

This study assesses tuberculosis (TB) treatment outcomes in Haiti.

Methods

Data from drug-susceptible patients with TB (2018-2019) were analyzed using the Fine & Gray model with multiple imputation.

Results

Of the 16,545 patients, 14.7% had concurrent HIV coinfection, with a 66.2% success rate. The median treatment duration was 5 months, with patients averaging 30 years (with an interquartile range of 22-42 years). The estimated hazard of achieving a successful treatment outcome decreased by 2.5% and 8.1% for patients aged 45 and 60 years, respectively, compared with patients aged 30 years. Male patients had a 6.5% lower estimated hazard of success than their female counterparts. In addition, patients coinfected with HIV experienced a 35.3% reduction in the estimated hazard of achieving a successful treatment outcome compared with those with a negative HIV serologic status.

Conclusions

Integrated health care approaches should be implemented, incorporating innovative solutions, such as machine learning algorithms combined with geographic information systems and non-conventional data sources (including social media), to identify TB hotspots and high-burden households.

Development and validation of a structured questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia

Background: Medication non-adherence is a significant concern in tuberculosis (TB) treatment, requiring a precise understanding of the associated risk factors. However, there is a lack of appropriate means to assess the risk factors among TB patients in Indonesia, leading to the development and validation of a structured questionnaire for this purpose. Method: This study unfolded in two distinct phases, namely, the first included questionnaire construction through framework development, item generation, item screening, and pretesting (in 50 patients). The second comprised questionnaire validation with 346 participants using confirmatory factor analysis (CFA) and structural equation modeling-partial least squares (SEM-PLS). Additionally, reliability testing was conducted using Cronbach's alpha and composite reliability statistical techniques. Results: In the development phase, 168 items were defined, consisting of sociodemographic characteristics (8 items) and risk factors for medication non-adherence (160 items). Expert evaluation reduced the number of items to 60, which decreased to 22 after performing a pilot study. Subsequent SEM-PLS modeling resulted in the identification of 14 valid items, representing five major risk factors, namely, socioeconomics (4 items), healthcare team (4 items), condition (3 items), therapy (2 items), and patient (1 item). Only condition-related factors were found to influence non-adherence, and all constructs showed good reliability based on Cronbach's alpha (>0.6) and composite reliability (0.7) values. Conclusion: The final 22 items that emerged from this rigorous process indicated a valid and robust questionnaire for assessing risk factors of medication non-adherence among pulmonary tuberculosis patients in Indonesia. The developed questionnaire was positioned to be a valuable tool for healthcare professionals, policymakers, and scientists in creating patient-centered strategies and interventions to address non-adherence.

"It is not easy": Experiences of people living with HIV and tuberculosis on Tuberculosis treatment in Uganda

Background

Completion of tuberculosis (TB) treatment presents several challenges to patients, including long treatment duration, medication adverse-effects and heavy pill burden. WHO emphasize the need for patient-centered TB care, but such approaches require understanding of patient experiences and perceptions.

Methods

In 2020, we nested a qualitative study within a clinical trial that recruited 128 HIV-TB co-infected adults in Kampala receiving rifampicin-based TB treatment, alongside anti-retroviral therapy. A purposively selected sub-sample of 46 trial participants contributed to nine gender segregated focus group discussions. Of these, 12 also participated in in-depth interviews. Sessions were recorded, transcribed verbatim and translated from local languages into English. Thematic analysis focused on drug adverse-effects, use of self-prescribed medications and barriers to treatment adherence.

Results

Patients seemed more concerned about adverse effects that clinicians sometimes overlook such as change in urine color. Those who remembered pre-treatment counselling advice were disinclined to manage adverse-effects by self-prescription. Difficulty in accessing a medical practitioner was reported as a reason for self-medication. Obstacles to adherence included stigma (especially from visible adverse-effects like "red urine"), difficulties with pill size and number, discomfort with formulation and medication adverse effects.

Conclusion

Tailored pre-treatment counselling, improved access to clinical services, and simpler drug administration will deliver more patient-centered care.

Magnitude and Impacts of Adverse Events of Injectable Containing Shorter Regimen in Programmatic Management of Multi-Drug Resistant Tuberculosis in Ethiopia: A Retrospective Cohort Study

Background

Since its launch as a standardized treatment for multidrug-resistant tuberculosis (MDR-TB) in Ethiopia in April 2018, the safety profile of the shorter injectable regimen under a programmatic setting has not been well studied. Thus, this study aimed to assess the status of adverse events in patients treated with a shorter injectable regimen in Ethiopia.

Methods

This is a retrospective cohort study. Data were collected using a structured data abstraction form and analyzed using SPSS, version 25, both descriptively and analytically. Logistic regression was conducted to assess predictors, and Kaplan-Meier analysis was used to examine the time to AEs and survival experiences.

Results

Of 256 patients, 245 (95.7%) were eligible for the study. Of 245, 107 (43.7%) patients experienced at least one AE. In total, 276 AE cases were observed out of which the most common were nausea/vomiting (20.3%), dyspepsia (18.1%), and ototoxicity (11.6%). Of 276 AEs, approximately 49 (17.8%) were serious. AEs led to drug discontinuation, dose modification, and regimen change in 29 (27%), 15 (14%) and 10 (9.3%) patients, respectively. Only 19.2% of 276 the overall AEs and 22.6% of 62 AE of special interest (AESI) were reported to the National Pharmacovigilance Center.

Conclusion

Although the observed extent of AEs associated with the shorter regimen (SR) seemed to be moderate, it significantly influenced the treatment schemes and patient conditions. Reporting of AEs was low, irrespective of their severity and AESI. Therefore, strengthening the implementation of active drug safety monitoring and management is required.

Loss to follow-up tuberculosis treatment and associated factors among adults attending at public health facilities in Warder District, Somali Regional State, Eastern Ethiopia

Background

Tuberculosis is a major public health problem worldwide, particularly in resource-limited countries. Loss of follow-up during treatment is one of the major obstacles in the fight against tuberculosis, which has serious implications for patients, their families, communities, and health service providers.

Purpose

To assess the magnitude of the loss to follow-up tuberculosis treatment and associated factors among adults attending public health facilities in Warder District, Somali Regional State, eastern Ethiopia from November 02-17, 2021.

Methods

A 5-year (from 1 January 2016 to 31 December 2020) retrospective study was conducted on 589 adult tuberculosis treatment records. Data were collected using a structured data extraction format. Data were analyzed using STATA version 14.0 statistical package. Variables with P < 0.05 in the multivariate logistic regression analysis were considered statistically significant.

Results

A total of 98 (16.6%) TB patients failed to follow up with their treatment. Age between 55 and 64 years (AOR = 4.4, 95% CI: 1.9-9.9), being male (AOR = 1.8, 95% CI: 1.1-2.9), living more than 10 km away from a public health facility (AOR = 4.9, 95% CI:2.5-9.4), and having a history of tuberculosis treatment (AOR = 2.3, 95% CI: 1.2-4.4) were associated with a higher likelihood of not following up, while having a positive initial smear result (AOR = 0.48, 95% CI: 0.24-0.96) was associated with a lower probability of not following up.

Conclusion

One out of six patients was lost to follow-up after initiating their tuberculosis treatment. Hence, improving the accessibility of public health facilities with a special focus on older adults, male patients, smear-negative patients, and retreatment cases is highly warranted among TB patients.

Stakeholders' perspective on the daily regimen of tuberculosis treatment- A qualitative approach

INTRODUCTION

In the context of changing over from an intermittent treatment regimen to a daily regimen, it becomes crucial to understand the impact of a daily regimen on the treatment process and outcome. It enables health professionals to strengthen strategies, to enhance the quality of treatment as well as the quality of life of TB patients. The perspective of each stakeholder involved in the process is important in assessing the impact of the daily regimen.

OBJECTIVES

To understand patients' and providers' perspectives on the daily regimen of Tuberculosis treatment.

METHODOLOGY

A qualitative study was conducted between March 2020 to June 2020, including in-depth interviews with TB patients on treatment and DOT providers, and Key Informant Interview(KII) with TB Health Visitors(TBHV) and family members of TB patients. A thematic-network analysis approach was utilized to get the results.

RESULTS

Two sub-themes emerged: (i) Acceptance of the daily regimen of treatment; (ii) operational difficulties of the daily regimen. No injections in the regimen, fewer side effects of drugs as dose depends on weight band, family members can be treatment supporter, awareness about disease and treatment, the drugs are as same as private drugs available, adherence has improved, monthly DBT were found to some of the enablers in the study. The Barriers found in the study were traveling daily to get drugs, loss of daily wages, accompanying patients daily, tracing private patients, pyridoxine is not given free in this regimen, increased workload for treatment providers, etc. CONCLUSION: The study points out that acceptance of the patient to the daily regimen is better as they have lesser side effects. The operational difficulties in the implementation of the daily regimen can be addressed by providing family members as treatment supporters.

Methodological - Theoretical approach to phenomenological studies on the experience of medication use: A systematic review

BACKGROUND

The study of medication use should include pharmacological, family, and social dimensions to explain how the lived experiences, beliefs, and perceptions of everyone, and their social and cultural environment affects consumption, using for this purpose the qualitative approach.

OBJECTIVE

To conduct a systematic review of the theoretical-methodological approaches to phenomenology to identify studies that allow an understanding of patients' experiences with the use of medications.a.

METHODS

A systematic literature search was conducted following the PRISMA guidelines to identify studies that address phenomenological research on patients' experiences of medications used and to apply them in subsequent studies. A thematic analysis was performed using ATLAS.ti software to facilitate data management.

RESULTS

Twenty-six articles were identified, most of them including adult patients diagnosed with chronic degenerative diseases. The semantic network obtained places Phenomenology at the center as the interpretative referential framework, with three theoretical approaches: descriptive, interpretative, and perceptual under the philosophies of Husserl, Heidegger, and Merleau-Ponty respectively; two techniques to collect data which are in-depth interview and focus groups; and to explore the life experiences of patients and understand the meaning in the context of their lives, thematic analysis, content analysis, and interpretative phenomenological analysis were identified.

CONCLUSIONS

It was evidenced that Qualitative Research approaches, methodologies, and techniques are applicable to describe people's experiences towards the use of medications. Phenomenology constitutes a useful referential framework in qualitative research to explain the experiences and perceptions about the disease and the use of medicines.

Lived Experience of Iranian Family Caregivers of Tubercular Patients: A Qualitative Study

OBJECTIVES

To investigate the lived experience of family caregivers of persons with tuberculosis.

METHODS

In this study, the method of hermeneutic phenomenology. Data were collected through online in-depth semi-structured interviews with nine family caregivers of TB patients. The obtained data were thematically analyzed to explain the concept of home care for TB patients through van Manen's 6-step methodology.

RESULTS

After the thematic analysis, three main themes of caregivers' mental distresses, quality care stasis, and facilitated care were obtained from 944 primary codes and 11 categories.

CONCLUSIONS

Family caregivers of these patients suffer from mental distress. This issue affects the quality and ease of caregiving for these patients. Therefore, policymakers of this area should pay attention to the family caregivers of these patients and attempt to provide support; they should try to improve their quality of life.

Barriers and facilitators of nutrition assessment, counseling, and support for tuberculosis patients: a qualitative study

Background

Nutrition has a substantial role in the prevention, treatment, and cure of tuberculosis. Thus, nutrition assessment, counseling, and support (NACS) have been implemented as part of tuberculosis treatment. However, evidence on the barriers and facilitators (enablers) of its implementation is lacking.

Objective

To explore barriers and facilitators of implementation of NACS for tuberculosis patients.

Methods

An exploratory qualitative study was conducted in public health facilities and health offices of Mekelle City, Northern Ethiopia. We conducted 17 interviews using purposively selected key informants comprising health professionals (n = 12) and tuberculosis patients (n = 5). Interviews were tape-recorded, transcribed verbatim, and coded and analyzed using a thematic approach in ATLAS.ti 7 software.

Results

Barriers were identified at three levels -organization, care provider, and patient levels. Suboptimal nutritional supply, lack of supportive supervision, lack of adequate workforce, staff turn-over, the sudden withdrawal of partners, and weak link with social service were the barriers at the organization level. Lack of commitment was reported as the only barrier at the care provider level, and socioeconomic status of patients, sharing and selling of supplies, perceived improved status, and perceived stigma were identified as the major barriers for the implementation of nutrition assessment, counseling, and support service. While training, availability of measurement and educational tools, the inclusion of nutrition indicators in the tuberculosis register, and the presence of collaborating partners were identified as facilitators at the organizational level. Patients’ motivation to know their health status was reported to be a facilitator at the patient level.

Conclusions

Organization, care provider, and patient-level barriers and facilitators were found to influence the implementation of NACS. Hence, multilevel factors should be considered to successfully implement the program and to gain its potential impact.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00463-x.

Substance use disorders and adherence to antituberculosis medications in Southwest Ethiopia: a prospective cohort study

OBJECTIVES

In Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia.

DESIGN

Prospective cohort study.

SETTINGS

Patients were recruited from 22 health centres and four hospitals in Southwest Ethiopia.

PARTICIPANTS

This study was conducted among 268 patients with TB, aged 18-80 in Southwest Ethiopia between October 2017 and October 2018. At baseline, patients who were exposed substance use disorders (134 patients) and unexposed to substance use disorders (134 patients) were recruited. Patients were followed for 6 months, and data were collected on three occasions.

MAIN OUTCOME MEASURE

Adherence to anti-TB medications.

RESULTS

Patients with substance use disorders had consistently higher prevalence of non-adherence than those without, 16.4% versus 3.0% at baseline, 41.7% versus 14.4% at 2-month follow-up and 45.7% versus 10.8% at 6-month follow-up assessments. Patients with khat use disorder were 3.8 times more likely to be non-adherent to anti-TB medications than patients without khat use disorder (Adjusted odds ratio (aOR)=3.8, 95% CI 1.8 to 8.0). Patients who had alcohol use disorder (AUD) were also 3.2 times likely to have poor adherence compared with their counterparts (aOR=3.2, 95% CI 1.6 to 6.6). In addition, being educated (aOR=4.4, 95% CI 1.7 to 11.3), and being merchant (aOR=6.1, 95% CI 1.2 to 30.8) were associated with non-adherence to anti-TB medications.

CONCLUSION

Khat and AUDs predict greater likelihood of non-adherence to anti-TB medication. This implies the need to integrate the management for substance use disorders into the existing TB treatment services.

The effects of family, society and national policy support on treatment adherence among newly diagnosed tuberculosis patients: a cross-sectional study

Background

Non-adherence to tuberculosis (TB) treatment is the most important cause of poor TB outcomes, and improving support for TB patients is a primary priority for governments, but there has been little research on the effects of family, social and national policy support factors on TB treatment adherence. The current study evaluated treatment adherence among newly diagnosed TB patients in Dalian, north-eastern China, and determined the effects of family, society, and national policy support factors on treatment adherence.

Methods

A cross-sectional survey was conducted among newly diagnosed TB patients treated at the outpatient department of Dalian Tuberculosis Hospital from September 2019 to January 2020. Data were collected using a questionnaire that measured medication adherence, family support, social support, and national policy support and so on. Differences between groups were assessed using Chi-square tests and Fisher’s exact tests. Ordinal logistic regression analysis was used to determine the predictors of adherence.

Results

A total of 481 newly diagnosed TB patients were recruited, of whom 45.7% had good adherence, and 27.4 and 26.8% had moderate and low adherence, respectively. Patients who had family members who frequently supervised medication (OR:0.34, 95% CI:0.16–0.70), family members who often provided spiritual encouragement (OR:0.13, 95% CI:0.02–0.72), a good doctor-patient relationship (OR:0.61, 95% CI:0.40–0.93), more TB-related knowledge (OR:0.49, 95% CI:0.33–0.72) and a high need for TB treatment policy support (OR:0.38, 95% CI:0.22–0.66) had satisfactory medication adherence. However, patients who had a college degree or higher (OR:1.69, 95% CI:1.04–2.74) and who suffered adverse drug reactions (OR:1.45, 95% CI:1.00–2.11) were more likely to have lower adherence.

Conclusions

Our findings suggested that non-adherence was high in newly diagnosed TB patients. Patients who had family members who frequently supervised medication and provided spiritual encouragement and a good doctor-patient relationship and TB-related knowledge and a high need for policy support contributed to high adherence. It is recommended to strengthen medical staff training and patient and family health education and to increase financial support for improving adherence.

Factors Influencing Patient Adherence to Tuberculosis Treatment in Ethiopia: A Literature Review

Background: Tuberculosis (TB) is a major global public health problem and one of the leading causes of death among infectious diseases. Although TB can be cured with first-line antibiotics treatment of 6 months regimen, non-adherence to the treatment remains the main challenge for TB prevention and control. Interventions to promote adherence need to address multiple underlying factors linked to non-adherence, which requires a synthesis of studies to understand these factors in the local context. Our review accordingly examines these factors for TB treatment in Ethiopia. Methods: Articles were searched from PubMed and ScienceDirect databases, as well as manual searches through Google and Google Scholar search engines. Both quantitative and qualitative studies that showed factors associated with or reasons for non-adherence, default or loss to follow up from TB treatment were included. A total of 276 articles were screened, and 29 articles were ultimately included in the review. Findings: The extracted factors were synthesized thematically into seven dimensions of patient-centred, social, economic, health system, therapy, lifestyle, and geographic access factors. More than 20 distinct factors were identified under these headings. Some of these factors may also apply quite widely in other settings, with greater or lesser influence, but some are particularly applicable to the Ethiopian setting. Conclusion: Helping patients to achieve full adherence to TB medication is a complex problem as it is influenced by interplay between many factors. Healthcare managers, providers, and researchers need to consider and address multiple underlying factors when designing adherence interventions. This work provides a reference set of such factors for Ethiopian interventions.

Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study

INTRODUCTION

Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap.

METHODS

From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors.

RESULTS

The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis.

CONCLUSION

A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed.

Video directly observed therapy for supporting and monitoring adherence to tuberculosis treatment in Uganda: a pilot cohort study

Introduction

Nonadherence to treatment remains an obstacle to tuberculosis (TB) control worldwide. The aim of this study was to evaluate the feasibility of using video directly observed therapy (VDOT) for supporting TB treatment adherence in Uganda.

Methods

From May to December 2018, we conducted a pilot cohort study at a TB clinic in Kampala City. We enrolled patients aged 18–65 years with ≥3 months remaining of their TB treatment. Participants were trained to use a smartphone app to record videos of medication intake and submit them to a secured system. Trained health workers logged into the system to watch the submitted videos. The primary outcome was adherence measured as the fraction of expected doses observed (FEDO). In a secondary analysis, we examined differences in FEDO by sex, age, phone ownership, duration of follow-up, reasons for missed videos and patients' satisfaction at study exit.

Results

Of 52 patients enrolled, 50 were analysed. 28 (56%) were male, the mean age was 31 years (range 19–50 years) and 35 (70%) owned smartphones. Of the 5150 videos expected, 4231 (82.2%) were received. The median FEDO was 85% (interquartile range 66%–94%) and this significantly differed by follow-up duration. Phone malfunction, uncharged battery and VDOT app malfunctions were the commonest reasons for missed videos. 92% of patients reported being very satisfied with using VDOT.

Conclusion

VDOT was feasible and acceptable for monitoring and supporting TB treatment. It resulted in high levels of adherence, suggesting that digital technology holds promise in improving patient monitoring in Uganda.

Video directly observed therapy is feasible and acceptable for supporting and monitoring TB treatment adherence in a low-resource setting like Uganda. Digital health interventions hold promise as alternative methods for improving patient care.http://bit.ly/2Hxnvwu

Factors Influencing Medication Nonadherence to Pulmonary Tuberculosis Treatment in Tibet, China: A Qualitative Study from the Patient Perspective

PURPOSE

Medication nonadherence is one of the most significant obstacles to tuberculosis (TB) control worldwide. Identification of the factors associated with medication nonadherence is important. However, few related studies have been carried out in Tibet. This study aimed to explore factors influencing medication nonadherence to pulmonary TB (PTB) treatment in Tibet, China, from the patient perspective.

PATIENTS AND METHODS

In this qualitative study, seventeen PTB patients in Tibet were recruited by purposive and maximum variation sampling methods. In-depth semistructured interviews were conducted to collect data on factors influencing medication nonadherence, and Colaizzi's seven-step method was used to analyze the data.

RESULTS

The medication nonadherence of PTB patients in Tibet was influenced by one or a combination of the following four factors. First, patient-related factors included a lack of knowledge of PTB treatment, poor self-management capability, poor self-regulation capability and misperception of health condition. Second, a medication-related factor was medication side effects. Third, health service-related factors included the poor treatment skills of doctors in primary hospitals and a lack of directly observed treatment (DOT). Last, sociocultural factors included the effect of traditional Tibetan medicine, lack of family member support and discrimination.

CONCLUSION

Multiple interplaying factors influenced medication nonadherence during PTB treatment in Tibet, and the main influencing factors were a lack of knowledge about PTB treatment, poor self-management capability, and the effect of traditional Tibetan medicine. TB health workers in Tibet should provide permanently viewable PTB treatment knowledge materials to PTB patients when oral health education is conducted, find feasible alternative strategies to DOT and establish links to traditional Tibetan medicine hospitals.

National Control of Tuberculosis: Does Primary Health Care System Play a Crucial Role in the Fight Against Tuberculosis?

OBJECTIVES

To analyze the tuberculosis control studies in a primary health care center and to observe the changes throughout the years.

MATERIALS AND METHODS

Data of patients followed up between 2005 and 2014 in the Elazığ Dispensary were investigated retrospectively.

RESULTS

Of the total 1,251 patients, 51.6% were male. Majority of patients were aged between 15 and 24 (19.9%), 25 and 35 (18.5%), and over 65 (14.4%). While the rate of a sputum smear examination was 71.6%, the positivity rate for Acid-Fast bacilli was 55.5%. It was detected that the drug sensitivity test was applied in only 25.8% of all patients. The treatment success of all patients was 85.8%. The cure rate of smear-positive cases was found to be 26.35%. The rate of the relapsing patients was 9.1%. An overall treatment response rate was found to be 87.4%.

CONCLUSION

The control of tuberculosis in primary health care is partially successful and insufficient. The rate of smear-positive defaulters was found to be high in young adult individuals, which indicates that the contamination is probably still going on at a dangerous rate. Furthermore, the overall rate of microscopic examination, sputum culture, and drug sensitivity tests performed in patients in the primary health care system is low and should be improved immediately.