A study on non-compliance in tuberculosis cases towards the directly observed treatment short course under RNTCP in Kanpur Nagar

Noncompliance of treatment among tuberculosis patients in intensive phase at Kalutara District of Sri Lanka

BACKGROUND

Tuberculosis (TB) is an ancient disease and remains to be a public health problem all over the world. Noncompliance of treatment among TB patients affect the control of disease, leading to increased burden of the disease, mortality, drug resistant and relapse. Assessing the factors associated with noncompliance of TB treatment will be useful to reduce the noncompliance and burden.

OBJECTIVES

To assess the factors associated with noncompliance of treatment among TB patients in intensive phase at Kalutara District, Sri Lanka.

METHODS

A descriptive cross-sectional study was conducted among the new TB patients registered at District Chest Clinic (DCC), Kalutara for a period of six months. A questionnaire was administered for total study population registered during the data collection period. The relevant data were abstracted from registers and records maintaining at the DCC.

RESULTS

Data were collected from 252 patients [males = 160 (63.5%) and females = 92 (36.5%)]. The percentage of noncompliance was 18.3% (n = 46) among newly diagnosed TB patients. Only 13.5% (n = 34) of TB patients visited Directly Observed Treatment, short-course (DOTS) provider daily. Majority (61.9%, n = 156) of DOTS providers did not observe for drug intake. The factors significantly associated with noncompliance for TB treatment were (1) not observing the drug intake by DOTS providers, (2) side effects of the drugs, (3) educational level, (4) living environment and (5) absent of a care giver.

CONCLUSIONS

Noncompliance of treatment is still a common problem among TB patients. Special emphasis should be made on TB patients based on the factors associated with the noncompliance of the treatment. DOTS providers should adhere to DOTS policy.

Mobile Health for Tuberculosis Management in South India: Is Video-Based Directly Observed Treatment an Acceptable Alternative?

Background

With the availability of low-cost mobile devices and the ease of internet access, mobile health (mHealth) is digitally revolutionizing the health sector even in resource-constrained settings. It is however necessary to assess end-user perceptions before deploying potential interventions.

Objective

This study aimed to assess the mobile phone usage patterns and the acceptability of mobile phone support during care and treatment in patients with tuberculosis (TB) in South India.

Methods

This exploratory study was conducted at an urban private tertiary care teaching hospital and nearby public primary-level health care facilities in Bangalore, South India. We recruited 185 patients with TB through consecutive sampling. Subsequent to written informed consent, participants responded to an interviewer-administered pretested questionnaire. The questionnaire included questions on demographics, phone usage patterns, and the benefits of using of mobile phone technology to improve health outcomes and treatment adherence. Frequency, mean, median, and SD or interquartile range were used to describe the data. Bivariate associations were assessed between demographics, clinical details, phone usage, and mHealth communication preferences using the chi-square test and odds ratios. Associations with a P value ≤.20 were included in a logistic regression model. A P value of <.05 was considered significant.

Results

Of the 185 participants, 151 (81.6%) used a mobile phone, and half of them owned a smartphone. The primary use of the mobile phone was to communicate over voice calls (147/151, 97.4%). The short message service (SMS) text messaging feature was used by only 66/151 (43.7%) mobile phone users. A total of 87 of the 151 mobile phone users (57.6%) knew how to use the camera. Only 41/151 (27.2%) mobile phone users had used their mobile phones to communicate with their health care providers. Although receiving medication reminders via mobile phones was acceptable to all participants, 2 participants considered repeated reminders as an intrusion of their privacy. A majority of the participants (137/185, 74.1%) preferred health communications via voice calls. Of the total participants, 123/185 (66.5%) requested reminders to be sent only at specific times during the day, 22/185 (11.9%) suggested reminders should synchronize with their prescribed medication schedule, whereas 40/185 (21.6%) did not have any time preferences. English literacy was associated with a preference for SMS in comparison with voice calls. Most participants (142/185, 76.8%) preferred video-based directly observed treatment when compared with in-person directly observed treatment.

Conclusions

Although mobile phones for supporting health and treatment adherence were acceptable to patients with TB, mHealth interventions should consider language, mode of communication, and preferred timing for communication to improve uptake.