Adherence to treatment of tuberculosis in patients with TB/HIV co-infection on concomitant treatment in Addis-Abeba, Ethiopia
Year: 2009
Type: dissertation
Study design: Observational Study
Abstract: Background: Non-adherence to treatment poses a challenge to tuberculosis (TB)\ntreatment since it increases the risk of drug resistance, death, relapse and prolonged\ninfectiousness. TB patients co-infected with human immunodeficiency virus (HIV)\nconstitute a large proportion of TB patients in Ethiopia. How being co-infected with HIV\nas well as concomitant treatment with anti-retroviral therapy (ART) among other things\naffect adherence to TB treatment has not been studied in Ethiopia, and we did a study to\nexplore this.\nObjectives: To assess magnitude of default and factors associated with defaulting from\nTB treatment in patients with TB/HIV co-infection who received concomitant treatment,\nand to assess co-infected patients’ and health professionals’ perspectives of barriers and\nfacilitators of TB treatment\nMethods: Through a review of records, we retrospectively assessed the TB treatment\noutcomes in a cohort of TB patients co-infected with HIV who were initiated on TB\ntreatment in the period July 2006-September 2007 and who concomitantly received ART\nin three Health Centers in Addis-Abeba. We conducted in-depth interviews with 15\npurposefully selected patients and 9 health professionals involved in their management.\nWe also conducted two focus group discussions in patients with TB/HIV co-infection\nreceiving concomitant treatment.\nResults: We found that, from the 248 patients included, 148(59.7%) completed treatment,\n32(12.9%) were cured, 31(12.5%) died, twenty six patients (10.5%) defaulted treatment,\n3(1.2%) failed and 8 patients (3.2%) were transferred out. Multiple regression analysis\nshowed that male sex (AOR= 2.66(95%CI: 1.05- 6.71), P=0.038), lower education\n(AOR= 3.81(95% CI: 1.38- 10.52), P= 0.009), and timing of ART initiation were\nassociated with defaulting from TB treatment, with those started on ART in the intensive\nphase having the highest risk of defaulting (AOR= 9.68(95%CI: 2.71- 34.57), P= <0.001,\nas compared to those initiated on ART in the continuation phase), followed by those\n6\ninitiated on ART before anti-TB initiation (AOR= 4.83(95% CI:1.19- 19.83), P= 0.025,\nas compared to those initiated on ART in the continuation phase) . The qualitative study\nfurther showed that many misperceptions exist among patients about TB/HIV, and that\nadverse perception of prognosis of TB in the presence of HIV with an eagerness to\nsurvive, support from families and health professionals were positively influencing\ntreatment, whereas side effects, pill burden, economic constraints, lack of food, stigma,\nlack of adequate communication with health professionals and poorly organized TB/HIV\ncollaborative activities were acting as barriers to treatment.\nConclusion: The default rate from TB treatment among patients who are TB/HIV coinfected\nand who received concomitant treatment is still higher than the World Health\nOrganization recommended rate, and many of those who finish treatment seem to face\nmany difficulties. Health professionals and policy makers should be aware of factors\ninfluencing TB treatment in these patients and act accordingly, since many of these\nfactors are amenable to change.
Author: Mekdes K. Gebremariam
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2472153612