TITLE:
Healthcare Worker-Related Factors Contributing to Tuberculosis Treatment Non-Adherence among Patients in Kisumu East Sub-County
AUTHORS:
Marlyn Ochieng, Jackline Nyaberi, Susan Mambo, Charles Wafula
KEYWORDS:
Tuberculosis, Treatment Adherence, Human Resources for Health
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.12 No.1,
March
11,
2024
ABSTRACT: 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. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%)
was recorded. Overall, patients who felt supported in dealing with the illness
were 8 times more likely to adhere to treatment compared to those who were not
(aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to
treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p =
0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and
non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication
[adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001)
and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 -
8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 -
11.075, p = 0.002). Conclusion: The study results underline importance of
patient-centered consultation for TB patients and targeted education and
counselling for improved treatment adherence.