Tuberculosis Treatment Adherence among Tuberculosis Patients: Insights from a Cross-Sectional Study in the Eastern Cape, South Africa

Benedict R Oamen; Margaret Williams; Larry D. Icard; Darelle Van Greunen; Alida Veldsman; Yemisi Oyedele; Phumla Dlamini; Adlai Davids

doi:10.25159/2520-5293/17413

Authors

Benedict R Oamen Stellenbosch University https://orcid.org/0000-0002-7300-5545
Margaret Williams Nelson Mandela University https://orcid.org/0000-0001-6121-2910
Larry D. Icard Nelson Mandela University
Darelle Van Greunen Nelson Mandela University
Alida Veldsman Nelson Mandela University
Yemisi Oyedele Nelson Mandela University
Phumla Dlamini Nelson Mandela University https://orcid.org/0000-0001-5049-8204
Adlai Davids Nelson Mandela University https://orcid.org/0000-0001-6898-2344

DOI:

https://doi.org/10.25159/2520-5293/17413

Keywords:

adherence, non-adherence, sociodemographic factors, socioeconomic factors, South Africa, treatment, tuberculosis

Abstract

Tuberculosis (TB) is a major cause of morbidity and mortality in South Africa. Poor TB treatment adherence (TBTA) is associated with sociodemographic and socioeconomic factors. This cross-sectional study investigated TBTA among TB patients aged 18 years and above. A sample of 110 TB patients participated in the study, of whom 65 (59%) were males and 45 (41%) females, with a mean age of 34.62 ± 9.77. Almost one-third (32%) of the respondents reported forgetting to take their medication. The reasons they gave for non-adherence to TB medication included: (i) simply forgot (21%); (ii) fell asleep/slept through dose time (13%); (iii) had problems taking pills at specified times (12%); (iv) were busy with other things (12%); (v) were away from home (11%); and (vi) drank alcohol (10%). Unlike prior studies, sex and age were not associated with TBTA. However, the following factors were significantly associated with TBTA: (i) the number of people living in a household and sharing the main meal of the day (X²[2] = 11.42; p = .003; V = 0,32) [increased non-adherence in larger households]; (ii) no one to take care of them or remind them to take their TB medication/take care of self (X² [1] = 4.90; p = .027; V = 0.21) [increased non-adherence in the group who had someone taking care of them or reminding them to take their TB medication]; and (iii) family support (t [108] = 2.08; p = .040; d = 0.43) [increased non-adherence in the group who reported a higher level of family support]. Counterintuitively, the results showed increased non-adherence among respondents who reported having someone taking care of or reminding them to take their TB medication and those who reported getting support from their family.

Author Biography

Adlai Davids, Nelson Mandela University

Senior Research Manager,

Human Sciences Research Council (HSRC)

References

Aibana, O., E. Dauria, T. Kiriazova, O. Makarenko, M. Bachmaha, N. Rybak, T. P. Flanigan, V. Petrenko, A. E. Becker, and M. B. Murray. 2020. “Patients’ Perspectives of Tuberculosis Treatment Challenges and Barriers to Treatment Adherence in Ukraine: A Qualitative Study.” BMJ Open 10 (1): 1–12. https://doi.org/10.1136/bmjopen-2019-032027

Akeju, O. O., S. C. Wright, and T. M. Maja. 2017. “Lived Experience of Patients on Tuberculosis Treatment in Tshwane, Gauteng Province.” Health SA Gesondheid 22: 259–267. https://doi.org/10.1016/j.hsag.2017.03.001

Alexander, M. 2023. “Mapping Poverty in South Africa. Where Are South Africa’s Poorest Places? Two Maps Find the Patterns of Poverty: The Share of Households Living in Poverty in Each Municipality, and the Number of Poor People Living There. An Animation Tries to Make Sense of the Maps.” Accessed August 4, 2024. https://southafrica-info.com/people/mapping-poverty-in-south-africa/

Ayiraveetil, R., S. Sarkar, P. Chinnakali, K. Jeyashree, M. Vijayageetha, P. Thekkur, S. Lakshminarayanan, S. Knudsen, N. S. Hochberg, C. R. Horsburgh, and J. Ellner. 2020. “Household Food Insecurity among Patients with Pulmonary Tuberculosis and Its Associated Factors in South India: A Cross-Sectional Analysis.” BMJ Open 10 (2): 1–9. https://doi.org/10.1136/bmjopen-2019-033798

Chakaya, J., M. Khan, F. Ntoumi, E. Aklillu, R. Fatima, P. Mwaba, N. Kapata, S. Mfinanga, S. E. Hasnain, P. D. Katoto, and A. N. Bulabula. 2021. “Global Tuberculosis Report 2020 –Reflections on the Global TB Burden, Treatment and Prevention Efforts.” International Journal of Infectious Diseases 113: S7–S12. https://doi.org/10.1016/j.ijid.2021.02.107

Chen, X., L. Du, R. Wu, J. Xu, H. Ji, Y. Zhang, X. Zhu, and L. Zhou. 2020. “The Effects of Family, Society and National Policy Support on Treatment Adherence among Newly Diagnosed Tuberculosis Patients: A Cross-Sectional Study.” BMC Infectious Diseases 20 (623): 1–11. https://doi.org/10.1186/s12879-020-05354-3

Chimeh, R. A., F. Gafar, I. S. Pradipta, O. W. Akkerman, E. Hak, J. W. Alffenaar, and J. F. van Boven. 2020. “Clinical and Economic Impact of Medication Non-Adherence in Drug-Susceptible Tuberculosis: A Systematic Review.” International Journal of Tuberculosis and Lung Disease 24 (8): 811–819. https://doi.org/10.5588/ijtld.19.0754

Dos Reis, J. 2016. “Factors Associated with Medication Adherence among Tuberculosis Patients in Timor-Leste.” PhD diss., Queensland University of Technology. Accessed August 3, 2024. https://eprints.qut.edu.au/94662/

Edginton, M. E., C. S. Sekatane, and S. J. Goldstein. 2002. “Patients’ Beliefs: Do They Affect Tuberculosis Control? A Study in a Rural District of South Africa.” International Journal of Tuberculosis and Lung Disease 6 (12): 1075–1082. PMID: 12546115

Endalamaw, A., C. F. Gilks, F. Ambaw, M. D. Chatfield, and Y. Assefa. 2022. “Satisfaction of Tuberculosis Patients to Healthcare Services at the Global Level: A Systematic Review.” Health and Social Care in the Community 30 (6): e3435–e3446. https://doi.org/10.1111/hsc.13953

Faye, L. M., M. C. Hosu, J. Iruedo, S. Vasaikar, K. A. Nokoyo, U. Tsuro, and T. Apalata. 2023. “Treatment Outcomes and Associated Factors among Tuberculosis Patients from Selected Rural Eastern Cape Hospitals: An Ambidirectional Study.” Tropical Medicine and Infectious Disease 8 (6): 1–15. https://doi.org/10.3390/tropicalmed8060315

Finlay, A., J. Lancaster, T. H. Holtz, K. Weyer, A. Miranda, and M. van der Walt. 2012. “Patient-and-Provider-Level Risk Factors Associated with Default from Tuberculosis Treatment, South Africa, 2002: A Case-Control Study.” BMC Public Health 12 (56): 1–12. https://doi.org/10.1186/1471-2458-12-56

Gashu, K. D., K. A. Gelaye, and B. Tilahun. 2021. “Adherence to TB Treatment Remains Low during Continuation Phase among Adult Patients in Northwest Ethiopia.” BMC Infectious Diseases 21 (725): 1–10. https://doi.org/10.1186/s12879-021-06428-6

Gebreweld, F. H., M. M. Kifle, F. E. Gebremicheal, L. L. Simel, M. M. Gezae, S. S. Ghebreyesus, Y. T. Mengsteab, and N. G. Wahd. 2018. “Factors Influencing Adherence to Tuberculosis Treatment in Asmara, Eritrea: A Qualitative Study.” Journal of Health, Population and Nutrition 37 (1): 1–9. https://doi.org/10.1186/s41043-017-0132-y

Kastien-Hilka, T., A. Abulfathi, B. Rosenkranz, B. Bennett, M. Schwenkglenks, and E. Sinanovic. 2016. “Health-Related Quality of Life and Its Association with Medication Adherence in Active Pulmonary Tuberculosis – a Systematic Review of Global Literature with Focus on South Africa.” Health and Quality of Life Outcomes 14: 42. https://doi.org/10.1186/s12955-016-0442-6

Moutinho, S. 2022. “Tuberculosis Is the Oldest Pandemic, and Poverty Makes It Continue.” Nature 605 (7910): S16–S20. https://doi.org/10.1038/d41586-022-01348-0

Munro, S. A., S. A. Lewin, H. J. Smith, M. E. Engel, A. Fretheim, and J. Volmink. 2007. “Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research.” PLoS Medicine 4 (7): 1–16. https://doi.org/10.1371/journal.pmed.0040238

Nezenega, Z. S., L. Perimal-Lewis, and A. J. Maeder. 2020. “Factors Influencing Patient Adherence to Tuberculosis Treatment in Ethiopia: A Literature Review.” International Journal of Environmental Research and Public Health 17 (15): 1–15. https://doi.org/10.3390/ijerph17155626

Ntoumi, F., J. B. Nachega, E. Aklillu, J. Chakaya, I. Felker, F. Amanullah, D. Yeboah-Manu, K. G. Castro, and A. Zumla. 2022. “World Tuberculosis Day 2022: Aligning COVID-19 and Tuberculosis Innovations to Save Lives and to End Tuberculosis.” Lancet Infectious Diseases 22 (4): 442–444. https://doi.org/10.1016/S1473-3099(22)00142-6

O’Donnell, M. R., A. Wolf, L. Werner, C. R. Horsburgh, and N. Padayatchi. 2014. “Adherence in the Treatment of Patients with Extensively Drug-Resistant Tuberculosis and HIV in South Africa: A Prospective Cohort Study.” Journal of Acquired Immune Deficiency Syndromes 67 (1): 22–29. https://doi.org/10.1097/QAI.0000000000000221

Pai, M., T. Kasaeva, and S. Swaminathan. 2022. “Covid-19’s Devastating Effect on Tuberculosis Care – a Path to Recovery.” New England Journal of Medicine 386 (16): 1490–1493. https://doi.org/10.1056/NEJMp2118145

SANAC (South African National AIDS Council). 2022. “South Africa’s National Strategic Plan for HIV, TB and STIs 2023–2028.” Accessed August 3, 2024. https://sanac.org.za/wp-content/uploads/2023/05/SANAC-NSP-2023-2028-Web-Version.pdf

Skinner, D., and M. Claassens. 2016. “It’s Complicated: Why Do Tuberculosis Patients not Initiate or Stay Adherent to Treatment? A Qualitative Study from South Africa.” BMC Infectious Diseases 16 (712): 1–9. https://doi.org/10.1186/s12879-016-2054-5

Stats SA (Statistics South Africa). 2023. “Census 2022 Statistical Release.” Accessed August 3, 2024. https://census.statssa.gov.za/assets/documents/2022/P03014_Census_2022_Statistical_Release.pdf

Tola, H. H., T. O. Azar, D. Shojaeizadeh, and G. Garmaroudi. 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): 1–11. Accessed August 3, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449995/pdf/IJPH-44-1.pdf

Van de Water, B. J., M. B. Brooks, R. Matji, B. Ncanywa, F. Dikgale, N. N. Abuelezam, B. Mzileni, M. Nokwe, S. Moko, L. Mvusi, M. Loveday, and S. Gimbel. 2024. “Systems Analysis and Improvement Approach to Optimize Tuberculosis (SAIA-TB) Screening, Treatment, and Prevention in South Africa: A Stepped-Wedge Cluster Randomized Trial.” Implementation Science Communications 5 (40): 1–13. https://doi.org/10.1186/s43058-024-00582-z

WHO (World Health Organization). 2023. “Global Tuberculosis Report 2023.” Accessed August 3, 2024. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023

WHO (World Health Organization). 2024. “Tuberculosis: Key Facts.” Accessed August 3, 2024. https://www.who.int/news-room/fact-sheets/detail/tuberculosis

Woimo, T. T., W. K. Yimer, T. Bati, and H. A. Gesesew. 2017. “The Prevalence and Factors Associated for Anti-Tuberculosis Treatment Non-Adherence among Pulmonary Tuberculosis Patients in Public Health Care Facilities in South Ethiopia: A Cross-Sectional Study.” BMC Public Health 17 (269): 1–10. https://doi.org/10.1186/s12889-017-4188-9

Zhang, C., Y. Wang, G. Shi, W. Han, H. Zhao, H. Zhang, and X. Xi. 2016. “Determinants of Multidrug-Resistant Tuberculosis in Henan Province in China: A Case Control Study.” BMC Public Health 16 (42): 1–8. https://doi.org/10.1186/s12889-016-2711-z