Predictors of tuberculosis (TB) and antiretroviral (ARV) medication non-adherence in public primary care patients in South Africa: a cross sectional study

BMC Public Health

Bomkazi Tutshana¹  Gugu Mchunu²  Gladys Matseke¹  Julia Louw¹  Karl Peltzer³  Pamela Naidoo⁴ 

[1] Population Health, Health Systems and Innovation (PHHSI)/HIV/STIs and TB (HAST) Research Programmes, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa, Private Bag X 9182, Cape Town 8000, South Africa;Department of Nursing, University of KwaZulu Natal, Durban, South Africa;ASEAN, Institute for Health Development, Mahidol University, Salaya, Thailand;Department of Psychology, University of the Western Cape, Cape Town, South Africa

关键词: Adherence to anti-TB treatment and ART;    High burden country;    ART;    Anti-TB treatment;    Bio-Psycho-Social factors;    Adult TB patients;   

Others  :  1162285
DOI  :  10.1186/1471-2458-13-396

 received in 2012-09-05, accepted in 2013-04-23,  发布年份 2013

【 摘 要 】

Background

Despite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge. The co-infection between TB and HIV adds to this disease burden. TB is completely curable through the intake of a strict anti-TB drug treatment regimen which requires an extremely high and consistent level of adherence.The aim of this study was to investigate factors associated with adherence to anti-TB and HIV treatment drugs.

Methods

A cross-sectional survey method was used. Three study districts (14 primary health care facilities in each) were selected on the basis of the highest TB caseload per clinic. All new TB and new TB retreatment patients were consecutively screened within one month of anti-tuberculosis treatment. The sample comprised of 3107 TB patients who had been on treatment for at least three weeks and a sub-sample of the total sample were on both anti-TB treatment and anti-retro-viral therapy(ART) (N = 757). Data collection tools included: a Socio-Demographic Questionnaire; a Post-Traumatic-Stress-Disorder (PTSD) Screen; a Psychological Distress Scale; the Alcohol Use Disorder Identification Test (AUDIT); and self-report measures of tobacco use, perceived health status and adherence to anti-TB drugs and ART.

Results

The majority of the participants (N = 3107) were new TB cases with a 55.9% HIV co-infection rate in this adult male and female sample 18 years and older. Significant predictors of non-adherence common to both anti-TB drugs and to dual therapy (ART and anti-TB drugs) included poverty, having one or more co-morbid health condition, being a high risk for alcohol mis-use and a partner who is HIV positive. An additional predictor for non-adherence to anti-TB drugs was tobacco use.

Conclusions

A comprehensive treatment programme addressing poverty, alcohol mis-use, tobacco use and psycho-social counseling is indicated for TB patients (with and without HIV). The treatment care package needs to involve not only the health sector but other relevant government sectors, such as social development.

【 授权许可】

   
2013 Naidoo et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization: (WHO): Global Tuberculosis Control. WHO report 2011. Geneva, Switzerland: WHO; 2011. http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf webcite. Accessed March 2012
• [2]Thompson MA, Mugavero MJ, Rivet Amico K, Cargill VA, Chang LW, Gross R, Orrell C, Altice FL, Bangsberg DR, Bartlett JG, Beckwith CG, Dowshen N, Gordon CM, Horn T, Kumar P, Scott JD, Stirratt MJ, Remien RH, Simoni JM, Nachega JB: Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care Panel. Ann Intern Med 2012, 156(11):817-833. http://www.annals.org webcite. Accessed March 2012
• [3]Gurung RAR: Health Psychology: A Cultural Approach. Belmont, CA: Wadsworth; 2010.
• [4]Friedman HS: Health Psychology. New Jersey: Prentice Hall; 2002.
• [5]Munro SA, Lewin SA, Smith HJ, Mark EE, Fretheim A, Volmink J: Patient adherence to tuberculosis treatment: a systematic review of qualitative research. Plos Med 2007, 4(7):e238.
• [6]McInerney PA, Nicholas PK, Wantland D, Corless IB, Ncama B, Bhengu B, McGibbon CA, Davis SM, Gallagher DM: Characteristics of anti-tuberculosis medication adherence in South Africa. Appl Nurs Res 2007, 20(4):164-170.
• [7]Naidoo P, Dick J, Cooper D: Exploring tuberculosis patient’s adherence to treatment regimens and prevention programs at a public health site. Qual Heal Res 2009, 19(1):55-70.
• [8]Mindachew M, Deribew A, Tessema F, Biadgilign S: Predictors of adherence to isoniazid preventive therapy among HIV positive adults in Addis Ababa, Ethiopia. BMC Public Health 2011, 11:916. BioMed Central Full Text
• [9]Peltzer K: Factors at follow-up associated with adherence with directly observed therapy (DOT) for tuberculosis patients in South Africa. J Psychol Afr 2001, 11(2):165-185.
• [10]Corless IB, Wantland D, Bhengu B, McInerney P, Ncama B, Nicholas PK, McGibbon C, Wong E, Davis SM: HIV and tuberculosis in Durban, South Africa: adherence to two medication regimens. AIDS Care 2009, 21(9):1106-1113.
• [11]Gebremariam MK, Bjune GA, Frich JC: Barriers and facilitators of adherence to TB treatment in patients on concomitant TB & HIV treatment: a qualitative study. BMC Publ Health 2010, 10:651. BioMed Central Full Text
• [12]Hirsch-Moverman Y, Daftary A, Franks J, Colson PW: Adherence to treatment for latent tuberculosis infection: systematic review of studies in the US and Canada. Int J Tuberc Lung Dis 2008, 2:1235-1254.
• [13]Amuha MG, Kutyabami P, Kitutu FE, Odoi-Adome R, Kalyango JN: Non-adherence to anti-TB drugs among TB/HIV co-infected patients in Mbarara Hospital Uganda: prevalence and associated factors. Afr Heal Sci 2009, 9(1):8-15.
• [14]Santha T, Garg R, Frieden TR, Chandrasekaran V, Subramani R, Gopi PG, Selvakumar N, Ganapathy S, Charles N, Rajamma J: Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India. Int J Tuberc Lung Dis 2000, 6:780-788.
• [15]Shinn SS, Mathew TA, Yanova GV, Fitzmaurice GM, Livchits V, Yanov SA, Strelis AK, Mishustin SP, Bokhan NA, Lastimoso CS: Alcohol consumption among men and women with tuberculosis in Tomsk, Russia. Cent Eur J Public Health 2010, 18:132-138.
• [16]World Health Organization (WHO): Treatment of Tuberculosis Guidelines. 2010. Geneva, Switzerland: WHO; 2010.
• [17]South African National AIDS Council (SANAC) report: The HIV epidemic in South Africa: What do we know and how has it changed?. South Africa; 2011. Available from: http://www.hsrc.ac.za webcite. Accessed August 2011
• [18]Kessler R, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walters EE, Zaslavsky AM: Short screening scales to monitor population prevalences and trends in nonspecific psychological distress. Psychol Med 2002, 32:959. e976
• [19]Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand S-LT, Manderscheid RW, Walters EE, Zaslavsky AM: Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003, 60(2):184.
• [20]Brooks RT, Beard J, Steel Z: Factor structure and interpretation of the K10. Psychol Assess 2006, 18(1):62e70.
• [21]Andrews G, Slade T: Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health 2001, 25:494-497.
• [22]Spies G, Kader K, Kidd M, Smit J, Myer L, Stein DJ, Seedat S: Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals. AIDS Care 2009, 21(9):1163-1168.
• [23]Babor TF, Higgins-Biddle JC: Brief Intervention for Hazardous and Harmful Drinking a Manual for Use in Primary Care. Geneva, Switzerland: World Health Organization; 2001.
• [24]Freeborn DK, Polen MR, Hollis JF, Senft RA: Screening and brief intervention for hazardous drinking in an HMO: effects on medical care utilization. J Behav Health Serv Res 2000, 27(4):446-453.
• [25]Saunders JB, Aasland OG, Amundsen A, Grant M: Alcohol consumption and related problems among primary health care patients: WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction 1993, 88(3):349-362.
• [26]Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S: Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS 2008, 22(2):147-158.
• [27]Chishinga N, Kinyanda E, Weiss HA, Patel V, Ayles H, Seedat S: Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia. BMC Psychiatry 2011, 11:75. BioMed Central Full Text
• [28]Kwara A, Flanigan TP, Carter EJ: Highly active antiretroviral therapy (HAART) in adults with tuberculosis: current status. Int J Tuberc Lung Dis 2005, 9:248-257.
• [29]Claxton AJ, Cramer J, Piece C: A systematic review of the associations between dose regimens and medication compliance. Clin Ther 2001, 23:1296-1310.
• [30]Ingersoll KS, Cohen J: The impact of medication regimen factors on adherence to chronic treatment: a review of the literature. J Behav Med 2008, 31:213-224.
• [31]Nevarro V: What we mean by the social determinants of health. Int J Heal Serv 2009, 39(3):423-441.
• [32]Marks DF, Murray M, Evans B, Willig C, Woodall C, Sykes CM: Health Psychology: Theory, Research & Practice. London: Sage; 2006.
• [33]Farmer P: Infections and Inequalities. Berkeley: Univ of California Press; 1999.
• [34]Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F: Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: a case control study. BMC Publ Health 2011, 11:696. BioMed Central Full Text
• [35]Morgenstern J, Langenbucher J, Labouvie E, Miller KJ: The co-morbidity of alcoholism and personality disorders in a clinical population: prevalence rates and relation to alcohol typology variables. J Abnorm Psychol 1997, 106:74-84.
• [36]Zuckerman M: Sensation Seeking: Beyond the Optimal Level of Arousal. New Jersey: Lawrence Erlbaum; 1979.
• [37]Sluijs E, van Dulmen S, van Dijk L, de Ridder D, Heerdink R, Bensing J: Patient adherence to medical treatment: a meta review. http://www.novel.nl webcite 2206. Accessed February 2013
• [38]Li L, Lee S-J, Thammawijaya P, Jiraphongsa C, Rotheram-Borus M: Stigma, social support, and depression among people living with HIV in Thailand. AIDS Care 2009, 21(8):1007-1013.
• [39]Kalichman SC, Simbayi LC, Cloete C, Ginindza T, Mthembu P, Nkambule T, Cherry C, Cain D: Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care 2009, 21:87-93.
• [40]UNAIDS: UNAIDS report on the global AIDS epidemic 2012. Joint United Nations Programme on HIV/AIDS (UNAIDS). http://www.unaids.org webcite. Accessed October 2012
• [41]Ross E, Deverell A: Psychosocial Approaches to Health, Illness and Disability: A Reader for Health Care Professionals. Pretoria: Van Schaik Publishers; 2004.
• [42]Corbett EL, Marston B, Churchyard GJ, De Cock KM: Tuberculosis in Sub-Saharan Africa: opportunities, challenges and changes in the era of antiretroviral treatment. Lancet 2006, 367:926-937.