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. 2017 Jan 1;21(1):23-31.
doi: 10.5588/ijtld.16.0433.

Multidrug-resistant tuberculosis patients' views of interventions to reduce treatment loss to follow-up

T Tupasi  1 , A M C G Garfin  2 , J M Mangan  3 , R Orillaza-Chi  4 , L C Naval  1 , G I Balane  1 , R Basilio  2 , A Golubkov  5 , E S Joson  1 , W-J Lew  6 , V Lofranco  7 , M Mantala  8 , S Pancho  7 , J N Sarol  1 , A Blumberg  3 , D Burt  3 , E V Kurbatova  3
Affiliations

Multidrug-resistant tuberculosis patients' views of interventions to reduce treatment loss to follow-up

T Tupasi et al. Int J Tuberc Lung Dis. .

Abstract

Setting: Patients who initiated treatment for multidrug-resistant tuberculosis (MDR-TB) at 15 Programmatic Management of Drug-resistant Tuberculosis (PMDT) health facilities in the Philippines between July and December 2012.

Objectives: To describe patients' views of current interventions, and suggest changes likely to reduce MDR-TB loss to follow-up.

Methods: In-depth interviews were conducted between April and July 2014 with MDR-TB patients who were undergoing treatment, had finished treatment at the time of the interview (controls), or had been lost to follow-up (LTFU). Responses were thematically analyzed.

Results: Interviews were conducted with 182 patients who were undergoing or had completed treatment and 91 LTFU patients. Views and suggestions could be thematically categorized as approaches to facilitate adherence or address barriers to adherence. The top themes were the need for transportation assistance or improvements to the current transportation assistance program, food assistance, and difficulties patients encountered related to their medications. These themes were addressed by respectively 63%, 60%, and 32% of the participants.

Conclusions: A more patient-centered approach is needed to improve MDR-TB treatment adherence. Programs should strive to provide assistance that considers patient preferences, is adequate to cover actual costs or needs, and is delivered in a timely, uninterrupted manner.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

Figure 1
Figure 1
Adherence barriers and enablers to improve treatment adherence as suggested by study participants (n =268). *A barrier to treatment adherence. †An enabler to improve treatment adherence. DOT = directly observed therapy.
Figure 2
Figure 2
Self-reported reasons for stopping treatment among persons lost to follow-up (n = 89*). Figure summarizes the results of qualitative analysis of answer on the question: ‘All of the questions I have asked address reasons why many people stop taking treatment before being advised to stop by their doctors. What were the main reasons you stopped taking your treatment early?’ *Of 91 cases, 1 person did not provide an answer and 1 person was initially categorized as a control but was a case. He was interviewed using a ‘control’ form, which did not contain this question, totaling 89 patients who responded to this question.
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References

    1. World Health Organization. Global tuberculosis report, 2013. Geneva, Switzerland: WHO; 2013. WHO/HTM/TB/2013.13.
    1. World Health Organization. Global tuberculosis report, 2014. Geneva, Switzerland: WHO; 2014. WHO/HTM/TB/2014.08.
    1. The Philippines Department of Health. Reports of accomplishments and targets of the Programmatic Management for Drug-resistant Tuberculosis in the Philippines. Manila, The Philippines: DoH; 2014.
    1. Tupasi TE, Garfin AM, Kurbatova EV, et al. Factors associated with loss to follow-up during treatment for multidrug-resistant tuberculosis, the Philippines, 2012–2014. Emerg Infect Dis. 2016;22:491–502. - PMC - PubMed
    1. World Health Organization. Guidelines for the programmatic management of drug-resistant tuberculosis, 2011 update. Geneva, Switzerland: WHO; 2011. WHO/HTM/TB/2011.6. - PubMed

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