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. 2023 May 18;13(5):e069938.
doi: 10.1136/bmjopen-2022-069938.

Adolescent, caregiver and provider perspectives on tuberculosis treatment adherence: a qualitative study from Lima, Peru

Silvia S Chiang  1   2 , Liz Senador  3 , Elmer Altamirano  3 , Milagros Wong  3 , Catherine B Beckhorn  3 , Stephanie Roche  4 , Julia Coit  5 , Victoria Elena Oliva Rapoport  6 , Leonid Lecca  3   5 , Jerome T Galea  7
Affiliations

Adolescent, caregiver and provider perspectives on tuberculosis treatment adherence: a qualitative study from Lima, Peru

Silvia S Chiang et al. BMJ Open. .

Abstract

Objectives: To understand the perspectives of adolescents (10-19 years old), their caregivers and healthcare providers regarding factors that impact adherence to tuberculosis (TB) treatment among adolescents.

Design: We conducted in-depth interviews using semistructured interview guides based on the World Health Organization (WHO)'s Five Dimensions of Adherence framework, which conceptualises adherence as being related to the health system, socioeconomic factors, patient, treatment and condition. We applied framework thematic analysis.

Setting: Between August 2018 and May 2019, at 32 public health centres operated by the Ministry of Health in Lima, Peru.

Participants: We interviewed 34 adolescents who completed or were lost to follow-up from treatment for drug-susceptible pulmonary TB disease in the preceding 12 months; their primary caregiver during treatment; and 15 nurses or nurse technicians who had ≥6 months' experience supervising TB treatment.

Results: Participants reported numerous treatment barriers, the most common of which were the inconvenience of health facility-based directly observed therapy (DOT), long treatment duration, adverse treatment events and symptom resolution. The support of adult caregivers was critical for helping adolescents overcome these barriers and carry out the behavioural skills (eg, coping with the large pill burden, managing adverse treatment events and incorporating treatment into daily routines) needed to adhere to treatment.

Conclusion: Our findings support a three-pronged approach to improve TB treatment adherence among adolescents: (1) reduce barriers to adherence (eg, home-based or community-based DOT in lieu of facility-based DOT, reducing pill burden and treatment duration when appropriate), (2) teach adolescents the behavioural skills required for treatment adherence and (3) strengthen caregivers' ability to support adolescents.

Keywords: PAEDIATRICS; Paediatric infectious disease & immunisation; Public health; QUALITATIVE RESEARCH; Tuberculosis.

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Conflict of interest statement

Competing interests: SC received an honorarium from Johnson & Johnson for a presentation on TB in youth at the World Lung Conference of the International Union Against Tuberculosis and Lung Disease (Virtual Conference, October 2021). The authors declare no other competing interests.

Figures

Figure 1
Figure 1
Participant screening, recruitment and enrolment.
Figure 2
Figure 2
Explanatory model of treatment adherence among adolescents with drug-susceptible tuberculosis in Lima, Peru. DOT, directly observed therapy; TB, tuberculosis.
See this image and copyright information in PMC

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