A SYSTEMATIC REVIEW OF QUALITATIVE STUDIES ON FACTORS RESPONSIBLE FOR POOR ADHERENCE TO TREATMENT OF TUBERCULOSIS

Abstract

Tuberculosis (TB) remains a major global public health problem, mainly in low- and middle-income nations. Irrespective of the availability of effective treatment, poor adherence to anti-tuberculosis treatment continues to contribute to treatment failures, relapse, resistance to the drugs and increased mortality. Understanding the factors influencing poor adherence is essential for improving treatment outcome. This systematic review aimed to systematically review qualitative studies on factors responsible for poor adherence to tuberculosis treatment among patients receiving anti-TB therapy. A systematic review of qualitative studies was conducted using 13 electronic on-line databases to search for studies that are of quality. These included PubMed, Google Scholar, Scopus and CINAHL. Relevant studies published in English Language were selected based on pre-defined inclusion and exclusion criteria. Data were thematically extracted and analyzed to identify common factors responsible for treatment non-adherence.

Twenty-four inter-related primary factors responsible for poor adherence to the treatment of tuberculosis were identified from the ten selected studies. The factors were grouped according to their similarities in meaning. Having grouped and synthesized the primary factors derived from the patients using thematic analysis, four basic factors were arrived at based on the interpretations and conclusions derived from the authors. The factors were poor knowledge of TB, financial constraint, social stigma/discrimination, side-effects of medication, long duration of treatment, inadequate health services, lack of family/ social support, difficulties in transportation and poor relationship between healthcare workers and TB patient. Other contributory factors were poverty. Forgetfulness in taking daily drugs, cultural belief and substance abuse.

Poor adherence to TB treatment is influenced by multiple interrelated social, economic, personal and health system factors. Addressing these factors through patient education, improved healthcare delivery, psycho-social support and community-based interventions can enhance adherence and improve TB treatment outcome. Poor adherence is common with long-term treatment and it is influenced by the interplay of many of the identified factors that are deemed responsible by the patients. The findings in this review can help to inform policy-makers on the use of mobile TB clinics for good coverage, especially in places were poor adherences have been reported to be high so as to make TB services available, accessible, affordable, improve treatment outcome and general health of TB patients.