Ozaltun Sahin Can, Akin Levent
Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara 06230, Türkiye.
Healthcare (Basel). 2024 Nov 25;12(23):2353. doi: 10.3390/healthcare12232353.
BACKGROUND/OBJECTIVES: The objective of this study was to investigate the factors influencing adherence with tuberculosis medication therapy. Non-adherence can result in treatment failure, ongoing infectiousness, and the development of drug resistance. Therefore, understanding the reasons behind non-adherence is crucial for achieving the World Health Organization's target of 90% treatment success.
Data were collected prospectively from a cohort at three different tuberculosis dispensaries (TBDs), with participants being followed up with at face-to-face visits every two months for a total of three visits.
In this study, the adherence rates among participants were the highest during the intensive treatment phase (81.0% at the first follow-up) but declined during the continuation phase, reaching 69.4% at the second follow-up (at the end of the fourth month of treatment) and 71.1% at the third follow-up (at the end of the sixth month of treatment) according to self-reports for the past 30 days. According to the generalised estimating equations method, factors significantly associated with better adherence included knowledge of infectiousness, daily access to medication, workplace permissions, high household income, regular sleep patterns, extrapulmonary TB, secondary education, and no alcohol consumption.
Non-adherence with anti-TB medication has been observed in patients with TB, particularly during the continuation phase of treatment. Interventions targeting patients who experience frequent forgetfulness, adverse drug reactions, or a lack of workplace flexibility may help to improve adherence. In addition, providing personalised health education that highlights the risks of non-adherence and emphasises the infectious nature of TB could improve understanding and commitment to treatment. Ensuring regular follow-ups and support, particularly for those with lower socioeconomic status or limited social support, can further reinforce the importance of adherence in TB treatment outcomes.
背景/目的：本研究的目的是调查影响结核病药物治疗依从性的因素。不依从会导致治疗失败、持续传染性以及耐药性的产生。因此，了解不依从背后的原因对于实现世界卫生组织90%治疗成功率的目标至关重要。
前瞻性地从三个不同的结核病诊疗所（TBD）的队列中收集数据，参与者每两个月接受一次面对面随访，共随访三次。
在本研究中，参与者的依从率在强化治疗阶段最高（第一次随访时为81.0%），但在继续治疗阶段有所下降，根据过去30天的自我报告，在第二次随访（治疗第四个月末）时降至69.4%，在第三次随访（治疗第六个月末）时降至71.1%。根据广义估计方程法，与更好的依从性显著相关的因素包括对传染性的了解、每天可获取药物、工作场所许可、家庭收入高、规律的睡眠模式、肺外结核、中等教育程度以及不饮酒。
在结核病患者中观察到了抗结核药物治疗的不依从情况，尤其是在治疗的继续阶段。针对经常健忘、药物不良反应或工作场所灵活性不足的患者进行干预可能有助于提高依从性。此外，提供个性化的健康教育，强调不依从的风险并突出结核病的传染性，可能会增进对治疗的理解和坚持。确保定期随访和支持，特别是对社会经济地位较低或社会支持有限的患者，可以进一步强化依从性对结核病治疗结果的重要性。
