Ochieng Marlyn, Nyaberi Jackline, Mambo Susan, Wafula Charles
Department of Environmental Health and Disease Control, School of Public Health, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya.
European and Developing Countries Clinical Trials Partnership (EDCTP), Strengthening Capacity for Epidemics Preparedness and Response in Sub-Saharan Africa (SCEPRESSA), Nairobi, Kenya.
J Tuberc Res. 2024;12(1):13-33. doi: 10.4236/jtr.2024.121002.
Treatment non-adherence poses significant risks to health outcomes and impedes the health system's efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients' TB treatment non-adherence in Kenya.
To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County.
Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients' perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14.
TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients' involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002).
The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.
治疗不依从对健康结果构成重大风险，并阻碍卫生系统的效率，从而限制了在可持续发展目标3.3下实现终结结核病战略的进展。尽管采取了干预措施来解决结核病治疗不依从问题，但肯尼亚仍报告结核病治疗不依从率高达35%，因此治疗成功率很低。医护人员在将民众与卫生服务联系起来方面发挥着关键作用，但在肯尼亚，他们对患者结核病治疗不依从的影响却鲜为人知。
分析基苏木东次县患者中与结核病治疗不依从相关的医护人员因素。
基于医疗机构的分析性横断面混合方法研究。在门诊就诊期间，对102名同意参与的成年（在107名成年人的总普查中）药物敏感结核病患者进行了关于治疗依从性和患者对医护人员看法的半结构化问卷调查。从6家医疗机构中按职级有目的地挑选了12名医护人员参加关键 informant 访谈。使用莫里isky 药物依从性量表测量药物依从性，然后将其表示为二分变量。定量分析使用 STATA 15.1版，而定性演绎主题分析使用 NVIVO 14版。
记录到结核病治疗不依从率为26%（CI：18% - 36%）。总体而言，感到在应对疾病方面得到支持的患者坚持治疗的可能性是未得到支持患者的8倍（调整后比值比 = 7.947，95% CI：2.214 - 28.527，p = 0.001）。影响治疗依从性的关键医护人员相关因素包括：友好（粗比值比 = 4.31，95% CI：1.514 - 12.284，p = 0.006）、尊重（粗比值比 = 6.679，95% CI：2.239 - 19.923，p = 0.001）和非歧视性服务（粗比值比 = 0.1478，95% CI：0.047 - 0.464，p = 0.001）、沟通[咨询时间的充足性（粗比值比 = 6.563，95% CI：2.467 - 17.458，p = 0.001）和患者参与其健康决策（粗比值比 = 3.02，95% CI：1.061 - 8.592，p = 0.038）]以及教育和咨询（粗比值比 = 4.371，95% CI：1.725 - 11.075，p = 0.002）。
研究结果强调了以患者为中心的结核病患者咨询以及针对性教育和咨询对提高治疗依从性的重要性。
