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A Systematic Review Of Patient Adherence To Tuberculosis Treatment (Dissertation Sample)


to discuss factors that contribute to patients' discontinuation of anti-tuberculosis treatment in africa

A systematic review of patient adherence to tuberculosis treatment in Sub-Saharan Africa: an analysis of factors resulting in interruption of anti-tuberculosis therapy
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Tuberculosis (TB) is one of the main contributors to the global disease burden with higher prevalence rates recorded in Sub-Saharan African countries. In the past decade, tremendous effort has been put in place in order to combat the disease which is commonly diagnosed among HIV/AIDS patients. However, the prevalence and incidence rates of the disease remain high especially in developing countries partly because of poor adherence to anti-tuberculosis therapy. One of the main challenges which stakeholders in the healthcare industry face in a bid to determine effective solutions against the disease is the absence of a comprehensive understanding of factors that both impede or facilitate adherence to treatment in those countries. It is imperative to understand factors that contribute to patient interruption of anti-TB therapy in Sub-Saharan Africa to guide the design and implementation of policies aimed at promoting patient adherence to treatment. This essay is thus a systematic review of literature on patient adherence to tuberculosis treatment in Sub-Saharan Africa and available interventions that have been or can be implemented to yield positive TB treatment outcomes.
Factors that result in patient interruption of anti-TB therapy in sub-Saharan Africa
According to Sanou et al (2004), most patients do not complete their anti-TB therapy because of poor infrastructural installations in developing countries, making it difficult for patients to consistently gain access to healthcare facilities. Poor road networks compel some patients to use donkeys and other primitive means of transport to get to hospital which is a major challenge considering their health condition already. Many TB patients in developing countries are also poor and can hardly afford proper transport hence rely on public means of transport which is often unsafe, unreliable and not readily available (Kagee et al, 2007). This compels them to opt out of the TB treatment programs. Furthermore, some of the hospitals and health centers are in very poor states that negatively impact the psychological profiles of patients. For instance, very dirty hospitals discourage patients from going there to complete their doses hence opt to remain at home and get the treatment there. Poor conditions of hospitals in developing countries make patients generally unenthusiastic about continuing their treatment (Singh et al, 2002). Developing countries also grapple with shortages of medical facilities. As much as some patients may want to religiously follow their treatment, they may be forced to interrupt because of lack of medicine in health care facilities. In addition, TB treatment is not readily affordable to many patients in developing countries. Most of such countries do not have subsidies or proper healthcare insurance to take care of such bills. As a result, many patients opt out of the treatment when they can no longer afford it (Kagee et al, 2011). Some patients also opt to interrupt their treatment for fear of losing their jobs or sources of income because of the time they take to visit health centers. Patients have responsibilities that must be met hence cannot remain out of work for long. Torn between treatment adherence and working, some of them are compelled to choose the latter (de Vos, 2002). Some of these poverty-related barriers also result in other barriers to patient adherence. For instance, when a patient misses treatment because they did not have a means of transport or because of failure to afford it, they develop the fear of going to continue with the treatment because they will be asked why they missed their treatment last time. Some of the medical practitioners can be harsh at times and scold such patients hence instill fear in them. Therefore, once such patients miss the treatment once due to some reason, they opt to stop altogether (Greene, 2004).
Patient interruption of anti-TB therapy is also contributed by how patients interpret the illness and their process of recovery. According to Rowe et al (2005), a significant number of TB patients who were interviewed confessed to interrupting their anti-TB therapy as soon as they felt better or the symptoms of the disease were alleviated. The same findings were also established by Watkins et al (2004), that some patients stopped their treatment as soon as they realized that they no longer had blood in their sputum. According to them the absence of blood in sputum was synonymous with their full recovery. Additionally, while some patients are fully aware that the disappearance of symptoms does not necessarily mean they have recovered they still discontinue the treatment because of the agony they feel when they take the pills. There are those who naturally detest medicine hence seize the slightest opportunity they realize they can do without the medicine. This is regardless of their knowledge that the disease may actually return and become worse (Greene, 2004).
TB treatment adherence is also influenced by patient knowledge, attitudes and beliefs they have about the disease. According to Edgington et al (2002), some patients in sub-Saharan Africa are influenced by their beliefs to stop the treatment. For instance, there are those who believe that no doctor can provide a cure for the disease hence stop the treatment to seek alternative means. Greene (2004) also found out that patients discontinued their treatment because they simply believed that the pills would not help them. The same findings were established by a study conducted by Ito (1999) where patients were found to interrupt their TB therapy merely because they believed the medication wouldn’t be of any use for them. Furthermore, some patients’ attitudes towards doctors or the whole process of treatment make them interrupt their treatment. For instance, Khan et al (2005) established that some patients found it rather unreasonable that they had to go all the way to hospital to be given medicine like children when they could simply take them from the comfort of their homes. As a result, they terminated the therapy. Some patients also believe that only tablets or medicine that is expensive has the capacity to cure them and often interpret low cost medicine as ineffective. Therefore, in cases where anti-TB treatment is subsidized to make it affordable to a larger section of the population, such patients opt to interrupt their therapy. Some patients have also been reported to find being told to take medicine so obvious that they do not find anything serious in either taking them or leaving. According to them, taking medicine is just as insignificant as not taking them (Gleissberg, 2001).
Patient adherence behavior and individual characteristics have also been found to contribute to interruption of anti-TB therapy. For instance, patients who abuse drugs or who start drinking very early in the morning have been found to be unlikely to remember their treatment programs (Dick et al., 1996). The same result was determined by Mara (2004). Additionally, patients who are unable to deal with emotional or other challenges in their lives may simply reject their medicine when they feel nothing in their lives matters any more. An example is patients who are also depressed (Ngamvithayapong et al, 2000).
The physical side effects of medicine also lead to patient non-adherence to treatment. Jaiswal et al (2003) found that patients discontinued their treatment because of the metallic taste of the medicine which was very unpleasant. Some patients have also been found to interrupt their treatment because the medicines made them itchy the whole the day whenever they took them (Matebesi, 2004).A similar result was observed in a study by Greene (2004).
Family, community and household influences also determine patient adherence to anti-TB treatment. According to Dick et al (1996) some patients live in societies that stigmatize TB patients hence stop their treatment. Additionally, there are those whose families do not just accept that they have TB and therefore need support. Greene (2004) established that some patients interrupt their treatment to stop their families from worrying. Previous studies have established that the presence of social support is associated with patient adherence to treatment (Holstard et al, 2006). Since TB is commonly associated with HIV/AIDS, there are patients who choose to interrupt their treatment because they will be thought to be suffering from HIV/AIDS. Patients who suffer from HIV/AIDS are highly stigmatized especially in developing countries hence many patients opt to interrupt their treatment for fear of being stigmatized. Without social support, patients in developing countries lack the motivation to go on with their treatment (Parker and Aggleton, 2003).
Possible interventions
It is imperative to empower developing countries not only with medicine but also infrastructural support to facilitate access to the TB treatments. Grants can also be given or subsidies in order to reduce the cost of medicine and make it more affordable to patients in developing countries. Disability grants can also be given to TB patients (Natrass, 2006). Mechanisms may be put in place to administer the medication to patients who cannot make it to hospital.
There is also need for public health education on the need to adhere to treatment. Education should also be conducted to dismiss common misconceptions about TB treatment. This can be done through advocacy campaigns. Additionally, the society should be enlightened on the need to accept and support patients who suffer from TB. Community support groups for patients with TB can also be set up to provide moral support to patients. Stigma ...
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