Social Determinants: Reinforcing and Enabling Factors as Predictors of Treatment-Adherence in Community-Based Drug Resistant Tuberculosis Patients in South-West, Nigeria
Abstract:
Background:
Medication Non-adherence in the treatment
of patients with Tuberculosis (TB) is a major challenge in community-based clinical
therapeutics. This has been attributed, in part, to duration and complexity of treatment
regimens and toxic side-effects, which facilitates disease transmission with emerging
resistance to anti-TB drugs.
This study was
undertaken to assess level of adherence to treatment and identify social determinants
moderating medication-adherence guided by the PRECEDE framework among patients receiving
treatment in South-west zone of Nigeria.
Method:
This was a cross-sectional
survey design conducted as a community-based study with 226 consenting patients
receiving second-line drug treatment based on data obtained from all DR-TB OPD Health
facilities within South-west, Nigeria. The study adopted total enumeration sampling
technique. Data analysis was performed using IBM SPSS version 22. Univariate and
multivariate Regression analysis was conducted to validate the association between
the independent variables (Reinforcing and Enabling factors) and outcome variables
(medication- adherence and appointment keeping behavior). The test of significance
was set at 5% for all statistical procedures.
Results:
Male participants
in this study was 61.3%. Mean treatment-adherence prevalence was 84.75% (20.34±3.37
measured on 24-point scale). Social/Environmental factors correlated positively
with treatment -adherence (r=0.165; p<0.01). Enabling factors with OR=1.44 (95%
CI=1.08-1.92, p=0.013) predicted treatment-adherence more significantly than reinforcing
factors for participants in this study.
Conclusion:
Patients’ level
of treatment-adherence was fair. Special
attention should be given to enabling and reinforcing factors during patient education
through social learning and structural support, which the study identified as inadequate,
to optimize treatment-adherence in DR-TB patients.
Keywords: Reinforcing, Enabling,
Drug resistance, Tuberculosis, Treatment-adherenc.
References:
[1]. Ajzen, I. (2002). Perceived behavioral control,
self-efficacy, locus of control, and the theory of planned behavior. Journal
of Applied Social Psychology, 32(4), 665–683.
https://doi.org/10.1111/j.1559-1816.2002.tb00236.x
[2].
Atulomah, N.O. (2014).
Effects of Two Health Education Interventions on Adherence to Antihypertensive Medication
and on Blood Pressure in Selected Tertiary Health Facilities in Southwestern Nigeria.
http://ir.library.ui.edu.ng/bitstream/123456789/648/1/Nnodimele%20Onuigbo%20ATULOMAH.pdf.
[3].
Baker, M., Das, D.,
Venugopal, K. & Howden-Chapman, P. (2008). Tuberculosis associated with household
crowding in a developed country. J Epidemiol Community Health, 62(8): 715-21.
[4].
Bhatt, R., Chopra,
K., Vashisht, R. (2019). Impact of integrated psycho-socio-economic support on treatment
outcome in drug resistant tuberculosis- A retrospective cohort study. India Journal
of Tuberculosis 66: 105-110.
[5].
Bosworth, H. B.,
Granger, B. B., Mendys, P., Brindis, R., Burkholder, R., Czajkowski, S. M., Daniel,
J. G., et al. (2011). Medication adherence: a call for action. American heart journal,
162(3), 412–424. https://doi.org/10.1016/j.ahj.2011.06.007.
[6].
Brown, M. T., &
Bussell, J. K. (2011). Medication adherence: WHO cares. Mayo Clinic proceedings,
86(4), 304–314.
[7].
De Vries G, Tsolova
S, Anderson LF, Gebhard AC, Heldal E, Hollo V., (2017). Health system factors influencing
management of multidrug-resistant tuberculosis in four European Union countries
- learning from country experiences. BMC Public Health;17(1):334. doi: 10.1186/s12889-017-4216-9.
[8].
Diwan V, Thorson
A, Winkvist A, eds (1998). Gender and tuberculosis. NHV report 1998. Göteborg: Nordic
School of Public Health, 1998. [13].
[9]. Duarte, A., Lönnrothd, K., Carvalh, of C, Limaa F., Carvalhog,
A. C., Mu˜noz-Torricoh, M. (2017). Tuberculosis, social determinants and co-morbidities
(including HIV). Pulmonol, 24.,2.,2018,115-119., [Accessed on:
25th March 2019].
[10].
Gebreweld, F.H., Kifle, M. M., Gebremicheal, F.E., Simel,
L.L., Gezae, M.M., Ghebreyesus, S.S., Mengsteab, Y.T., Wahd, N.G. (2018). Factors influencing adherence to tuberculosis
treatment in Asmara, Eritrea: a qualitative study. J Health Popul Nutr.; 37:
1. Published online 2018 Jan 5. doi: 10.1186/s41043-017-0132-y.
[11]. Green LW, Kreuter MW. (2005). Health Program Planning: An Educational and Ecological Approach.
(4th Edition). New York: McGraw-Hill.
[12].
Hargreaves,
J. R., Boccia, D., Evans, C. A., Adato, M., Petticrew, M., & Porter, J. D. (2011).
The social determinants of tuberculosis: from evidence to action.
American journal of public health, 101(4), 654–662. https://doi.org/10.2105/AJPH.2010.199505.
[13]. Horton, K. C., MacPherson, P., Houben, R. M., White, R. G., & Corbett,
E. L. (2016). Sex Differences in Tuberculosis
Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review
and Meta-analysis. PLoS medicine, 13(9), e1002119.
[14]. Johnson, O.E., Ibekwe, F.E. (2015). Gender
Differences among Clients Attending Tuberculosis Unit of a Teaching Hospital in
Southern Nigeria. Sch. J. App. Med. Sci.,
2015; 3(1D):228-233.
[15]. Kim, M. T., Hill, M. N., Bone, L. R., and Levine, D.
M. (2000).
Development and Testing of the Hill-Bone Compliance to High Blood Pressure Therapy
Scale. Progress in Cardiovascular Nursing. 15.3:90-96.
[16].
Lönnroth K, Castro KG, Chakaya
JM, Chauhan LS, Floyd K, Glaziou P, Raviglione MC. (2010). Tuberculosis control and elimination 2010-50: cure, care,
and social development. Lancet.; 22;375 (9728):1814-29. doi: 10.1016/S0140-6736(10)60483-7.
[17].
Munro SA, Lewin SA, Smith HJ,
Engel ME, Fretheim A, Volmink J. (2007). Patient adherence to tuberculosis treatment:
a systematic review of qualitative research PLoS Med.; 24;4(7): e238. Review.
[18]. Obermeyer, Z., Abbott-Klafter J, Murray, C.J (2008). Has the DOTS strategy improved case finding
or treatment success? An empirical assessment. PLoS One 2008;
3: e1721.
[19].
OʼDonnell,
M. R., Wolf, A., Werner, L., Horsburgh, C. R., & Padayatchi, N. (2014).
Adherence in the treatment of patients with extensively drug-resistant tuberculosis
and HIV in South Africa: a prospective cohort study. Journal of acquired immune
deficiency syndromes (1999), 67(1), 22–29.
[20]. Osterberg L, Blaschke T.
(2005). Adherence to medication. N Engl J Med. 2005; 353(5):487-497.
[21].
Ritchie, H. (2019).
https://ourworldindata.org/who-smokes-more-men-or-women.
[22]. Subbaraman, R., de Mondesert, L., Musiimenta, A.,
et al
(2018). Digital adherence technologies for the management of tuberculosis therapy:
mapping the landscape and research priorities BMJ Global Health 2018; 3:
e001018.
[23]. Tian, J.H., Lu, Z.X., Bachmann, M.O., et al (2014). Effectiveness of directly observed treatment
of tuberculosis: a systematic review of controlled studies. Int J Tuberc Lung Dis 2014;
18:1092–8.
[24]. Valencia, S., León,
M., Losada, I., Sequera, V.G., Quevedo, M.F & García-Basteiro, A.L. (2016): How do we measure adherence to anti-tuberculosis
treatment?, Expert Review of Anti-infective Therapy, DOI: 10.1080/14787210.2017.1264270
To link to this article: http://dx.doi.org/10.1080/14787210.2017.1264270
[25].
Van Hoorn, R., Jaramillo, E.,
Collins, D., Gebhard, A., van den Hof, S. (2016). The Effects of Psycho-Emotional and Socio-Economic
Support for Tuberculosis Patients on Treatment Adherence and Treatment Outcomes
- A Systematic Review and Meta-Analysis. PLoS One.;11(4): e0154095.
doi: 10.1371/journal.pone.0154095. eCollection 2016. Review.
[26]. Velligan, DI, Wang, M, Diamond P, Glahn, D.C, Castillo, D, Bendle, S, Lam,
YW, Ereshefsky, L, Miller AL. (2007). Relationships among subjective
and objective measures of adherence to oral antipsychotic medications. Psychiatr Serv. 2007 Sep; 58(9):1187-92.
[27]. Vik SA, Maxwell CJ, Hogan DB. (2004). Review Measurement, correlates,
and health outcomes of medication adherence among seniors. Ann Pharmacother.; 38(2):303-12.
[28].
Williams, A.O.,
Makinde, O.A. & Ojo, M. (2016). Community-based management
versus traditional hospitalization in treatment of drug-resistant tuberculosis:
a systematic review and meta-analysis. glob health res policy 1, 10.
https://doi.org/10.1186/s41256-016-0010-y.
[29]. World Health Organization. (2014). Companion Handbook to the WHO Guidelines
for the Programmatic Management of Drug-Resistant Tuberculosis. Geneva: 12, Patient-centred
care, social support and adherence to treatment. Available
from: https://www.ncbi.nlm.nih.gov/books/NBK247419.
[30]. WHO Global TB Report, (2019). Global TB report.
Available at:
https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf
(Accessed on 16th April, 2020).
[31]. World Health Organization. Definitions and reporting
framework for tuberculosis – (2013) revision. Geneva: World Health Organization;
2014.
[32]. WHO A Draft Global Strategy for TB Research and Innovation.
(2019).
Available at: https://www.who.int/tb/features_archive/Revised_draft_Researchstrategy_based_on_public_comments.pdf.
[33]. Yellappa V, Lefèvre P, Battaglioli T, Narayanan &
Van der Stuyft (2016). Coping with
tuberculosis and directly observed treatment: a qualitative study among patients
from South India. BMC Health Serv Res; 16:283.
[34]. Yin J, Wang X, Zhou L, Wei X. (2018). The relationship
between social support, treatment interruption and treatment outcome in patients
with multidrug-resistant tuberculosis in China: a mixed methods study. Trop Med
Int Health. 2018; 23(6):668–677.