Intervention strategies to improve tuberculosis treatment adherence in Limpopo Province, South Africa

Abstract

Even though tuberculosis is curable, it remains a major cause of ill-health among millions of people. Globally tuberculosis is the second leading cause of death from an infectious disease after the Human immunodeficiency virus. The major unresolved challenge in the management of tuberculosis is treatment completion. In the Limpopo Province, tuberculosis treatment adherence remains low with a tuberculosis treatment success rate of 80.6% which is below a national target of 85%. If this problem is not addressed, many people will develop Multidrug resistant tuberculosis or die. The purpose of the study was therefore to develop intervention strategies to improve tuberculosis treatment adherence in the Limpopo Province. The study was conducted in eight Community health centres in three selected districts (Vhembe, Waterberg, and Capricorn) of Limpopo province. The study comprised of three phases. Phase one used exploratory sequential mixed methods design to assess and describe factors contributing to non-adherence to tuberculosis treatment among tuberculosis patients. In phase two, the researcher used the findings obtained from Phases 1a and Phase 1b, to develop evidence-based intervention strategies that encompasses Behaviour change techniques aimed at overcoming the identified barriers and factors affecting tuberculosis treatment adherence. In phase three, the researcher then validates the developed intervention strategies with district tuberculosis manager using the checklist to see if they meet Affordable, Practical, Effective, Acceptable, Safe, Equitable criteria. Qualitative approach was used to collect data among 16 tuberculosis patients, three district tuberculosis managers, eight facility operation managers, eight tuberculosis focal person through key informant interview and 18 directly observed treatment supporters through focus group discussion. Colaizzi's method for data analysis which follows seven data analysis steps was used to analyze qualitative data to identify meaningful information and organize it into themes. Results from the qualitative were used to inform development of questionnaire for quantitative approach to collect data among tuberculosis patients. Quantitative data were collected from 207 respondents using questionnaires and analysed using Statistical Package for Social Sciences® version 26.0. In the analysis of qualitative data, the researcher found the most descriptive words for each topic and turned them into categories. Related topics were then grouped to reduce the number of categories and to create themes. Qualitative data findings revealed five major themes from the raw data: (1) Social and Cultural factors, (2) Patients related factors, (3) Treatment related factors, (4) Socio-economic factors and (5) Health care and health system factors. The findings indicated that TB patients do not adhere to their prescribed TB treatment because of lack of knowledge about TB and its treatment. Due to lack of knowledge tuberculosis patients were found to visit traditional healers and prophets for help even after their diagnosis. Only 9.2% of the participants indicated that they knew about tuberculosis before their diagnosis. Environmental related barriers were attitude of health workers, lack of support by family and community, lack of food and abuse of alcohol and illicit drugs. Wrong perception about tuberculosis and misperceptions cultural beliefs, stigma and refusal of directly observed treatment supporters affected treatment adherence. In Phase two, Adherence Improvement Management Strategy was developed through stakeholder workshop based on the interpretation of the findings from both approaches and was guided by the last two stages of Behaviour change Wheel. The Intervention strategy will be delivered using patient’s information leaflets materials by the community health workers to the patients, community, and family members. In Phase three, the developed intervention strategy was then validated by the stakeholders using Affordable, Practical, Effective, Acceptable, Safe, Equitable criteria. The findings of this study highlight an urgent need for collaboration between Department of Health and the community to address the need of the community.