Abstract:
Background: Treatment non-adherence poses significant risks to health out
comes and impedes the health system’s efficiency, hence curtailing progress
towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interven
tions to address TB treatment non-adherence, Kenya still reports high TB
treatment non-adherence rates of 35% and consequently poor treatment out
come 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. Objective: To analyze HCW-related
factors associated with TB treatment non-adherence among patients in Kisumu
East Sub-County. Methods: 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 parti
cipated 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. Results: 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
DOI: 10.4236/jtr.2024.121002 Mar. 11, 2024
13
Journal of Tuberculosis Research
M. Ochieng’ et al.
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). Conclu
sion: The study results underline importance of patient-centered consultation
for TB patients and targeted education and counselling for improved treat
ment adherence.
Keywords
Tuberculosis, Treatment Adherence, Human Resources for Health
