Skip to main content
Top
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study

Authors: Mekdes K Gebremariam, Gunnar A Bjune, Jan C Frich

Published in: BMC Public Health | Issue 1/2010

Login to get access

Abstract

Background

Tuberculosis is a major public health problem in Ethiopia, and a high number of TB patients are co-infected with HIV. There is a need for more knowledge about factors influencing treatment adherence in co-infected patients on concomitant treatment. The aim of the present study is to explore patients' and health care professionals' views about barriers and facilitators to TB treatment adherence in TB/HIV co-infected patients on concomitant treatment for TB and HIV.

Methods

Qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients.

Results

We found that interplay of factors is involved in the decision making about medication intake. Factors that influenced adherence to TB treatment positively were beliefs in the curability of TB, beliefs in the severity of TB in the presence of HIV infection and support from families and health professionals. Barriers to treatment adherence were experiencing side effects, pill burden, economic constraints, lack of food, stigma with lack of disclosure, and lack of adequate communication with health professionals.

Conclusion

Health professionals and policy makers should be aware of factors influencing TB treatment in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Our results suggest that provision of food and minimal financial support might facilitate adherence. Counseling might also facilitate adherence, in particular for those who start ART in the early phases of TB treatment, and beliefs related to side-effects and pill burden should be addressed. Information to the public may reduce TB and HIV related stigma.
Literature
1.
go back to reference World Health Organization: Global Tuberculosis Control: surveillance, planning, financing. 2008, Geneva: World Health Organization World Health Organization: Global Tuberculosis Control: surveillance, planning, financing. 2008, Geneva: World Health Organization
2.
go back to reference Federal Ministry of Health of Ethiopia: Manual for tuberculosis, leprosy and TB/HIV prevention and control program. 2008, Addis Ababa: Federal Ministry of Health Federal Ministry of Health of Ethiopia: Manual for tuberculosis, leprosy and TB/HIV prevention and control program. 2008, Addis Ababa: Federal Ministry of Health
3.
go back to reference Corbett EL, Marston B, Churchyard GJ, De Cock KM: Tuberculosis in Sub-Saharan Africa: opportunities, challenges and changes in the era of antiretroviral treatment. Lancet. 2006, 367: 926-937. 10.1016/S0140-6736(06)68383-9.CrossRefPubMed Corbett EL, Marston B, Churchyard GJ, De Cock KM: Tuberculosis in Sub-Saharan Africa: opportunities, challenges and changes in the era of antiretroviral treatment. Lancet. 2006, 367: 926-937. 10.1016/S0140-6736(06)68383-9.CrossRefPubMed
4.
go back to reference Dean GL, Edwards SG, Ives NJ, Matthews G, Fox EF, Navaratne L, Fisher M, Taylor GP, Miller R, Taylor CB, de Ruiter A, Pozniak AL: Treatment of tuberculosis in HIV infected persons in the era of highly active antiretroviral therapy. AIDS. 2002, 16: 75-83. 10.1097/00002030-200201040-00010.CrossRefPubMed Dean GL, Edwards SG, Ives NJ, Matthews G, Fox EF, Navaratne L, Fisher M, Taylor GP, Miller R, Taylor CB, de Ruiter A, Pozniak AL: Treatment of tuberculosis in HIV infected persons in the era of highly active antiretroviral therapy. AIDS. 2002, 16: 75-83. 10.1097/00002030-200201040-00010.CrossRefPubMed
5.
go back to reference Kwara A, Flanigan TP, Carter EJ: Highly active antiretroviral therapy (HAART) in adults with tuberculosis: current status. Int J Tuberc Lung Dis. 2005, 9: 248-257.PubMed Kwara A, Flanigan TP, Carter EJ: Highly active antiretroviral therapy (HAART) in adults with tuberculosis: current status. Int J Tuberc Lung Dis. 2005, 9: 248-257.PubMed
6.
go back to reference Breen RA, Miller RF, Gorsuch T, Smith CJ, Schwenk A, Holmes W, Ballinger J, Swaden L, Johnson MA, Cropley I, Lipman MC: Adverse events and treatment interruption in tuberculosis patients with and without HIV co-infection. Thorax. 2006, 6: 791-794. 10.1136/thx.2006.058867.CrossRef Breen RA, Miller RF, Gorsuch T, Smith CJ, Schwenk A, Holmes W, Ballinger J, Swaden L, Johnson MA, Cropley I, Lipman MC: Adverse events and treatment interruption in tuberculosis patients with and without HIV co-infection. Thorax. 2006, 6: 791-794. 10.1136/thx.2006.058867.CrossRef
7.
go back to reference Aaron L, Saadoun D, Calatroni I, Launay O, Mémain N, Marchal G, Dupont B, Bouchaud O, Valeyre D, Lortholary O: Tuberculosis in HIV infected patients: a comprehensive review. Clin Microbiol Infect. 2004, 10: 388-398. 10.1111/j.1469-0691.2004.00758.x.CrossRefPubMed Aaron L, Saadoun D, Calatroni I, Launay O, Mémain N, Marchal G, Dupont B, Bouchaud O, Valeyre D, Lortholary O: Tuberculosis in HIV infected patients: a comprehensive review. Clin Microbiol Infect. 2004, 10: 388-398. 10.1111/j.1469-0691.2004.00758.x.CrossRefPubMed
8.
go back to reference Ingersoll KS, Cohen J: The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008, 31: 213-224. 10.1007/s10865-007-9147-y.CrossRefPubMedPubMedCentral Ingersoll KS, Cohen J: The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008, 31: 213-224. 10.1007/s10865-007-9147-y.CrossRefPubMedPubMedCentral
9.
go back to reference Claxton AJ, Cramer J, Pierce C: A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001, 23: 1296-1310. 10.1016/S0149-2918(01)80109-0.CrossRefPubMed Claxton AJ, Cramer J, Pierce C: A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001, 23: 1296-1310. 10.1016/S0149-2918(01)80109-0.CrossRefPubMed
10.
go back to reference Richter A, Anton SE, Koch P, Dennett SL: The impact of reducing dose frequency on health outcomes. Clin Ther. 2003, 25: 2307-2335. 10.1016/S0149-2918(03)80222-9.CrossRefPubMed Richter A, Anton SE, Koch P, Dennett SL: The impact of reducing dose frequency on health outcomes. Clin Ther. 2003, 25: 2307-2335. 10.1016/S0149-2918(03)80222-9.CrossRefPubMed
11.
go back to reference Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J: Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS Med. 2007, 4: e238-10.1371/journal.pmed.0040238.CrossRefPubMedPubMedCentral Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J: Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS Med. 2007, 4: e238-10.1371/journal.pmed.0040238.CrossRefPubMedPubMedCentral
12.
go back to reference Shargie EB, Lindtjørn B: Determinants of treatment adherence among smear positive pulmonary tuberculosis patients in Southern Ethiopia. PLoS Med. 2007, 4: e37-10.1371/journal.pmed.0040037.CrossRefPubMedPubMedCentral Shargie EB, Lindtjørn B: Determinants of treatment adherence among smear positive pulmonary tuberculosis patients in Southern Ethiopia. PLoS Med. 2007, 4: e37-10.1371/journal.pmed.0040037.CrossRefPubMedPubMedCentral
14.
go back to reference Farmer P: Social scientists and the new tuberculosis. Soc Sci Med. 1997, 44: 347-358. 10.1016/S0277-9536(96)00143-8.CrossRefPubMed Farmer P: Social scientists and the new tuberculosis. Soc Sci Med. 1997, 44: 347-358. 10.1016/S0277-9536(96)00143-8.CrossRefPubMed
15.
go back to reference Chesney MA, Morin M, Sherr L: Adherence to HIV combination therapy. Soc Sci Med. 2000, 50: 1599-1605. 10.1016/S0277-9536(99)00468-2.CrossRefPubMed Chesney MA, Morin M, Sherr L: Adherence to HIV combination therapy. Soc Sci Med. 2000, 50: 1599-1605. 10.1016/S0277-9536(99)00468-2.CrossRefPubMed
16.
go back to reference Demissie M, Kebede D: Defaulting from tuberculosis treatment at the Addis Abeba Tuberculosis Centre and factors associated with it. Ethiop Med J. 1994, 32: 97-106.PubMed Demissie M, Kebede D: Defaulting from tuberculosis treatment at the Addis Abeba Tuberculosis Centre and factors associated with it. Ethiop Med J. 1994, 32: 97-106.PubMed
17.
go back to reference Getahun H, Aragaw D: Tuberculosis in rural northwest Ethiopia: community perspective. Ethiop Med J. 2001, 39: 283-291.PubMed Getahun H, Aragaw D: Tuberculosis in rural northwest Ethiopia: community perspective. Ethiop Med J. 2001, 39: 283-291.PubMed
18.
go back to reference Tekle B, Mariam DH, Ali A: Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis. 2002, 6: 573-579.PubMed Tekle B, Mariam DH, Ali A: Defaulting from DOTS and its determinants in three districts of Arsi Zone in Ethiopia. Int J Tuberc Lung Dis. 2002, 6: 573-579.PubMed
19.
go back to reference Shargie EB, Lindtjørn B: Determinants of treatment adherence among smear positive pulmonary tuberculosis patients in Southern Ethiopia. PLoS Med. 2007, 4: e37-10.1371/journal.pmed.0040037.CrossRefPubMedPubMedCentral Shargie EB, Lindtjørn B: Determinants of treatment adherence among smear positive pulmonary tuberculosis patients in Southern Ethiopia. PLoS Med. 2007, 4: e37-10.1371/journal.pmed.0040037.CrossRefPubMedPubMedCentral
20.
go back to reference Michael KW, Belachew T, Jira C: Tuberculosis defaulters from the "dots" regimen in Jimma zone, southwest Ethiopia. Ethiop Med J. 2004, 42: 247-253.PubMed Michael KW, Belachew T, Jira C: Tuberculosis defaulters from the "dots" regimen in Jimma zone, southwest Ethiopia. Ethiop Med J. 2004, 42: 247-253.PubMed
21.
go back to reference Getahun H, Maher D: Contribution of "TB clubs" to tuberculosis control in a rural district in Ethiopia. Int J Tuberc Lung Dis. 2000, 4: 174-178.PubMed Getahun H, Maher D: Contribution of "TB clubs" to tuberculosis control in a rural district in Ethiopia. Int J Tuberc Lung Dis. 2000, 4: 174-178.PubMed
22.
go back to reference Demissie M, Getahun H, Lindtjorn B: Community tuberculosis care through "TB clubs" in rural north Ethiopia. Soc Sci Med. 2003, 56: 2009-2018. 10.1016/S0277-9536(02)00182-X.CrossRefPubMed Demissie M, Getahun H, Lindtjorn B: Community tuberculosis care through "TB clubs" in rural north Ethiopia. Soc Sci Med. 2003, 56: 2009-2018. 10.1016/S0277-9536(02)00182-X.CrossRefPubMed
23.
go back to reference Sagbakken M, Frich JC, Bjune G: Barriers and enablers in the management of tuberculosis treatment in Addis-Ababa, Ethiopia: a qualitative study. BMC Public Health. 2008, 8: 11-10.1186/1471-2458-8-11.CrossRefPubMedPubMedCentral Sagbakken M, Frich JC, Bjune G: Barriers and enablers in the management of tuberculosis treatment in Addis-Ababa, Ethiopia: a qualitative study. BMC Public Health. 2008, 8: 11-10.1186/1471-2458-8-11.CrossRefPubMedPubMedCentral
24.
go back to reference Addis Ababa Health Bureau: Strategic plan of Addis-Ababa City Administration Health Bureau 2004-2007. 2007, Addis Ababa: Addis Ababa Health Bureau Addis Ababa Health Bureau: Strategic plan of Addis-Ababa City Administration Health Bureau 2004-2007. 2007, Addis Ababa: Addis Ababa Health Bureau
25.
go back to reference Federal Ministry of Health, Federal HIV/AIDS Prevention and Control Office: Guidelines For implementation of the antiretroviral therapy programme in Ethiopia. 2007, Addis Ababa: Federal Ministry of Health Federal Ministry of Health, Federal HIV/AIDS Prevention and Control Office: Guidelines For implementation of the antiretroviral therapy programme in Ethiopia. 2007, Addis Ababa: Federal Ministry of Health
26.
go back to reference Cummings KM, Becker MH, Maile MC: Bringing the models together: an empirical approach to combining variables used to explain health actions. J Behav Med. 1980, 3: 123-145. 10.1007/BF00844986.CrossRefPubMed Cummings KM, Becker MH, Maile MC: Bringing the models together: an empirical approach to combining variables used to explain health actions. J Behav Med. 1980, 3: 123-145. 10.1007/BF00844986.CrossRefPubMed
27.
go back to reference Noyes J, Popay J: Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services?. J Adv Nurs. 2007, 57: 227-243. 10.1111/j.1365-2648.2006.04092.x.CrossRefPubMed Noyes J, Popay J: Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services?. J Adv Nurs. 2007, 57: 227-243. 10.1111/j.1365-2648.2006.04092.x.CrossRefPubMed
28.
go back to reference Malterud K: Shared understanding of the qualitative research process. Guidelines for the medical researcher. Fam Pract. 1993, 10: 201-206. 10.1093/fampra/10.2.201.CrossRefPubMed Malterud K: Shared understanding of the qualitative research process. Guidelines for the medical researcher. Fam Pract. 1993, 10: 201-206. 10.1093/fampra/10.2.201.CrossRefPubMed
29.
go back to reference Liefooghe R, Baliddawa JB, Kipruto EM, Vermeire C, De Munynck AO: From their own perspective. A Kenyan community's perception of tuberculosis. Trop Med Int Health. 1997, 2: 809-821. 10.1046/j.1365-3156.1997.d01-380.x.CrossRefPubMed Liefooghe R, Baliddawa JB, Kipruto EM, Vermeire C, De Munynck AO: From their own perspective. A Kenyan community's perception of tuberculosis. Trop Med Int Health. 1997, 2: 809-821. 10.1046/j.1365-3156.1997.d01-380.x.CrossRefPubMed
30.
go back to reference Rowe KA, Makhubele B, Hargreaves JR, Porter JD, Hausler HP, Pronyk PM: Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings?. Int J Tuberc Lung Dis. 2005, 9: 263-269.PubMed Rowe KA, Makhubele B, Hargreaves JR, Porter JD, Hausler HP, Pronyk PM: Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings?. Int J Tuberc Lung Dis. 2005, 9: 263-269.PubMed
31.
go back to reference Edginton ME, Sekatane CS, Goldstein SJ: Patients' beliefs: do they affect tuberculosis control? A study in a rural district of South Africa. Int J Tuberc Lung Dis. 2002, 6: 1075-1082.PubMed Edginton ME, Sekatane CS, Goldstein SJ: Patients' beliefs: do they affect tuberculosis control? A study in a rural district of South Africa. Int J Tuberc Lung Dis. 2002, 6: 1075-1082.PubMed
32.
go back to reference Mehta S, Moore RD, Graham NM: Potential factors affecting adherence with HIV therapy. AIDS. 1997, 11: 1665-1670. 10.1097/00002030-199714000-00002.CrossRefPubMed Mehta S, Moore RD, Graham NM: Potential factors affecting adherence with HIV therapy. AIDS. 1997, 11: 1665-1670. 10.1097/00002030-199714000-00002.CrossRefPubMed
33.
go back to reference Chesney M: Adherence to HAART regimens. AIDS Patient Care STDS. 2003, 17: 169-177. 10.1089/108729103321619773.CrossRefPubMed Chesney M: Adherence to HAART regimens. AIDS Patient Care STDS. 2003, 17: 169-177. 10.1089/108729103321619773.CrossRefPubMed
34.
go back to reference Rocha M, Pereira S, Ferreira L, Barros H: The role of adherence in tuberculosis HIV positive patients treated in ambulatory regimen. Eur Respir J. 2003, 21: 785-788. 10.1183/09031936.03.00077302.CrossRefPubMed Rocha M, Pereira S, Ferreira L, Barros H: The role of adherence in tuberculosis HIV positive patients treated in ambulatory regimen. Eur Respir J. 2003, 21: 785-788. 10.1183/09031936.03.00077302.CrossRefPubMed
35.
go back to reference Ngamvithayapong J, Uthaivoravit W, Yanai H, Akarasewi P, Sawanpanyalert P: Adherence to tuberculosis preventive therapy among HIV-infected persons in Chiang Rai Thailand. AIDS. 1997, 11: 107-112. 10.1097/00002030-199701000-00016.CrossRefPubMed Ngamvithayapong J, Uthaivoravit W, Yanai H, Akarasewi P, Sawanpanyalert P: Adherence to tuberculosis preventive therapy among HIV-infected persons in Chiang Rai Thailand. AIDS. 1997, 11: 107-112. 10.1097/00002030-199701000-00016.CrossRefPubMed
36.
go back to reference Wares DF, Singh S, Acharya AK, Dangi R: Non-adherence to tuberculosis treatment in the eastern Tarai of Nepal. Int J Tuberc Lung Dis. 2003, 7: 327-335.PubMed Wares DF, Singh S, Acharya AK, Dangi R: Non-adherence to tuberculosis treatment in the eastern Tarai of Nepal. Int J Tuberc Lung Dis. 2003, 7: 327-335.PubMed
37.
go back to reference Kaona FA, Tuba M, Siziva S, Sikaona L: An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health. 2004, 4: 68-10.1186/1471-2458-4-68.CrossRefPubMedPubMedCentral Kaona FA, Tuba M, Siziva S, Sikaona L: An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. BMC Public Health. 2004, 4: 68-10.1186/1471-2458-4-68.CrossRefPubMedPubMedCentral
38.
go back to reference Hardon AP, Akurut D, Comoro C, Ekezie C, Irunde HF, Gerrits T, Kglatwane J, Kinsman J, Kwasa R, Maridadi J, Moroka TM, Moyo S, Nakiyemba A, Nsimba S, Ogenyi R, Oyabba T, Temu F, Laing R: Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007, 19: 658-665. 10.1080/09540120701244943.CrossRefPubMed Hardon AP, Akurut D, Comoro C, Ekezie C, Irunde HF, Gerrits T, Kglatwane J, Kinsman J, Kwasa R, Maridadi J, Moroka TM, Moyo S, Nakiyemba A, Nsimba S, Ogenyi R, Oyabba T, Temu F, Laing R: Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007, 19: 658-665. 10.1080/09540120701244943.CrossRefPubMed
39.
go back to reference Federal Ministry of Health, Federal HIV/AIDS Prevention and Control Office: Guidelines for Management of Opportunistic Infections and Antiretroviral Treatment in Adolescents and Adults in Ethiopia. 2007, Federal Ministry of Health Federal Ministry of Health, Federal HIV/AIDS Prevention and Control Office: Guidelines for Management of Opportunistic Infections and Antiretroviral Treatment in Adolescents and Adults in Ethiopia. 2007, Federal Ministry of Health
40.
go back to reference Corbett EL, Marston B, Churchyard GJ, De Cock KM: Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment. Lancet. 2006, 367: 926-937. 10.1016/S0140-6736(06)68383-9.CrossRefPubMed Corbett EL, Marston B, Churchyard GJ, De Cock KM: Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment. Lancet. 2006, 367: 926-937. 10.1016/S0140-6736(06)68383-9.CrossRefPubMed
41.
go back to reference Ngamvithayapong J, Winkvist A, Diwan V: High AIDS awareness may cause tuberculosis patient delay: results from an HIV epidemic area, Thailand. AIDS. 2000, 14: 1413-1419. 10.1097/00002030-200007070-00015.CrossRefPubMed Ngamvithayapong J, Winkvist A, Diwan V: High AIDS awareness may cause tuberculosis patient delay: results from an HIV epidemic area, Thailand. AIDS. 2000, 14: 1413-1419. 10.1097/00002030-200007070-00015.CrossRefPubMed
42.
go back to reference Daniel OJ, Alausa OK: Treatment outcome of TB/HIV positive and TB/HIV negative patients on directly observed treatment, short course (DOTS) in Sagamu, Nigeria. Niger J Med. 2006, 15: 222-226.PubMed Daniel OJ, Alausa OK: Treatment outcome of TB/HIV positive and TB/HIV negative patients on directly observed treatment, short course (DOTS) in Sagamu, Nigeria. Niger J Med. 2006, 15: 222-226.PubMed
43.
go back to reference Volmink J, Garner P: Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2007, CD003343- Volmink J, Garner P: Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev. 2007, CD003343-
Metadata
Title
Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study
Authors
Mekdes K Gebremariam
Gunnar A Bjune
Jan C Frich
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-651

Other articles of this Issue 1/2010

BMC Public Health 1/2010 Go to the issue