Access and adherence to tuberculosis treatment among people with TB in rural Tamil Nadu, India
V. Chakrapani1, M.K. Vedhanayagam2, D.K. Dakshinamoorthy1, S.K.J. Kumar1, C.R.M. Antoniswami2, R. Angamuthu3
1Indian Network for People Living with HIV/AIDS (INP+), Chennai, India, 2Perundurai Medical College & Hospital, Perundurai, Erode, India, 3District Government Headquarters Hospital, Erode, India
Background: People living with HIV (PLHIV) are at increased risk of getting TB. A mixed methods study was conducted in Erode, India, to identify barriers and facilitators to access and adherence to TB treatment for people living with HIV.
Methods: Between August 2009 and February 2010, survey among 199 participants (males=132; females=67), 5 focus groups (n=25) and 5 key-informant interviews were conducted. Eligible participants included those who have completed at least 2 months of TB DOTS (Directly Observed Treatment-Short Course) at the time of study enrolment. Participants were primarily recruited from TB DOTS centres in Erode Government Headquarters Hospital and IRT Perundurai Medical College Hospital, Erode Government Antiretroviral Treatment centre, and Erode PLHIV network. For survey, SPSS was used. Qualitative data were explored using framework analysis.
Results: All the participants accessed free TB treatment at government DOTS centres. Half of the participants were HIV-positive (n=96/199; 48.2%). Among PLHIV, most (n=77/96; 80%) were on antiretroviral treatment. About one-tenth of male participants (n=17/132; 12.8%) reported having consumed alcohol in the past one month. Patient-related access delay, more than one month between onset of TB symptoms and first visit to formal healthcare provider, was experienced by nearly one-third (31.7%; n=63/197). About one-fourth (24.5%; n=48/199) missed TB doses (consecutively) from one week to more than two months. Social support and utilization of PLHIV network TB services were facilitators of TB treatment adherence. Access and adherence barriers included pill burden (especially for PLHIV with TB), alcohol use, fear of side-effects, mistrust about the quality of government TB medications, and lack of family support.
Conclusions: TB treatment access/adherence for people with TB, including PLHIV, can be promoted by: providing adequate TB education/counselling; building the capacity of service providers to address individual/healthcare system barriers; initiating programs to increase support from family/society; and linking with alcohol de-addiction programs.
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