Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China – A Mixed Method Research Study
Received 23 November 2020
Accepted for publication 18 February 2021
Published 15 March 2021 Volume 2021:14 Pages 999—1012
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Suresh Antony
Wei Xing,1,* Rui Zhang,1,* Weixi Jiang,2,* Ting Zhang,3,* Michelle Pender,4 Jiani Zhou,1 Jie Pu,1 Shili Liu,1 Geng Wang,1 Yong Chen,1 Jin Li,1 Daiyu Hu,5 Shenglan Tang,4 Ying Li1
1Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China; 2Duke Kunshan University, Kunshan, Jiangsu, People’s Republic of China; 3Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Chongqing, People’s Republic of China; 4Duke Global Health Institute, Duke University, Durham, NC, USA; 5Chongqing Institute of TB Prevention and Treatment, Chongqing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Shenglan Tang
Duke Global Health Institute, Duke University, Durham, NC, USA
Email [email protected]
Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
Email [email protected]
Aim: This paper evaluated the treatment adherence for multidrug-resistant tuberculosis (MDR-TB) and MDR-TB case management (MTCM) in Chongqing, China in order to identify factors associated with poor treatment adherence and case management.
Methods: Surveys with 132 MDR-TB patients and six in-depth interviews with health care workers (HCWs) from primary health centers (PHC), doctors from MDR-TB designated hospitals and MDR-TB patients were conducted. Surveys collected demographic and socio-economic characteristics, as well as factors associated with treatment and case management. In-depth interviews gathered information on treatment and case management experience and adherence behaviors.
Results: Patient surveys found the two main reasons for poor adherence were negative side-effects from the treatment and busy work schedules. In-depth interviews with key stakeholders found that self-perceived symptom improvement, negative side-effects from treatment and financial difficulties were the main reasons for poor adherence. MDR-TB patients from urban areas, who were unmarried, were female, had migrant status, and whose treatments were supervised by health care workers from primary health clinics, had poorer treatment adherence (P< 0.05). Among the MDR-TB patients surveyed, 86.7% received any type of MTCM in general (received any kind of MTCM from HCWs in PHC, MDR-TB designated hospital and centers of disease control/TB dispensaries and 62.50% received MTCM from HCWs in PHC sectors). Patients from suburban areas were more likely to receive both MTCM in general (OR=6.70) and MTCM from HCWs in MDR-TB designated hospitals (OR=2.77), but female patients (OR=0.26) were less likely to receive MTCM from HCWs in PHC sectors, and patients who were not educated about MTCM by TB doctors in designated hospitals were less likely to receive MTCM in general (OR=0.14). Patients who had not been hospitalized were less likely to receive MTCM from HCWs in MDR-TB designated hospitals (OR=0.21).
Conclusion: Stronger MTCM by HCWs in PHC sectors would improve treatment adherence among MDR-TB patients. Community-based patient-centered models of MTCM in PHC sectors and the use of digital health technology could help to improve case management and thereby improve adherence.
Keywords: multi-drug-resistant tuberculosis, management, treatment, adherence behaviors
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