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Factors that influence treatment adherence of tuberculosis patients living in Java, Indonesia

Authors Widjanarko B, Gompelman M, Maartje Dijkers, van der Werf MJ

Published 5 August 2009 Volume 2009:3 Pages 231—238


Review by Single-blind

Peer reviewer comments 3

Bagoes Widjanarko1,2, Michelle Gompelman3, Maartje Dijkers4, Marieke J van der Werf 5,6

1Magister program of Health Promotion, Graduate study of Diponegoro University, Indonesia; 2Faculty of Public Health, Diponegoro University, Indonesia; 3Healthcare and Culture, VU Medical Center, Free University, Amsterdam, The Netherlands; 4Academic Medical Center, University of Amsterdam, The Netherlands; 5KNCV Tuberculosis Foundation, The Hague, The Netherlands; 6Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, The Netherlands

Background and objective: Due to nonadherence of tuberculosis (TB) patients to treatment, complications may arise and if remaining infectious, these patients may infect other people with TB. To obtain information about factors associated with nonadherence, we performed a study comparing adherent and nonadherent TB patients.

Methods: Adherent and nonadherent patients randomly selected from hospital records in one urban and two rural districts were interviewed using semi-structured questionnaires. Key informant interviews were done with TB nurses and doctors.

Results: The most frequently mentioned reason for nonadherence to treatment was feeling better. Although the drugs were given free of charge, many patients were nonadherent because of lack of money. Social support was considered very important for adherence. The study indicated that some patients had a negative image about the health care staff, treatment, and quality of medication.

Conclusion: Treatment adherence of TB patients receiving treatment in hospitals in Central Java might be improved by providing health education about treatment duration and side effects, facilitating procedures for receiving treatment free of charge and reducing costs of transportation and consultation. Qualified friendly health care staff able to motivate patients might further improve adherence.

Keywords: tuberculosis, adherence, DOTS treatment, patient knowledge, Indonesia

General overview

When tuberculoses patients do not take their treatment regularly, they may remain infectious and develop more complications. We assessed the behavior and characteristics of patients that took their treatment regularly and patients that did not take their treatment regularly. We selected patients from private and public hospitals in Central Java and interviewed them. We also performed interviews with TB doctors and nurses who treated tuberculosis patients. Most patients who did not take their treatment regularly had stopped their treatment because they were feeling better, often in combination with not having enough money to pay for transportation to the hospital and other costs. Social support was considered important. More patients might take their tuberculosis treatment according to prescription if they are clearly informed about treatment and if the costs for treatment are reduced.

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