Tuberculosis treatment adherence among the economically active age- group (15-64 years) patients in Zimbabwe: A study of Wilkins hospital and its catchment area.

Abstract

The general question for this study was concerned with why TB patients fail to adhere to treatment yet it is in their best interest to do so. The aim of this study was to assess factors associated with adherence to TB treatment and the effects of the burden of treatment among economically activeage-group patients in Zimbabwe. Wilkins Hospital and its catchment area was chosen as the study setting. The overall objective of this study is to assess the burden TB treatment non-adherence and factors associated with tuberculosis adherence among active age-group patients on tuberculosis treatment at Wilkins Infectious Diseases Hospital and its catchment area. The specific objectives of this study were to assess the prevalence of TB and policies, practices and legal frameworks that support adherence to TB treatment in Zimbabwe, identify personal factors associated with treatment adherence of the active age-group patients on tuberculosis, assess institutional factors associated with treatment adherence of the active age-group patients, determine the burden of treatment on adherence to tuberculosis treatment among the active age-group patients and establish strategies for improving drug treatment adherence among the active age-group patients at Wilkins Hospital and its catchment area. The study utilised mixed methods. For the quantitative aspect of the study, a survey was conducted and questionnaires were used to gather data from respondents. An average of 700 TB patients receiving treatment at Wilkins hospital and its catchment area were targeted for this study. The sample size for this study was calculated based on the G*Power analysis. A sample size of 500 respondents is actually greater than 337 respondents, an Apriori power analysis using G*Power. Logistic regression was used to analyse quantitative data. The researcher used Focus Group Discussions, in-depth interviews, and key informant interviews to elicit qualitative data from the study participants. The data was analysed using Force-Field Analysis, N-VIVO and thematic content analysis. Personal and institutional factors associated with adherence to TB treatment together with self-reports by TB patients were analysed. The burden of treatment theory was used to provide an understanding of adherence to TB treatment among the active age-group patients and descriptive statistics were used for analysis of the burdens. Findings from this study show that personal factors associated with adherence to TB treatment include marital status, level of education attained, religion, vending as a source of income, consultation before seeking treatment, attitude on long treatment, alcohol consumption, knowledge on cure, attitude on drugs, attitude on sick leave, and perception on initiative. Institutional forces that influence adherence were found to be clinical setting, treatment enforcement strategies and institutional arrangements at the hospital and clinics. Study findings also revealed that the burden of treatment had an effect on the mental well-being of patients who ended-up failing to sleep, losing motivation, sense of achievement, energy and ability to take initiative regarding their treatment. The study concluded that TB patients fail to adhere to treatment largely because of circumstances beyond their control since institutions played a significant role during TB treatment. Recommendations from the study suggest that a patient`s individual and environmental strengths be combined to form a collaborative strategy in promoting adherence. It is also recommended that the state and interested players in health combine their efforts in retooling the soft and hardware of things at the hospital. This can be done through the provision of modern equipment, infrastructure, qualified and motivated staff to operate TB hospitals and clinics.