Factors associated with tuberculosis treatment interruption in Igembe south, meru county, Kenya

Abstract

Background: Kenya has TB prevalence of 426/100,000 population, and national treatment interruption rate of 4.7%. Treatment Interruption involves not taking TB medication for 2 consecutive days or more. Treatment interruption will lead to treatment completion failure and increase potential for drug resistance which has higher financial implication. In 2016, Meru County reported treatment interruption rate of 5.9% with the highest rate recorded in Igembe South Sub-County. This study determined factors associated with treatment interruption among TB patients in Igembe South in 2015-2016. Methodology: Treatment registers were reviewed to determine proportion of treatment interrupters among TB patients. A case control study was conducted among 306 participants (153 cases, 153 controls). A case was a failure to adhere to prescribed TB medication for two consecutive days or more among patients on treatment in 2015-2016 while a control was adherence to prescribed medication among patients on treatment in 2015-2016. All cases in register were selected and equal numbers of controls were selected by systematic random sampling. Both cases and controls were interviewed after obtaining written consent and data collected using structured questionnaire. Three focus group discussion (FGD) sessions (n=26) were conducted among cases. We calculated crude and adjusted odds ratios (aOR) at 95% confidence interval (CI) and factors with p-value of ≤0.05 in the final logistic regression model were considered statistically significant. The FGDs responses were recorded and later transcribed and analyzed using Nvivo 10 software. Data was coded into themes and emerging themes from the qualitative study was presented with the quantitative study results. Results: Of the 1461 registered TB patients, 1046 (72%) were male, majority 1289 (88%) had pulmonary TB, 1430 (98%) were new patients, 279 (19 %) had HIV coinfection and 180(12%) have interrupted treatment. Among the ones who interrupted their treatment, 109 (61%) were male, 145 (81%) had pulmonary TB and 70 (39 %) had HIV coinfection. Factors that were statistically significant for treatment interruption were; waiting time at the health facility for≥1 hour(aOR3.9, CI2.1-7.1), income ≤3000 shillings (aOR2.5, CI1.4-4.2), taking alcohol (aOR2.3 CI1.2-4.4), cost of transport to health facilities of ≥150 shillings (aOR2.0, CI1.3-3.4) and not disclosing ones’ TB status to relatives (aOR2.9, CI1.1-7.5).Poverty, staying far from health facilities, high transport costs and long waiting time at hospital was common concerns raised in FGD. Conclusions: The interruption rate among TB patients of Igembe south was double the national average. Waiting time ≥1-hour, high transport cost to health facility, income ≤3000 shillings and not disclosing ones’ TB status to relatives were risk factors for treatment interruption. Recommendation: Health facilities to improve triage and TB status disclosure of TB. Consider innovative ways to minimize financial costs associated with seeking TB treatment like using community health workers to deliver drugs at home.