Drivers of Tuberculosis Treatment interruption among Tuberculosis Patients in Marsabit County, Kenya, 2020

Abstract

Introduction: In 2020 ≈ 9.9 million TB cases and 1.5 million deaths were reported globally (WHO, 2020). Kenya is among top 30 high TB burden countries with an incidence of 140,000/100,000 population. Treatment success rate was 85.2% (target 90%) in Kenya, lost to follow up 5.7% target (<2%). Marsabit County reported 1069 cases in 2020 and a treatment success rate of 77%, lost to follow up 3%. The purpose of the study was to determine determinants of tuberculosis treatment interruption in the County. Methods: A cross-sectional study conducted in Marsabit County. Study population was 2019 and 2020 TB patients. Data on drug susceptible TB, clinical information, and DOTS type was extracted from TB register. Data on sociodemographic information, drug side effects, infection prevention, and health care provider was collected using structured questionnaire. Sample size of 340 was obtained using Cochrane formula and adjusted for non-response of 10%. Drug sensitive TB patients list was used as sampling frame. Table of random numbers was used to obtain sample size and probability proportionate to size was used to allocate patients to Sub Counties. Results: Of the 340 targeted respondents, 307 were recruited giving a response rate of 90.3%).There was 67 (22%) treatment interruption. Male patients had 25% interruption, age-group 55-64 years 28%, while those above 65 years had 13%. Saku Sub County had 28% treatment interruption, and North horr had 8%. Married participants reported 30% treatment interruption and widowed 1%. On multivariate analysis, long waiting time ≥ 1 hour at the clinic (AOR 6.95, CI, 2.46-19.61) was significantly associated with treatment interruption and Female sex was protective against treatment interruption (AOR 0.4, CI= 0.18-0.93). Conclusions: Proportion of TB patients interrupting treatment is high and male sex is contributing higher proportion. Modifiable factors of male sex and long waiting time were significantly associated with treatment interruption. The County health department needs to design an intervention targeting male TB patients to reduce male treatment interruption. Expansion of TB service delivery points and early opening of clinic could help reduce waiting time hence reduction in treatment interruption.