Experiences and factors associated with utilization of directly observed treatment strategy (DOTs) among tuberculosis patients in Mombasa County, Kenya

Abstract

Background: Tuberculosis burden in Kenya is 558/100,000 population as per the TB Prevalence survey of 2016. Directly observed treatment for TB, (DOTs) is a TB control strategy recommended by WHO, whereby anti-tuberculosis medications are swallowed by patients under supervision of a health worker, a community volunteer or a family member. Mombasa County has a high Tuberculosis burden (HTB) of 861/100000 population, an increase in TB cases and deaths since 2016 and a decline in cure rate from 73.4% in 2017 to 71% in 2018 despite patients being on DOTs. The study therefore is aimed at documenting experiences of TB patients during DOTs treatment and factors associated with DOTs utilization. Objectives: To determine factors associated with utilization of DOTs and to evaluate patient’s experiences with DOTs in Mombasa County. Method: A mixed method design was used in the study that was conducted in 8 TB treatment sites in Mombasa County. Participants were TB patients on treatment .In the qualitative approach, Key informant interviews and focus group discussions were conducted among 50 participants. Qualitative data was transcribed and the transcript analyzed thematically. In quantitative approach, consecutive sampling was used to select study participants and structured questionnaires were used to collect demographic and clinical data, from 369 patients’ aged ≥18 years on DOTs. Continuous variables were summarized using measures of central tendency and dispersion; categorical variables were summarized by frequencies and proportions. Bivariate and multivariate logistic regression was used to determine factors associated with utilization of DOTs. Odds ratio (OR) was used as measures of association and Statistical significance was considered for p value < 0.05. Results: The response rate was 100%, mean age of participants was 46.17 ±14.44 years. Among the participants, 224 (60.7%) were males; 35(9.5%) had Drug resistant TB and 334(90.5%) had Drug sensitive TB. Factors significantly associated with DOTs utilization included; Facility TB treatment was sought (AOR=1.21;95%Cl 1.718- 17.47); DOTs provider enquiring on TB patient’s progress and providing health education (AOR=7.3; 95%Cl: 2.027- 26.29) and DOTs provider counseling patients on TB drug side effects (AOR=11.72;95%Cl:1.49-92.13) .In in-depth interviews, patients reported, TB drugs side effects, lack of social support and stigma as critical factors associated with utilizing DOTs. Health education for patients contributed to DOTs utilization. Conclusion: The study demonstrated the following factors being significantly associated with DOTs utilization; Facility first TB treatment was sought, health education on TB and TB drugs side effects, monitoring health progress of TB patients on DOTs, Stigma, lack of social support, loss of employment and distance to health facilities. These factors hinder the successful uptake of DOTs. Recommendations: Comprehensive and continuous health education on TB and TB drug side effects to patients at the health facilities and monitoring of TB patient’s progress by HCWs. Strengthen community support structures through CHVs to educate and encourage patients, family members and community to visit nearest health facility for proper TB diagnosis and treatment and also the benefits of early TB diagnosis.