Factors Associated With Tuberculosis Treatment Outcomes Under The Directly Observed Theraphy At The La General Hospital

Abstract

Background: Ghana is among the countries in Africa that is burdened with tuberculosis. Despite the tremendous improvement in tuberculosis diagnosis and treatment, patient related factors, healthcare provider factors and community factors have an influence on the desired outcome. Objective: This research sought to determine the patient, community and healthcare provider factors associated with tuberculosis treatment outcome. Method: The study adopted a mixed methods approach to collect data from participants at the La General Hospital. For the quantitative methods, total sampling technique was used to sample all tuberculosis patients folders registered under Directly Observed Therapy in 2016. Data extraction tool was designed and used to gather information on patient related factors. For the qualitative research method, purposive sampling technique was applied to select and interview ten tuberculosis patients, five healthcare providers and five community members (known as tuberculosis treatment supporters). Quantitative data was analysed using SPSS version 21 and summarized using frequencies and proportions. Contingency tables were used to test for associations between treatment outcomes and patient, healthcare provider and community factors. Simple and multinomial logistic regression was used to test associations at p<0.05. Framework analysis was adopted in analysing the qualitative interview data where emerging themes were identified and discussed in relation to existing theories. The analysis was supported by Nvivo software. Quantitative Results: The quantitative results showed an association between HIV positive and unsuccessful treatment outcome (p <0.03, CI: 1.78 – 16.15). TB/HIV negative patients had greater odds of getting cured from TB compared with TB/HIV positive patients (OR: 0.001). There was no association between tuberculosis treatment outcome and distance, gender and age. Qualitative findings: The qualitative study found both positive and negative perceptions of how patient, healthcare provider and community-related factors could influence tuberculosis treatment outcome. Conclusion: The study concluded that of all the patient related factors examined, co-morbidity in respect of TB/HIV status had a significant association with treatment outcomes in the quantitative study. HIV-positive tuberculosis patients had greater chances of obtaining unsuccessful treatment outcome. However, socio-demographic factors, including age and gender were not associated with treatment outcome. For the qualitative study, the conclusion was that some patient factors and healthcare provider factors could have both positive and negative influence on treatment outcome. For the community-related factors, the study concluded that distance was not associated with treatment outcome when examined in the quantitative study. Besides, other community factors such as stigma and use of alternative treatment could have negative influence on treatment outcome. Recommendation: The study recommends that health policy makers and practitioners should revise policies toward improving TB/HIV comorbidity treatment outcome in the search for strategies to control and manage tuberculosis. Keywords: Tuberculosis; Treatment outcomes; HIV

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Associated, Tuberculosis, Observed Theraphy, La General Hospital

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