Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective
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Date
2023
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
Background Despite having an effective community-based Directly Observed Therapy Short-course (DOTS) strategy
for tuberculosis (TB) care, treatment adherence has been a major challenge in many developing countries including
Ghana. Poor adherence results in discontinuity of treatment and leads to adverse treatment outcomes which pose an
increased risk of drug resistance. This study explored barriers to TB treatment adherence and recommended potential
patient-centered strategies to improve treatment adherence in two high-burden TB settings in the Ashanti region of
Ghana.
Methods The study was conducted among TB patients who defaulted on treatment in the Obuasi Municipal
and Obuasi East districts in the Ashanti region. A qualitative phenomenology approach was used to explore the
barriers to TB treatment adherence. Purposive sampling was adopted to select study participants with different
sociodemographic backgrounds and experiences with TB care. Eligible participants were selected by reviewing the
medical records of patients from health facility TB registers (2019–2021). Sixty-one (61) TB patients met the eligibility
criteria and were contacted via phone call. Out of the 61 patients, 20 were successfully reached and consented
to participate. In-depth interviews were conducted with participants using a semi-structured interview guide. All
interviews were audio recorded and transcribed verbatim. The transcripts were imported into Atlas.ti version 8.4
software and analyzed using thematic content analysis.
Results Food insecurity, cost of transportation to the treatment center, lack of family support, income insecurity,
long distance to the treatment center, insufficient knowledge about TB, side effect of drugs, improvement in health
after the intensive phase of the treatment regimen, and difficulty in accessing public transportation were the main
co-occurring barriers to treatment adherence among the TB patients.
Conclusion The main barriers to TB treatment adherence identified in this study reveal major implementation
gaps in the TB programme including gaps related to social support, food security, income security, knowledge, and
Description
Research Article
Keywords
Tuberculosis, Patient-related barriers, Treatment adherence, Ashanti region, Ghana