Abstract:
Background
In light of growing bacterial resistance and the side effects of medications, this study investigates the factors leading to poor treatment adherence among patients receiving care at the Franceville Epidemiology and Endemic Disease Control Base in southeastern Gabon.
Material and methods:
Prospective and observational, this study was conducted from February 13 to September 28, 2024, and collected the records and charts of patients aged 15 years and over, primo-infected with pulmonary tuberculosis. Subjected to the initial phase of standard first-line antituberculosis treatment for 2 months, patients underwent a 4-month continuation phase of antituberculosis treatment under direct observation (DOT). Overall treatment adherence was assessed and calculated at the end of each calendar month during the study, following WHO recommendations. Using a standard questionnaire, sociodemographic, clinical, and medical history characteristics were recorded. Correlations between different variables were performed using R software version 3.6.1, for statistical analysis of trends over time. Within a 95% confidence interval, results were considered significant at p ≤0, 05.
Results:
This study involved a total of 178 individuals diagnosed with tuberculosis (TB). After six months of first-line anti-TB treatment (2EHRZ/4HR) and achieving a 100% response rate, the results revealed that overall adherence to anti-TB treatment was sub-optimal in 32 patients (18%, 95% CI: [0.13-0.24]), compared to 146 patients (82%, 95% CI: [0.76-0.88]) who demonstrated optimal adherence. Statistical analyses, including univariate and multivariate models, indicated that being male (adjusted Odds Ratio = 3.49; 95% CI [1.7; 7.03], p=0.000), living outside Franceville (adjusted Odds Ratio = 1.03; 95% CI [1.01; 1.04], p=0.000), and co-infection with HIV/TB (adjusted Odds Ratio = 3.24; 95% CI [1.47; 7.15], p=0.002) were significantly associated with sub-optimal treatment adherence, regardless of the specific regimen used (INH + RIF + PZA, INH + RIF + EMB, or INH + RIF + PZA + EMB). These findings highlight key factors influencingtreatment adherence among TB patients
Conclusion :
The different therapeutic combinations evaluated in this study demonstrated varying levels of effectiveness against tuberculosis. Nevertheless, to achieve the eradication of this disease, significant improvements in the treatment of multidrug-resistant tuberculosis are essential.