Pulmonary tuberculosis therapy outcomes among patients, adherent or non-adherent to therapy at the intensive phase of treatment in Kakamega County, Kenya

Abstract

Background: Tuberculosis (TB) therapy is delivered in two stages, an intensive and a continuation stages or phases. Treatment failure is the result of a futile intensive phase while relapse is the result of an unsuccessful continuation phase of therapy. The Tuberculosis Cohort Report of 2019 from the Kenya Health Information System (KHIS) Aggregate, indicated that of the 1,088 new tuberculosis cases enrolled for treatment in Kakamega County, 61 (5.6%) did not have the required smear test done after the intensive phase of therapy while 144 (13.2%) were unaccounted for after the same stage. Objectives: To assess the association between adherence at the intensive phase and the treatment indicators, demonstrate the effect of adherence on treatment outcome and to identify the factors that contribute to non-adherence to TB treatment during the intensive phase. Methods: The study utilized a comparative study design targeting 1,974 TB patients across 5 randomly sampled health facilities in Kakamega County. Systematic sampling was then applied to select 127 clients who adhered and 127 who did not adhere to TB treatment at the intensive phase. A data collection questionnaire and an interviewer guide were then employed for the collection of data. Descriptive statistics in terms of frequencies and proportions were engaged. Chi Square test (x2) and logistic regression were performed to measure the association between adherence at the intensive phase and treatment indicators. The Odds and Risk Ratios were also determined. Results: Out of the 254 clients enrolled, 45.3% were male while 54.7% were female. There was significant association of occupation and adherence at the intensive phase (x2=7.8, p=.021). The same was also evident in the duration of treatment at the facility (x2=254.0, p<.001). Of those who adhered to therapy in the intensive phase, 123 (96.9%) completed their continuation phase of therapy in the desired 4 months of treatment, while 81 (63.8%) of those who did not adhere to the intensive phase of therapy did not even get into the continuation phase of therapy. Considering the final outcome, 15 (11.8%) of those who did not adhere to therapy at the intensive phase died with none dying among those that adhered. The odds of treatment success were 18.569 greater for those who adhered to therapy at the intensive phase with a relative risk of 0.136 of either being dead or lost to follow-up. Conclusion: Adherence to TB therapy at the intensive phase is hindered when one is not engaged in gainful employment. Once a patient is put on TB treatment, there should be constant linkage to the health facility for continuity in treatment. There is increased risk of death among those who do not adhere to therapy at the intensive phase. Recommendations: The National, County and Sub-County TB Coordinators should have increased focus on TB patients who have been identified as unemployed or are not engaged in gainful employment so as to improve their adherence to prescribed therapy at the intensive phase. National Tuberculosis, Leprosy and Lung Disease Program (NTLD-P) should streamline reporting mechanisms between facilities and allow a patient who is a distance away from the parent facility to pick their medication from an accessible facility.