ABSTRACT
Background: The prolonged multi-drug treatment regimen for tuberculosis (TB) can lead to non-adherence and unsuccessful treatment outcomes. Educational and psychological health models can be used to design cognitive and behavioral interventions to improve adherence and treatment outcomes. Objective: To determine the effect of cognitive and behavioral interventions on TB treatment outcomes. Methods: The quasi-experimental study conducted in six TB treatment centers involved reinforced medication education and adherence counseling (MEAC), designed from a structured validated psychometric scale. Data were collected three different times during the intensive and continuation phases of treatment from 463 TB patients (232 in the control and 231 in the intervention group). Baseline demographic and clinical characteristics were compared between the groups. The generalized estimating equation model was used to analyze the repeated measures by determining if treatment success was associated with the cognitive and behavioral interventions and medication adherence. Results: The males made up 290(62.6 %) of the population. The mean age was 36.75±13.9. Most of the TB patients were newly diagnosed 413(89.2%) and HIV negative 315(68%), with secondary level of education 216(46.6%). There was no significant difference in baseline characteristics between the groups. The intervention group was four times more likely to have treatment success (p<0.01; CI=1.5-8.4), compared to the control group. Medication-adherent TB patients were 24 times more likely to have treatment success than patients who did not adhere (p<0.001; 10.8-52.1). TB patients' emotions, attitudes, and perceptions of their medicines were predictors of treatment success (p<0.05; 1.0 - 1.1). Conclusion: The cognitive and behavioral interventions administered to TB patients improved successful treatment outcomes.
ABSTRACT
Psychometric scales can be used to assess the cognition of and behavior toward tuberculosis (TB) disease and anti-TB medicines in TB patients by applying the Information-Motivation-Behavioral-Skills model. This study validated a psychometric scale from the responses of 115 TB patients using principal component (PCA) and reliability analyses. The Cronbach's-alpha was 0.864. The PCA identified 21 factors, with eigenvalues greater than one. Six factors, with factor loading >0.5 had more than two items loaded to a factor. Twenty-five items validated from six factors suggest that the scale can be used for cognitive and behavioral assessment and interventions in tuberculosis patients.
Subject(s)
Motivation , Tuberculosis , Cognition , Humans , Nigeria , Psychometrics , Reproducibility of Results , Surveys and Questionnaires , Tuberculosis/diagnosis , Tuberculosis/psychologyABSTRACT
BACKGROUND: Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos-North and Mangu Local Government Areas of Plateau State, North-Central Nigeria. METHODS: The retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State. Data were collected from 10,156 TB patient's health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariate and multivariate logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA. RESULTS: During the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ± SD was 35.5 ± 15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. The factors associated with treatment success were gender, age, year of enrollment, and HIV status. Extrapulmonary TB was less likely associated with treatment success (AOR:95% CI- 0.72:0.61-0.84, p < 0.001). CONCLUSION: With the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.
