FACTORS INFLUENCING POOR ADHERENCE LEADING TO POOR OUTCOMES IN TUBERCULOSIS TREATMENT: A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.71000/d1w4d356Keywords:
Pill Burden, Adverse Drug Reaction, Anti-Tuberculous Agents, Medication Adherence, Tuberculosis, Treatment Compliance, Transportation BarriersAbstract
Background: Tuberculosis (TB) remains one of the leading causes of infectious disease–related mortality worldwide. Despite the availability of effective first-line antituberculous therapy, non-adherence continues to undermine treatment success, leading to prolonged infectiousness, drug resistance, and disease relapse. Multiple behavioral, clinical, and logistical factors influence adherence levels, particularly in low-resource settings. Understanding these factors is vital for improving treatment compliance and strengthening TB control strategies at the regional level.
Objective: To determine the prevalence and major contributing factors associated with non-adherence to anti-tuberculous treatment among patients attending a tertiary care hospital in Peshawar, Pakistan.
Methods: A cross-sectional study was conducted from 21st December 2024 to 20th April 2025 at the Department of Pulmonology, Hayatabad Medical Complex, Peshawar. A total of 181 male and female patients aged 20–60 years with poor adherence to antituberculous treatment were enrolled using a convenient sampling technique. Factors evaluated included pill burden, medication adverse effects, concurrent medical illness, forgetfulness, and transportation difficulties. Data were collected through structured interviews, transcribed into English, and analyzed using SPSS version 26. Continuous variables were expressed as mean ± SD, while categorical variables were reported as frequencies and percentages.
Results: The mean age of participants was 37.83 ± 11.99 years, and the mean BMI was 22.58 ± 1.59 kg/m². Males constituted 55.8% (n = 101) of the sample, while 43.6% (n = 79) were older than 40 years. A BMI above 23 kg/m² was observed in 35.9% (n = 65). Forgetfulness emerged as the leading cause of non-adherence (23.8%, n = 43), followed by medication adverse effects, concurrent medical illness, and transportation barriers, each affecting 19.9% (n = 36). Pill burden was the least frequent factor (11.6%, n = 21).
Conclusion: A considerable proportion of TB patients failed to adhere to their prescribed therapy, primarily due to forgetfulness, adverse drug reactions, concurrent illness, and limited access to healthcare facilities. Targeted patient education, early side effect management, and decentralization of DOTS services are essential to enhance adherence and improve treatment outcomes.
References
Nezenega ZS, Perimal-Lewis L, Maeder AJ. Factors Influencing Patient Adherence to Tuberculosis Treatment in Ethiopia: A Literature Review. Int J Environ Res Public Health. 2020;17(15):5626-37.
Hongprasit P, Sonthisombat P. Assessment of TB treatment adherence using computer-assisted self-interviewing. Int J Tuberc Lung Dis. 2023;27(8):626-31.
Ghimire S, Iskandar D, van der Borg-Boekhout R, Zenina M, Bolhuis MS, Kerstjens HAM, et al. Combining digital adherence technology and therapeutic drug monitoring for personalised tuberculosis care. Eur Respir J. 2022;60(6).
Thamineni R, Pradeepkumar B, Padmapriya JC, Rajanandh M. Comparison of treatment adherence among TB patients with and without COVID-19 in South India. Indian J Tuberc. 2024;71 Suppl 2:S214-s20.
Kafie C, Mohamed MS, Zary M, Chilala CI, Bahukudumbi S, Gore G, et al. Cost and cost-effectiveness of digital technologies for support of tuberculosis treatment adherence: a systematic review. BMJ Glob Health. 2024;9(10).
Zaidi HA, Wells CD. Digital health technologies and adherence to tuberculosis treatment. Bull World Health Organ. 2021;99(5):323-a.
Zhang M, Wang G, Najmi H, Yaqoob A, Li T, Xia Y, et al. Digitizing tuberculosis treatment monitoring in Wuhan city, China, 2020-2021: Impact on medication adherence. Front Public Health. 2023;11:1033532.
Ruan QL, Huang XT, Yang QL, Liu XF, Wu J, Pan KC, et al. Efficacy and safety of weekly rifapentine and isoniazid for tuberculosis prevention in Chinese silicosis patients: a randomized controlled trial. Clin Microbiol Infect. 2021;27(4):576-82.
Zaidi I, Sarma PS, Umer Khayyam K, Toufique Ahmad Q, Ramankutty V, Singh G. Factors associated with treatment adherence among pulmonary tuberculosis patients in New Delhi. Indian J Tuberc. 2024;71 Suppl 1:S52-s8.
Devaleenal DB, Jeyabal L, Nair D, Mahalingam V, R R, Rebecca BP, et al. Improving treatment adherence among tuberculosis patients through evening DOTS in Chennai, India. Natl Med J India. 2023;36(4):219-23.
Dawit Z, Abebe S, Dessu S, Mesele M, Sahile S, Ajema D. Incidence and predictors of mortality among children co-infected with tuberculosis and human immunodeficiency virus at public hospitals in Southern Ethiopia. PLoS One. 2021;16(6):e0253449.
Manurung N. Involving religious organizations in improving TB medication adherence. Indian J Tuberc. 2024;71 Suppl 2:S191-s6.
Islam S, Das S, Das DK. Nutritional status and adherence to anti-tubercular treatment among tuberculosis patients in a community development block of Eastern India. Indian J Tuberc. 2024;71 Suppl 2:S178-s83.
Tzelios CA, Malatesta S, Carney T, White LF, Weber SE, Thomson S, et al. Patient Determinants and Effects on Adherence of Adverse Drug Reactions to Tuberculosis Treatment: A Prospective Cohort Analysis. Clin Infect Dis. 2025;81(1):167-75.
Matreja PS, Garg R, Maqusood M. Pharmacovigilance monitoring and treatment adherence in patients on anti-tubercular drugs. Indian J Tuberc. 2023;70(4):409-15.
Lienhardt C, Dooley KE, Nahid P, Wells C, Ryckman TS, Kendall EA, et al. Target regimen profiles for tuberculosis treatment. Bull World Health Organ. 2024;102(8):600-7.
Alinaitwe B, Shariff NJ, Madhavi Boddupalli B. Treatment adherence and its association with family support among pulmonary tuberculosis patients in Jinja, Eastern Uganda. Sci Rep. 2025;15(1):11150.
Burman M, Zenner D, Copas AJ, Goscé L, Haghparast-Bidgoli H, White PJ, et al. Treatment of latent tuberculosis infection in migrants in primary care versus secondary care. Eur Respir J. 2024;64(5).
Khattak M, Rehman AU, Muqaddas T, Hussain R, Rasool MF, Saleem Z, et al. Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis. Ann Med. 2024;56(1):2313683.
Overbeck V, Malatesta S, Carney T, Myers B, Parry CDH, Horsburgh CR, et al. Understanding the impact of pandemics on long-term medication adherence: directly observed therapy in a tuberculosis treatment cohort pre- and post-COVID-19 lockdowns. BMC Infect Dis. 2024;24(1):1154.
Chen H, Zhang H, Cheng J, Sun D, Wang Q, Wu C, et al. Adherence to preventive treatment for latent tuberculosis infection in close contacts of pulmonary tuberculosis patients: A cluster-randomized controlled trial in China. Int J Infect Dis. 2024;147:107196.
Lemma Tirore L, Ersido T, Beyene Handiso T, Shiferaw Areba A. Non-adherence to anti-tuberculosis treatment and associated factors among TB patients in public health facilities of Hossana town, Southern Ethiopia, 2022. Front Med (Lausanne). 2024;11:1360351.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Romesa Khattak, Muhammad Asif Khan, Hasnan Ibrahim, Fatima Fareed, Aimen Zeb (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
