Comparative Study of Patients' Adherence between Hospital-based and Communitybased Treatment for Multidrug Resistant Tuberculosis (MDR-TB) in Kaduna State,

Abstract

Background: Multidrug-Resistant Tuberculosis (MDR-TB) epidemic is threatening the global control of TB. It is driven by the programme, health system  and patient related factors. This study aimed at comparing the level of adherence to treatment among MDR-TB patients treated in hospital-based and  community-based models of care.

Methods: This was a comparative cross-sectional survey conducted in 2019 with mixed methods of data collection. The study population were 360 MDR-  TB patients treated in hospital-based and community-based facilities in Kaduna between 2013 and 2018. Questionnaire, FGD and KII guides respectively  were the quantitative and qualitative data collection tools used. Statistical Package for Social Sciences (SPSS) version 25.0 was used to analyze the  quantitative data while thematic analysis was used for analysing qualitative data. The quantitative results were presented in descriptive statistics with  level of significance set at p<0.05 and the qualitative results were presented as prose.

Results: The majority were males in the community-based 135 (71.8%) and the hospital-based model 126 (73.3%), with median (IQR) ages of 33 (27-40)  years and 34 (27-43) years respectively. Adherence to treatment was significantly higher among patients in hospital-based (64%) compared to  community-based (36%), (p 0.001). Availability of family and community support encourages adherence while lack of food supplies, dissatisfaction with  services and drug side effects were factors against adherence to treatment. Treatment success rate was similar in both models.

Conclusion: Adherence was better among patients initiated on treatment in the hospital-based model. Adherence should be strengthened in the  community-based model by regular counselling and health education.