Factors that influence adherence — MSF Tuberculosis

What this guideline says

GMJ summary

This section of the MSF tuberculosis guideline addresses the multiple factors that influence patient adherence to TB treatment, categorising them into patient-related, treatment-related and therapeutic environment-related barriers. Whilst not all barriers can be addressed, the guidance emphasises that treatment and therapeutic environment factors can be controlled by health programmes.

Patient-related factors include socioeconomic issues (work responsibilities, treatment costs, income loss), psychological factors (stigma, shame, fear), physical or mental disability, lack of knowledge, and perceptions about disease and treatment. Treatment-related factors focus on simplifying regimens through fixed-dose combinations (FDC) and prompt management of adverse effects. Therapeutic environment factors encompass free provision of all TB services, building patient-provider relationships, ensuring confidentiality, minimising waiting times, rigorous drug supply management, proximity of distribution sites, integrated ‘one-stop service’ for TB-HIV co-management and co-morbidities, and limiting hospitalisation to clinically necessary cases.

The guideline advocates for individualised solutions identified on a case-by-case basis, whilst implementing system-level improvements to the therapeutic environment that can benefit all patients.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Discuss with patients before treatment initiation and at every contact to identify and anticipate barriers to adherence including socioeconomic factors, psychological factors, disability, knowledge gaps and disease perceptions
2. Use fixed-dose combinations (FDC) to simplify treatment by reducing tablet numbers and preventing omission of individual TB drugs
3. Detect and manage adverse effects promptly to prevent treatment interruption
4. Provide TB diagnosis, monitoring and treatment (including TB drugs, drugs for adverse effects and co-morbidities, mental health care) free of charge
5. Implement 'one-stop service' for TB-HIV co-management, providing TB and HIV treatment at the same time and place to reduce visits and waiting times
6. Ensure rigorous drug supply management to prevent shortages that lead to treatment interruption and loss of patient confidence
7. Locate drug distribution sites proximally and provide a few extra days of treatment to patients in case they cannot attend as scheduled
8. Limit hospitalisation to patients requiring hospital-level care, with adequate accommodation and discharge as soon as clinical condition allows

From the guideline

Verbatim

“To ensure the widest possible access to treatment, TB diagnosis, monitoring and treatment (including TB drugs, drugs for adverse effects and co-morbidities, mental health care) should be provided free of charge.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

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