Presentation

Page 1

Title and Authors

• Determinants of Adherence to Multi-Drug Resistant Tuberculosis Treatment

• Author: Dr. Nazrana Nawaz

• Research Supervisor: Prof. Dr. Ikhlaq Ahmad

• ID: 000717/HSA/MSPH-2023

Page 2

Introduction

• MDR-TB is a significant public health issue, especially in low-resource settings.

• Caused by Mycobacterium tuberculosis resistant to isoniazid and rifampicin.

• Second-line medications are less effective, more expensive, and have severe side effects.

• WHO emphasizes the need for effective treatment adherence to control MDR-TB.

• Understanding various factors influencing adherence is essential for improving treatment outcomes.

Page 3

Treatment Adherence Challenges

• MDR-TB poses a public health risk due to resistance to conventional medications.

• Successful treatment outcomes depend on patient adherence.

• Study focuses on factors affecting adherence in public health settings, particularly at PIMS, Islamabad.

Page 4

Literature Review

• MDR-TB remains a challenge, particularly in low- and middle-income countries like Pakistan.

• Treatment adherence barriers include socio-economic, psychological, and healthcare system factors.

• WHO reported 450,000 new MDR-TB cases globally in 2021.

• In 2022, 175,650 people received MDR-TB treatment, reflecting the ongoing challenge to improve these numbers.

Page 5

Rationale of the Study

• Aim to investigate adherence factors at PIMS for MDR-TB treatment.

• Focus on the challenges of long treatment durations and side effects of medications.

• Insights will help design interventions to improve adherence.

Page 6

Aims and Objectives

• Aim: Explore factors affecting MDR-TB treatment adherence at PIMS.

• Primary Objectives:

  • Identify factors influencing treatment adherence.

  • Explore psychological, social, and healthcare-related factors.

  • Understand providers’ perspectives on adherence challenges.

  • Develop recommendations to improve adherence.

Page 7

Proposed Methodology

• Study Design: Mixed-methods approach with a cross-sectional design for context-specific insights.

• Data Sources:

  • MDR-TB patients at PIMS.

  • Healthcare providers (physicians, nurses).

  • Key informants (public health experts, policymakers).

Page 8

Inclusion and Exclusion Criteria

• Inclusion:

  • Adults (18+) diagnosed with MDR-TB, on treatment for at least a month.

  • Healthcare providers with at least 6 months of involvement with MDR-TB patients.

  • Key informants with TB care expertise.

• Exclusion:

  • Patients with communication barriers.

  • Severely ill patients unable to participate.

Page 9

Study Population and Sample Size

• Population:

  • MDR-TB patients receiving treatment.

  • Healthcare providers involved with MDR-TB treatment.

  • Key informants related to TB care.

• Sample Size:

  • MDR-TB Patients: 30-50 participants.

  • Healthcare Providers: 10-15 participants.

  • Key Informants: 5-10 participants.

Page 10

Results and Discussion

• Overview of findings.<br>

Page 11

Demographic Distribution

• Gender: Male 54%, Female 46%.

• Marital Status: Married 62%, Single 23%, Widowed 15%.

• Educational Level: None 46%, Matric 46%, Intermediate 8%.

• Employment Status: Unemployed 69%, Employed 31%.

• Monthly Household Income: Avg 34.4k, Range 20k-65k.

Page 12

Medical History and Treatment Adherence Factors

• Adherence:

  • Always following medication: 60%, Often: 40%.

• Motivations for adherence:

  • Fear of disease progression: 36%.

  • Family support: 24%.

• Challenges:

  • Side effects: 31%.

  • Lack of support: 22%.

• Coping strategies:

  • Family support: 31%.

• Ever missed a dose: Yes: 85%.

Page 13

Support System

• Family support: Yes: 63%, No: 28%.

• Friends' support: Yes: 23%, No: 77%.

• Support from healthcare providers: Yes: 100%.

Page 14

Knowledge and Awareness

• Understanding of treatment:

  • Very well: 77%, Well: 23%.

• Informed about MDR-TB:

  • Healthcare provider: 92%.

  • Family member: 8%.

Page 15

Stigma & Discrimination

• Experienced stigma/discrimination: Yes: 62%, No: 28%.

• Support from healthcare providers: Yes: 100%.

Page 16

Patient Preferences & Recommendations

• Suggestions to improve adherence:

  • Regular medicine: 23%.

  • Complete and regular medication: 69%.

Page 17

Discussion

• Adherence challenges include severe side effects, financial difficulties, and lack of support.

• Socio-economic and psychological factors are significant barriers to adherence.

• Healthcare system issues, including medication stockouts, complicate treatment adherence.

Page 18

Conclusion

• Study underscores the complexities of MDR-TB adherence.

• Holistic approaches addressing multiple barriers are necessary for improving outcomes.

Page 19

References

• Various studies and reports on tuberculosis and treatment adherence.

Page 20

Acknowledgment

• Thanks.