Choice of Treatment Supporter and Its Association with Treatment Interruption and Outcomes Among Multidrug-Resistant Tuberculosis Patients in Southeast Nigeria
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Abstract
Community-based management of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) relies substantially on treatment supporters to supervise directly observed treatment (DOT), promote adherence and provide psychosocial support. Effective DOT supervision and interventions are crucial to improving treatment success rates and mitigating the spread of drug-resistant tuberculosis strains. This study assessed treatment interruption, outcomes, and satisfaction with care among MDR/RR-TB patients in Southeast Nigeria based on their choice of treatment supporter. An analytical cross-sectional study was conducted among a cohort of ambulatory MDR/RR-TB patients initiated on treatment between January 2015 and December 2019 across all Southeast Nigeria states. A total of 249 patient records were reviewed and a telephone-administered satisfaction survey was completed by 169 respondents. Descriptive and inferential analysis at the 5% significance level were done. The most frequent treatment supporters were family members (70.7%). Treatment interruption rates were similar during the intensive (32.5%) and continuation (33.7%) phases. Treatment success rate was 74.7%. Choice of treatment supporter was significantly associated with treatment interruption during the continuation phase (χ2 = 25.28, p < 0.0001). Family treatment supporters were associated with a lower treatment success rate (69.9%) compared to other supporters. This study demonstrated that family members were the predominant treatment supporter choice. However, treatment interruption remained substantial, with a significant association between treatment supporter type and interruption during the continuation phase. Strengthening training, supervision, follow-up and referral systems for treatment supporters are recommended for improved adherence and treatment outcomes.
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