Academic journal article Iranian Journal of Public Health

Tuberculosis Treatment Non-Adherence and Lost to Follow Up among TB Patients with or without HIV in Developing Countries: A Systematic Review

Academic journal article Iranian Journal of Public Health

Tuberculosis Treatment Non-Adherence and Lost to Follow Up among TB Patients with or without HIV in Developing Countries: A Systematic Review

Article excerpt

Introduction

Despite the availability of effective short course regimen first line drug since 1980s (1, 2), TB remains a major global health problem; it causes illhealth and death among millions of people each year and ranks second leading cause of death from an infectious disease worldwide, after human immunodeficiency vims (HIV) (2). Current global estimates indicate that about one in every three people in the world is believed to be infected with Mycobacterium tuberculosis (M. tuberculosis) and at risk of developing the disease (3). According to WHO global TB report of 2012 there are 8.7 million new cases and 1.4 million deaths in 2011; and almost one million death among HIV positive TB patients (2, 4).

The proportion of TB cases co-infected with HIV is highest in African region countries; overall, African region accounted for 79% of TB cases among people living with HIV (PLHIV) (2, 5, 6), because the synergy between TB and HIV is strong; i.e. PLHIV ranged from 20-37 folds at increased risk of active TB development compared to HIV uninfected people depending on the state of HIV epidemic in the area (4, 7, 8).

The burden of TB among low and meddle income countries is fuelled due to HIV pandemic, and smoothen by numerous socioeconomic conditions (9). According to research findings, socioeconomic factors such as homelessness, lack of food, financial limitation, lack of transportation cost, low education level, gender, poor health care worker-patient communication, joblessness, social supports etc. are highly associated with TB treatment non-adherence and lost to follow up (911).These conditions are related to each other and form a network of causal pathways against TB patient tolerance ability (9). Additionally, overcrowded living condition (9, 12), HIV related immunological weakness (13) and malnutrition (14, 15) are factors that facilitate transmission of bacilli, treatment non-adherence and lost to follow up at economically disadvantaged settings. In general many social determinants of health (SDH) reinforce social stratification in society. Social stratification in turn to an unequal distribution of the social determinants of health, including material living conditions and psychosocial circumstances as well as behavioural and biological risk factors to health problems including TB; finally influence patients' treatment adherence tolerance (16).

Beside, socioeconomic factors, patient's individual behavioural factors, like knowledge about TB disease, duration of treatment, consequences of treatment non-adherence and lost to follow up, feeling better after few weeks of treatment, fear of stigma; attitudes towards treatment and poor communication with health care workers, lack of self-efficacy or motivation to complete treatment are the main behavioural factors that associate with TB treatment non-adherence and lost to follow up (1719). Furthermore, alcohol consumption (19- 22) and cigarette smoking (17, 22) are the two individual behavioural factors that associated with TB treatment non-adherence and lost to follow up that reported so far. TB treatment non-adherence and lost to follow up are continues throughout the nations, and it extended its potential consequences, like initial treatment failure and relapse, which are in turns to prolonging morbidity, mortality, prolonged transmission of bacilli and development of medication resistance types ofM. tuberculosis)(23).

The current anti-TB therapies are fraught with problems, predominantly because of the longterm treatment and the increasing occurrence of medication resistance types of M. tuberculosis organism (24, 25), which is most probably due to treatment non-adherence and lost to follow up. The most dangerous tiling of drug resistant is formation of Multi drug resistant TB (MDR-TB) (24, 26-28) and extensively drug resistant TB (XDRTB) (28). According to WHO 2012 global TB report about 3.7% of new TB patients in the world infected with MDR-TB strains. …

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