Effectiveness of Health Education Video in Improving Treatment Adherence among Patients with Tuberculosis: An Interventional Study from Bengaluru, India

Background: Non-adherence to tuberculosis (TB) treatment might prolong disease transmission and also increases the risk of drug resistance. Various studies have been carried out to determine the predictors of non-adherence but intervention-based studies to address treatment adherence are scarce. This study intends to estimate the treatment adherence rates following delivery of patient-centered health education videos in the intervention tuberculosis unit (TU) and to compare the treatment adherence with that in the comparison TU. Methods: An interventional study was conducted in two TUs of Bengaluru urban district among all newly diagnosed TB cases on daily regimen treatment over a period of three months from November 2017 to January 2018. A patient centered health education video was developed and shown by the treatment supporters to all eligible participants consenting to participate in the intervention TU. The video was shown once at the beginning of intensive phase treatment and once in the continuation phase of treatment. A total of 100 patients, 21 from intervention TU and 79 from comparison TU formed the study sample. Patient details were obtained from their treatment cards. Data on missed doses per month per patient were also noted. Data were entered into Microsoft excel worksheet and analyzed using statistical package for social sciences. Data are expressed as frequency and percentages. Chi-square test was applied to compare groups. Results: The majority of the study participants were aged between 25 - 44 years. Equal distribution of cases was seen among males and females. Intervention TU had significantly higher number of pulmonary TB cases. Treatment adherence rates were 90.5% and 84.8% at end of intensive phase and 85% and 71.4% at end of continuation phase in the intervention and comparison TU respectively, and this difference was not statistically significant. Conclusion: Use of mobile video-based health education showed better treatment rates and was found to improve TB treatment adherence.

Relationship between Nutritional Support and Tuberculosis Treatment Outcomes in West Bengal, India

Introduction: Poverty and poor nutrition are associated with the risk of developing tuberculosis (TB). Socioeconomic factors may interfere with anti-tuberculosis treatment compliance and its outcome. We examined whether providing nutritional support (monthly supply of rice and lentil beans) to TB patients who live below the poverty line was associated with TB treatment outcome. Methods: This was a retrospective cohort study of sputum smear-positive pulmonary TB patients living below the poverty line (income of <$1.25 per day) registered for anti-tuberculosis treatment in two rural districts of West Bengal, India during 2012 to 2013. We compared treatment outcomes among patients who received nutritional support with those who did not. A log-binomial regression model was used to assess the relation between nutritional support and unsuccessful treatment outcome (loss-to-follow-up, treatment failure and death). Results: Of 173 TB patients provided nutritional support, 15 (9%) had unsuccessful treatment outcomes, while 84 (21%) of the 400 not provided nutrition support had unsuccessful treatment outcomes (p < 0.001). After adjusting for age, sex and previous treatment, those who received nutritional support had a 50% reduced risk of unsuccessful treatment outcome than those who did not receive nutritional support (Relative Risk: 0.51;95% Confidence Intervals: 0.30 - 0.86). Conclusion: Under programmatic conditions, monthly rations of rice and lentils were associated with lower risk of unsuccessful treatment outcome among impoverished TB patients. Given the relatively small financial commitment needed per patient ($10 per patient per month), the national TB programme should consider scaling up nutritional support among TB patients living below the poverty line.

印度结核病流行病学:综述

印度的结核病形势可以用高患病率、高发病率高传染率来描述。自二十世纪50年代以来在印度不同地区进行的疾病监测报告显示:涂阳肺结核患病率为0.6-7.6/1000,培阳肺结核患病率为1.7-9.8/1000,培阳和/或涂阳结核患病率为1.8-12.7/1000。从已进行的有限的研究资料分析,涂阳肺结核的发病率在1.0-1.6/1000之间,培阳肺结核发病率在1.0-2.5/1000之间。根据不同时期在不同地区进行的结核菌素监测估计,结核年感染率(ARTI)为1-2%。在2000-2003年进行的全国范围研究估计,平均ARTI为1.5%。多数在第3级卫生保健中心进行的研究显示在结核病例中人类免疫缺陷病毒(HIV)血清阳性率在增加,不同研究的结果介于0.4%-28.8%之间。新病例中耐多药(MDR)率相对较低,约0.5-5.3%之间。但在复治病例中MDR为8%-67%。

Patients direct costs to undergo TB diagnosis

Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple visits.Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.Methods:We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis.Surveys of 2225 adults attending smear-microscopy centres in Nigeria,Nepal,Ethiopia and Yemen.Adults>18 years with cough>2 weeks were enrolled prospectively.Direct costs were quantified using structured questionnaires.Patients with costs>75^(th) quartile were considered to have high expenditure(cases)and compared with patients with costs<75^(th) quartile to identify factors associated with high expenditure.Results:The most significant expenses were due to clinic fees and transport.Most participants attended the centres with companions.High expenditure was associated with attending with company,residing in rural areas/other towns and illiteracy.Conclusions:The costs incurred by patients are substantial and share common patterns across countries.Removing user fees,transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs.In locations with limited resources,support could be prioritised for those most at risk of high expenditure;those who are illiterate,attend the service with company and rural residents.