Medication Adherence among Pulmonary Tuberculosis Patients in Treatment Centers in a Southern Nigerian Local Government Area: Question Mark on Performance of DOTS Services

Background: Directly observed treatment short-course (DOTS) offers free, accessible and effective treatments with high treatment success rate and retention. Despite this, evidence from Rivers State suggests a downward trend in tuberculosis (TB) cure rate and a high burden of drug resistance among pulmonary tuberculosis (PTB) patients. Medication adherence appears to play a key role in TB evolution.

Aim: to assess medication adherence and its determinants among pulmonary TB clients in DOTS centers.

Methodology: A total of 225 adult PTB clients from eight active DOTS centers in the Obio/Akpor Local Government Area of Rivers State were selected. A validated questionnaire, Morisky Medication adherence Scale-8 was used to collect the medication-taking behaviour of clients, dichotomised into adherent and non-adherent. Binary logistic regression was conducted to check the crude association between medication adherence and client/treatment factors. Variables with p<0.2 were selected and subjected to multivariate logistic regression with alpha set at p<0.05.

Results: Non-adherence to medication was 35.1%, with forgetfulness and stress with the medication plan as top reasons for non-adherence. Factors associated with non-adherence included persisting sputum production (aOR:2.951(1.027-8.482);p=0.045), past treatment history (aOR: 5.422(1.93-15.228);p=0.001) and smoking (aOR: 7.779(1.58-38.305);p=0.012).

Conclusion: Over one-third of PTB clients in DOTS centers in Obio/Akpor LGA were non-adherent to anti-TB medications. Factors associated with non-adherence included persisting sputum production, past treatment history and smoking. To attenuate these risk factors for non-adherence, training and retraining of DOTS center staff on counselling is a smart option that can be explored by the LGA, providers and managers of the DOTS programme.