Best practice guidelines to address barriers to treatment completion for patients with drug-resistant tuberculosis in Ethiopia

Abstract

Purpose: The purpose of this study was to develop best practice guidelines to address barriers to treatment completion of patients with drug-resistant tuberculosis (DR-TB) in Ethiopia. Method: This study utilised a research design that is exploratory, descriptive, and contextual in nature, guided by the convergent concurrent mixed method design. Quantitative data were collected using a pre-tested questionnaire from 487 randomly selected DR-TB patient charts at Hospitals A, B, and C, Ethiopia. Quantitative data were analysed using SPSS version 24 for Windows. The associations between treatment completion and independent variables were assessed by logistic regression. In-depth interviews with fifteen experienced healthcare providers (HCPs) who have been working with the patients on programmatic management of DR-TB were conducted. Moreover, six focus group discussions (FGDs) were conducted with 42 purposively selected DR-TB patients with a previous history of unsuccessful treatment outcomes and currently on retreatment regimens in Hospitals A, B, C, and D. A group of seven patients comprised each focus group session. A conventional content analysis approach was used, focusing on both the manifest and latent content of the narratives. ATLAS.ti 8 software was used in data coding and sorting. Findings: Among the 487 study patients included in the quantitative strand, 354 (72.69%) had successful treatment completion. On the other hand, 133 (27.31%) had not completed treatment. Age, registration group, comorbidity, drug susceptibility testing (DST) results, psychotic symptoms, drug-induced hepatitis, renal toxicity, electrolyte disturbance, and arthritis were factors which had statistically significant association with treatment completion. From the in-depth interviews, three themes and fourteen categories emerged, which captured the views of healthcare providers on DR-TB treatment completion. From the FGDs, five themes and twenty categories emerged on the lived experiences of previously treated DR-TB patients on completion of treatment. This study established a number of barriers to treatment completion for patients with DR-TB in Ethiopia related to clinical Issues, drug-related factors, patient factors, the health system, socio-economic factors, programmatic factors, and provider-related factors. Findings from this study and a systematic review of existing evidence informed the development of best practice guidelines addressing barriers to treatment completion for patients with DR-TB in Ethiopia. Conclusion: The findings established a wide range of barriers to treatment completion for patients with DR-TB in Ethiopia. Derivied from the findings of the study and informed by a systematic review of existing evidence, best practice guidelines on barriers to treatment completion for patients with DR-TB in Ethiopia were developed.