Determinants of non adherence to tuberculosis treatment in Argentina:
               barriers related to access to treatment

Herrero, María Belén; Ramos, Silvina; Arrossi, Silvina

doi:10.1590/1980-5497201500020001

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Original Articles • Rev. bras. epidemiol. 18 (2) • Apr-Jun 2015 • https://doi.org/10.1590/1980-5497201500020001 copy

Determinants of non adherence to tuberculosis treatment in Argentina: barriers related to access to treatment

Determinantes da não adesão ao tratamento da tuberculose na Argentina: barreiras relacionadas com o acesso ao tratamento

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To identify the association between non-adherence to tuberculosis treatment and access to treatment.

METHODS:

A cross-sectional study was carried out in the Metropolitan Area of Buenos Aires, Argentina. One hundred twenty three patients notified in 2007 (38 non adherent and 85 adherents) were interviewed regarding the health care process and socio-demographic characteristics. Factors associated to non-adherence were assessed through logistic regression analysis.

RESULTS:

An increased risk of non-adherence with to treatment was found in male patients (OR = 2.8; 95%CI 1.2 - 6.7), patients who had medical check-ups at hospitals (OR = 3.4; 95%CI 1.1 - 10.0) and those who had difficulties with transportation costs (OR = 2.5; 95%CI 1.1 - 5.9).

CONCLUSION:

Risk of non-adherence increases as a result of economic barriers in accessing health care facilities. Decentralization of treatment to primary health care centers and social protection measures for patients should be considered as priorities for disease control strategies in order to lessen the impact of those barriers on adherence to treatment.

Tuberculosis; Medication adherence; Therapeutics; Epidemiologic factors; Argentina; Decentralization

Participation in the study	Non-adherents		Adherents		Total
Participation in the study	n	%	n	%	n	%
Yes	38	30.9	85	69.1	123	100.0
No	40	57.1	30	42.9	70	100.0
Total	78	40.4	115	59.6	193	100.0

Characteristics	Non-adherents		Adherents		Total	p-value
Characteristics	n = 38	%	n = 85	%	n = 123	p-value
Sex
Male	12	22.2	42	77.8	54	0.05
Female	26	37.7	43	62.3	69	0.05
Age (years)
18 – 24	11	37.9	18	62.1	29	ns
25 – 34	12	27.3	32	72.7	44
35 – 64	13	35.1	24	64.9	37
65 and more	2	15.4	11	84.6	13
Mean age (SD)	37 (2.3)		41 (1.8)			ns
Educational level
Never gone to school/ Primary Incomplete	8	24.2	25	75.8	33	ns
Primary Complete	12	37.5	20	62.5	32
Secondary or more	18	31.0	40	69.0	58
Social Security
Yes	6	24.0	19	76.0	25	ns
No	32	32.7	66	67.3	98	ns
Head of household Social Security
Yes	6	17.6	28	82.4	34	ns
No	32	36.0	57	64.0	89	ns
Type of occupation of patients*
Employed with social protection	3	12.0	22	88.0	25	ns
Employed without social protection	27	35.1	50	64.9	77
Inactive or Unemployed	8	40.0	12	60.0	20
Household income level**
More than 750 $	14	22.2	49	77.8	63	0.023
Up to 750 $	24	41.4	34	58.6	58	0.023

Treatment and health care characteristics	Non-adherents		Adherents		Total	p-value
Treatment and health care characteristics	n = 38	%	n = 85	%	n = 123	p-value
DOT status
No	37	30.6	84	69.4	121	ns
Yes	1	50.0	1	50.0	2	ns
Type of health facility were treatment was provided
Primary Health Centre	7	17.5	33	82.5	40	0.026
Referral hospital	31	37.3	52	62.7	83	0.026
Type health facility where control visits were carried out
Primary Health Centre/Others	7	17.1	34	82.9	41	0.022
Referral hospital	31	37.8	51	62.2	82	0.022
Delays in health care attention
Less than 30 minutes	30	32.3	63	67.7	93	ns
More than 30 minutes	8	26.7	22	73.3	30	ns
Difficulties in cost of transportation*
Yes	25	40.3	37	59.7	62	0.020
No	12	20.7	46	79.3	58	0.020
Difficulties with transportation time*
Yes	13	41.9	18	58.1	31	ns
No	24	27.0	65	73.0	89	ns
Distance to the Health Care Facility
Less than 3.4 kilometers	22	29.3	53	70.7	75	ns
More than 3.4 kilometers	16	33.3	32	66.7	48	ns
Media distance (in kilometers)
All patients	3.4 (2.9 – 3.9)
Among cases	4 (2.6 – 5.4)
Among controls	3.1 (2.7 – 3.6)

Characteristics	Univariate analysis			Multivariate analysis
Characteristics	OR	95%CI	p-value	OR	95%CI	p-value
Sex
Female	1
Male	2.2	(1.0 – 5.2)	0.05	2.8	(1.2 – 6.7)	0.020
Household level income
More than $750	1
Up to $750	2,5	(1.1 – 5.4)	0.025
Type of health facility were treatment was provided
Primary Health Centre	1
Referral hospital	2.8	(1.1 – 7.1)	0.029
Type health facility were control visits were carried out
Primary Health Centre/Others	1
Referral hospital	3.4	(1.3 – 9.0)	0.014	3.4	(1.1 – 10.0)	0.025
Difficulties with cost of transportation
No	1
Yes	2.6	(1.1– 5.8)	0.022	2.5	(1.1 – 5.9)	0.042

Socio-demographics Characteristics	Non-adherents (n = 78)		Adherents (n = 115)		p-value
	Participation in the Surrey		Participation in the Surrey
	Yes n = 38	No n = 40	Yes n = 85	No n = 30
Mean age (SD)	37 (2.3)	36 (2.5)	41 (1.8)	35 (2.3)	ns
Sex
Female	54,5%	45,5%	70,5%	29,5%	ns
Male	46,4%	53,6%	77,8%	22,2%	ns

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[1] Corresponding author: Silvina Arrossi. Sánchez de Bustamante, 27, C1173AAA, Ciudad Autónoma de Buenos Aires, Argentina. E-mail: silviarrossi2020@gmail.com