Thesis:
Effectiveness of a family-centered support intervention in improving treatment adherence among tuberculosis patients in Jinja, Uganda

Abstract

Tuberculosis (TB) claimed the lives of 1.4 million individuals globally in 2021. Uganda has a high occurrence of TB, with an incidence rate of about 200 cases per 100,000 individuals.Jinja, a district in Eastern Uganda, has a case notification rate (225 per 100,000 individuals)higher than the national average. Poor adherence to TB treatment impedes disease control, slowing down the target to end TB by 2035. Uganda's treatment adherence rate ranges between 65% and 74%, which is lower than that of similar countries. Despite the implementation of community-based directly observed therapy, the adherence levels have persistently remained poor. With limited evidence on the effect of family involvement in improving TB treatment adherence, this study investigated the effect of a family-centered TB (FaCeTB) treatment support intervention on the level treatment adherence among patients in Jinja. The study utilized a before-and-after non-equivalent quasi-experimental design with both intervention and control study groups. The nurse invited the patient and one accompanying family member to an engagement session at the TB clinic. During the session, orientation, TB treatment health education, and the assignment of adherence support roles to the family caregiver were accomplished. The study enrolled patients with pulmonary tuberculosis who had undergone ≥2 weeks of first-line therapy. Treatment adherence was assessed using the Medication Adherence Rating Scale. The data was analyzed using SPSS v25. The descriptive statistics comprised of frequencies, percentages, median, mean, and standard deviation (SD). Mann-Whitney U test and Wilcoxon Signed-Rank test were used to evaluate the effect of the intervention on treatment adherence. The Mount Kenya Ethics Research Committee and the Mbale Regional Referral Hospital Ethics Committee provided ethical clearance. Research approval was obtained from the Uganda National Council of Science and Technology. The study enrolled 147 participants, with 73 in the intervention arm and 74 in the control arm. A total of 127 patients were successfully followed up, where 67 were in the intervention group and 60 in the control group. The mean age was 37.85±13.89 years. More than one-half (55.8%) of the patients were male, and 36.7% were HIV-positive. In the baseline assessment, overall, 65.3% of the patients had a high level of TB treatment adherence. The level was 71.2% in the intervention group and 59.5% in the control group. One-third (68.7%) of the patients reported a high level of perceived family support. Caregivers offered actual treatment support in the form of medication reminders, motivation, and both emotional and practical support. After the intervention, the overall adherence increased to 74.8%. In the intervention group, the level increased to 91.0%, while in the control group, it decreased to 56.7%. The adherence scores after the intervention were significantly higher in the intervention study arm than in the control arm (p=0.000), with a medium to large effect size (r=0.474). Supportive family involvement is vital in supporting patients during the TB treatment period, and it should be embraced as routine practice in Uganda to achieve optimal TB treatment adherence levels.

Cite this Publication
Alinaitwe, B. (2024). Effectiveness of a family-centered support intervention in improving treatment adherence among tuberculosis patients in Jinja, Uganda. Mount Kenya University. https://erepository.mku.ac.ke/handle/123456789/7218

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Mount Kenya University