Adherence to TB Treatment Remains Low during Continuation Phase among Adult Patients in Northwest Ethiopia

Abstract Background: Adherence to Tuberculosis (TB) treatment remained a challenge for TB treatment programs. However, paucity of evidences specifically during continuation phase where the treatment is mainly patient-centered. This study aimed to determine the level and determinants of adherence to TB treatment among adult patients during continuation phase.Methods: We deployed a facility-based cross-sectional study design supplemented with lived experiences and perspectives of focal care providers. The study population included all adult (≥18 years) TB patients enrolled in the continuation treatment phase and TB focal care providers (for key-informant interviews). The study included 307 participants from 22 health facilities. Nine TB focal care providers were purposively selected for key-informant interviews. A shorter form, 11-item ARMS (adherence to refill and medication scale) was used for measuring adherence. Binary logistic regression was applied to identify factors associated with patient adherence. The audio data was transcribed, coded and categorized into themes using OpenCode software. The interpretation and analysis were conducted using thematic analysis.Results: Among 307 participants, 197 (64.2%) [95% CI (58.6% - 69.4%)] were adhere to TB treatment. A multi-variable analysis shown that secondary education (AOR = 4.138, 95% CI; 1.594-10.74); good provider-patient relationship (AOR=1.863, 95% CI; 1.014-3.423); good knowledge on TB treatment (AOR=1.845, 95% CI; 1.012-3.362) and middle family wealth (AOR= 2.646, 95% CI; 1.360-5.148) have shown significant association with adherence. Many patients mentioned that forgetfulness, traveling away from home without pills, and feeling sick were major reasons for non-adherence to TB treatment. Conclusions: The study indicated that patients’ adherence to TB treatment remains low during continuation phase. The patient’s education level, knowledge, family wealth, and provider-patient relationship were found positively associated with patient adherence. Forgetfulness, traveling away, and feeling sick were major reasons for non-adherence to TB treatment. Interventional studies are needed on those factors to improve patient adherence to TB treatment during continuation phase.