Objectives: Non-adherence to tuberculosis (TB) treatment causes development of multi-drug resistance (MDR). In Armenia, about 47% of previously-treated TB patients develop MDR-TB. This pilot intervention intended to explore the feasibility and effectiveness of a family-based-counseling (FBC) that included a psychological component in terms of improved adherence of TB patients to treatment and reduced stigma of TB. Methods: Overall, 136 regular TB patients (55) and their family members (81) participated in a single 90-minute interactive counseling session conducted in each household by the team of professional psychologist and TB nurse. To evaluate FBC effectiveness, we administered baseline and follow-up surveys to 52 TB patients and their 57 family members in 2012 and compared treatment outcomes of the study participants with the national data for 2011 and 2013. Results: We found that the intervention substantially improved the mean knowledge score of TB patients (from 19.2 to 21.6, p < 0.001) and family members (from 18.0 to 21.7, p < 0.001). Percent of study participants thinking that TB was not negatively impacting their family relationships increased from 60% at baseline to 71% at follow-up. Following family-based counseling, there were notable improvements in interpersonal relationships within families, increased family support for TB patients and improved adherence to treatment which resulted in zero “default” rate for treatment outcomes among the family-based counseling participants compared to 5% “default” in the comparison group (p = 0.07). Conclusion: The evaluation showed that a low-cost one-time family– based educational intervention with a psychological component can be effective in improving treatment outcomes of TB patients.
References
[1]
Donald, P. and Helden, P.D. (2009) The Global Burden of Tuberculosis—Combating Drug Resistance in Difficult times. The New England Journal of Medicine, 360, 2393-2395. https://doi.org/10.1056/NEJMp0903806
[2]
Volmink, J. and Garner, P. (2000) Interventions for Promoting Adherence to Tuberculosis Management. Cochrane Database of Systematic Reviews, 4, Article ID: CD000010.
[3]
Aït-Khaled, N., Alarcón, E., Armengol, R., et al. (2010) Management of Tuberculosis. A Guide to the Essentials of Good Practice. 6th Edition, International Union against Tuberculosis and Lung Disease, Paris.
[4]
Aziz, M.A. and Wright, A. (2005) The World Health Organization/International Union against Tuberculosis and Lung Disease Global Project on Surveillance for Anti-Tuberculosis Drug Resistance: A Model for Other Infectious Diseases. Clinical Infectious Diseases, 41, S258-S262. https://doi.org/10.1086/430786
[5]
Vink, K., Colombani, P., Mosneaga, A., Dara, M., Dauby, C., Hennig, C., Bates J. and Khachatryan, S. (2005) Tuberculosis Assessment Mission to Armenia. WHO Regional Office for Europe, Copenhagen.
[6]
Barnhoorn, F. and Adriaanse, H. (1992) In Search of Factors Responsible for Noncompliance among Tuberculosis Patients in Wardha District, India. Social Science & Medicine, 34, 291-306. https://doi.org/10.1016/0277-9536(92)90271-Q
[7]
M’Imunya, J.M., Kredo, T. and Volmink, J. (2012) Patient Education and Counselling for Promoting Adherence to Treatment for Tuberculosis. Cochrane Database of Systematic Reviews, 5, Article ID: CD006591.
[8]
Morisky, D.E., Malotte, K., Davidson, P., et al. (1990) A Patient Education Program to Improve Adherence Rates with Antituberculosis Drug Regimens. Health Education Quarterly, 17, 253-267. https://doi.org/10.1177/109019819001700303
[9]
Guo, N., Marra, F. and Marra, C.A. (2009) Measuring Health-Related Quality of Life in Tuberculosis: A Systematic Review. Health and Quality of Life Outcomes, 7, 14. https://doi.org/10.1186/1477-7525-7-14
[10]
Mitchell, A.J. and Selmes, T. (2007) Why Don’t Patients Take Their Medicine? Reasons and Solutions in Psychiatry. Advances in Psychiatric Treatment, 13, 336-346. https://doi.org/10.1192/apt.bp.106.003194
[11]
Newell, J.N., Baral, S.C., Pande, S.B., Bam, D.S. and Malla, P. (2006) Family-Member DOTS and Community DOTS for Tuberculosis Control in Nepal: Cluster-Randomised Controlled Trial. The Lancet, 367, 903-909. https://doi.org/10.1016/S0140-6736(06)68380-3
[12]
Akkslip, S., Rasmithat, S., Maher, D. and Sawert, H. (1999) Direct Observation of Tuberculosis Treatment by Supervised Family Members in Yasothorn Province, Thailand. The International Journal of Tuberculosis and Lung Disease, 3, 1061-1065.
[13]
Garner, P. and Volmink, J. (2006) Families Help Cure Tuberculosis. The Lancet, 367, 878-879. https://doi.org/10.1016/S0140-6736(06)68356-6
[14]
Maciel, E.L.N., Guidoni, L.M., Brioshi, A.P., et al. (2010) Household Members and Health Care Workers as Supervisors of Tuberculosis Treatment. Revista de Saúde Pública, 44, 339-343. https://doi.org/10.1590/S0034-89102010000200015
[15]
Mezzich, J.E., Appleyard, J., Botbol, M., et al. (2014) Summary Report of the Seventh Geneva Conference on Personcentered Medicine. The International Journal of Person Centered Medicine, 4, 139-144.
[16]
Curry, L.A., Nembhard, I.M. and Bradley, E.H. (2009) Qualitative and Mixed Methods Provide Unique Contributions to Outcomes Research. Circulation, 119, 1442-1452. https://doi.org/10.1161/CIRCULATIONAHA.107.742775
[17]
Meyer, J. (2000) Qualitative Research in Health Care: Using Qualitative Methods in Health Related Action Research. British Medical Journal, 320, 178-181. https://doi.org/10.1136/bmj.320.7228.178
[18]
CDC (2008) Self-Study Modules on Tuberculosis. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta.
[19]
ARC (2011) Tuberculosis (TB) Teaching Flip Chart. Armenian Red Cross Society, Yerevan.
[20]
Hertzog, M.A. (2008) Considerations in Determining Sample Size for Pilot Studies. Research in Nursing & Health, 31, 180-191. https://doi.org/10.1002/nur.20247
[21]
Truzyan, N., Crape, B., Grigoryan, R., Martirosyan, H. and Petrosyan, V. (2015) Increased Risk for Multidrug-Resistant Tuberculosis in Migratory Workers, Armenia. Emerging Infectious Diseases, 21, 474-476. https://doi.org/10.3201/eid2103.140474
[22]
Andres, A.M. and Mato, A.S. (1994) Choosing the Optimal Unconditioned Test for Comparing Two Independent Proportions. Computational Statistics & Data Analysis, 17, 555-574. https://doi.org/10.1016/0167-9473(94)90148-1
[23]
Miller, D. and Miller, L.T. (1993) Armenian Families, in Survivors: An Oral History of the Armenian Genocide. University of California Press, Berkeley.
[24]
Endris, M., Moges, F., Yeshambel Belyhun, Y., et al. (2014) Treatment Outcome of Tuberculosis Patients at Enfraz Health Center, Northwest Ethiopia: A Five-Year Retrospective Study. Tuberculosis Research and Treatment, 2014, Article ID: 726193. https://doi.org/10.1155/2014/726193
[25]
Albuquerque, M.F., Ximenes, R.A., Lucena-Silva, N., et al. (2007) Factors Associated with Treatment Failure, Dropout, and Death in a Cohort of Tuberculosis Patients in Recife, Pernambuco State, Brazil. Cadernos de Saúde Pública, 23, 1573-1582. https://doi.org/10.1590/S0102-311X2007000700008
[26]
Raza, S., Sarfaraz, M. and Ahmad, M. (2012) Practice of Family and Non-Family Based Directly Observed Treatment for Tuberculosis in Pakistan: A Retrospective Cohort Study. The Health, 3, 39-44.
[27]
Liefooghe, R., Suetens, C., Meulemans, H., Moran, M.B. and De Muyncket, A. (1999) A Randomised Trial of the Impact of Counselling on Treatment Adherence of Tuberculosis Patients in Sialkot, Pakistan. International Journal of Tuberculosis and Lung Disease, 3, 1073-1080.
[28]
Gebremariam, K.M., Bjune, G.A. and Frich, J.C. (2010) Barriers and Facilitators of Adherence to TB Treatment in Patients on Concomitant TB and HIV Treatment: A Qualitative Study. BMC Public Health, 10, 651.
[29]
Thiam, S., LeFevre, A.M., Hane, F., et al. (2007) Effectiveness of a Strategy to Improve Adherence to Tuberculosis Treatment in a Resource-Poor Setting. A Cluster Randomized Controlled Trial. JAMA, 297, 380-386.
