‘They prefer hidden treatment': anti-tuberculosis drug-taking practices and drug regulation in Karakalpakstan

Setting: The joint Médecins Sans Frontières/Ministry of Health multidrug-resistant tuberculosis (MDR-TB) programme; Karakalpakstan, Uzbekistan. Objective: Uzbekistan has high rates of MDR-TB. We aimed to understand patients’ and prescribers’ attitudes to TB drug prescription, regulation, and drug-taking behaviour. Methods: Participants (12 patients, 12 practitioners) were recruited purposively. Data were gathered qualitatively using field notes and in-depth interviews and analysed thematically. Findings: Our analysis highlighted two main themes. First, shame and stigma were reported to increase the likelihood of self-treatment and incorrect use of TB drugs, most commonly at initial stages of illness. A health system failure to promote health information was perceived, leading to wrong diagnoses and inappropriate therapies. Motivated by shame, patients hid their condition by resorting to drug-treatment options outside the programme, compounding the risk of chaotic management and dissemination of erroneous information through lay networks. Second, positive influences on treatment were reported through patients, practitioners and peers working effectively together to deliver the correct information and support, which acted to normalise TB, reduce stigma and prevent misuse of TB drugs. Conclusion: Effective case finding, patient support and community education strategies are essential. Patients, practitioners and peers working together can help reduce stigma and prevent misuse of TB drugs

Factors Associated with Unfavorable Treatment Outcomes in New and Previously Treated TB Patients in Uzbekistan: A Five Year Countrywide Study.

TB is one of the main health priorities in Uzbekistan and relatively high rates of unfavorable treatment outcomes have recently been reported. This requires closer analysis to explain the reasons and recommend interventions to improve the situation. Thus, by using countrywide data this study sought to determine trends in unfavorable outcomes (lost-to-follow-ups, deaths and treatment failures) and describe their associations with socio-demographic and clinical factors.A countrywide retrospective cohort study of all new and previously treated TB patients registered in the National Tuberculosis programme between January 2006 and December 2010.Among 107,380 registered patients, 67% were adults, with smaller proportions of children (10%), adolescents (4%) and elderly patients (19%). Sixty per cent were male, 66% lived in rural areas, 1% were HIV-infected and 1% had a history of imprisonment. Pulmonary TB (PTB) was present in 77%, of which 43% were smear-positive and 53% were smear-negative. Overall, 83% of patients were successfully treated, 6% died, 6% were lost-to-follow-up, 3% failed treatment and 2% transferred out. Factors associated with death included being above 55 years of age, HIV-positive, sputum smear positive, previously treated, jobless and living in certain provinces. Factors associated with lost-to-follow-up were being male, previously treated, jobless, living in an urban area, and living in certain provinces. Having smear-positive PTB, being an adolescent, being urban population, being HIV-negative, previously treated, jobless and residing in particular provinces were associated with treatment failure.Overall, 83% treatment success rate was achieved. However, our study findings highlight the need to improve TB services for certain vulnerable groups and in specific areas of the country. They also emphasize the need to develop unified monitoring and evaluation tools for drug-susceptible and drug-resistant TB, and call for better TB surveillance and coordination between provinces and neighbouring countries

Unfavorable treatment outcomes over five years in Uzbekistan 2006–2010.

<p>Unfavorable treatment outcomes over five years in Uzbekistan 2006–2010.</p

Factors associated with deaths among TB patients in Uzbekistan 2006–2010.

<p>TB, Tuberculosis; PTB, Pulmonary TB; EPTB, Extrapulmonary TB; OR, Odds Ratio, CI, Confidence Interval</p><p>^aAdjusted odds ratios only presented for variables included in the multivariate model; 92812 records included in the multivariate model</p><p>^b0- patients who refused treatment, or treatment category not defined, or where TB diagnosis was based on the findings of a post-mortem</p><p>^cData should not be considered relevant as unknown cases more than 50% in this group of patients</p><p>Factors associated with deaths among TB patients in Uzbekistan 2006–2010.</p

Socio-demographic and clinical characteristics and treatment outcomes of tuberculosis patients, Uzbekistan 2006–2010.

<p>TB, Tuberculosis; PTB, Pulmonary TB; EPTB, Extrapulmonary TB.</p><p>Socio-demographic and clinical characteristics and treatment outcomes of tuberculosis patients, Uzbekistan 2006–2010.</p

Treatment outcomes of all registered tuberculosis patients by TB type and treatment history, Uzbekistan 2006–2010.

<p>Treatment outcomes of all registered tuberculosis patients by TB type and treatment history, Uzbekistan 2006–2010.</p

Factors associated with treatment failure in TB patients in Uzbekistan, 2006–2010.

<p>TB, Tuberculosis; PTB, Pulmonary TB; EPTB, Extrapulmonary TB; OR, Odds Ratio, CI, Confidence Interval</p><p>^aAdjusted odds ratios only presented for variables included in the multivariate model; 92055 records included in the multivariate model</p><p>^b0- patients who refused treatment, or treatment category not defined, or where TB diagnosis was based on findings of a post-mortem</p><p>^cData should not be considered relevant as unknown cases more than 50% in this group of patients</p><p>Factors associated with treatment failure in TB patients in Uzbekistan, 2006–2010.</p

Factors associated with loss to follow-up among TB patients in Uzbekistan 2006–2010.

<p>TB, Tuberculosis; PTB, Pulmonary TB; EPTB, Extrapulmonary TB; OR, Odds Ratio, CI, Confidence Interval</p><p>^aAdjusted odds ratios only presented for variables included in the multivariate model; 92812 records included in the multivariate model</p><p>^b0- patients who refused treatment, or treatment category not defined, or where TB diagnosis was based on the findings of a post-mortem</p><p>^cData should not be considered relevant as unknown cases more than 50% in this group of patients</p><p>Factors associated with loss to follow-up among TB patients in Uzbekistan 2006–2010.</p