Understanding tuberculosis treatment completion in urban areas of Nepal

Abstract

Non-completion of tuberculosis (TB) treatment has been a major topic of debate ever since combined drug therapy started to be used. It has threatened global TB control and posed a challenge to many National TB Programmes (NTPs) especially in developing countries where the burden of TB is highest and the poor are worst hit. As a means of controlling TB, WHO advocated a strategy branded as DOTS, which includes direct observation of treatment (DOT). Many countries have implemented DOTS, so DOT has become a central component of NTPs’ TB control strategy. DOTS as a comprehensive package was shown to be successful in many countries: however, this success over-credited the direct observation component, which led to a focus on the concept of TB treatment completion. The Nepal NTP implemented DOTS in the late 1990s and has achieved high treatment success rates under DOTS, but has not been exempted from the debate. There have been many studies which have identified the need to minimise non-completion as vital to controlling TB: however, few have considered how non-completion could be tackled through establishing locally feasible patient-centred care within existing TB control procedures. The overall aim of my study was, therefore, to gain a better understanding of experiences and issues faced by People Living with TB (PLTB) during the course of TB treatment under DOTS and identify appropriate ways of addressing the issues identified in the context of the NTP in urban setting in Kathmandu, Nepal.. The study used a qualitative research approach to investigate why and how different factors hindered or facilitated successful completion of TB treatment in an urban TB control setting in Nepal. The study used semi-structured qualitative interviews (49), focus group discussions (6) and observation techniques to generate data and a content analysis approach to analyse the data. Study respondents were PLTB; family members of PLTB; health care providers, NTP officials and community members. My study shows that, as defined by the NTP, successful completion of TB treatment was not straightforward for PLTBs. PLTBs underwent TB treatment in very difficult circumstances, as various obstacles to successful TB treatment completion complicated the treatment process and thus made PLTBs and their families further vulnerable. Obstacles arising from causes related to the health system had a greater impact on PLTBs and their families than obstacles arising from causes related to the PLTBs