Drug delivery problems to TB patients in Gauteng
After declining for many years, the incidence of tuberculosis (TB) is on the increase again. With TB resurgence there is also resistance of some TB strains to the commonly used TB drugs. This condition is kno wn as multi-drug resistance tuberculosis (MDR TB). Among all factors that increase TB and MDR TB, treatment compliance and completion is the greatest challenge. MDR TB is mainly caused by poor adherence to TB treatment by either the patient or the prescriber. In order to improve patient adherence to treatment. Directly Observed Therapy (DOT) has been implemented in many countries including South Africa. DOT means that each consumption of TB drugs by the patient is observed by a reliable person. Even with DOT in place, many patients still do not adhere to the prescribed treatment. This study aimed at determining from health workers the following: • Problems experienced by the health workers when giving treatment to TB patients, • causes for non-adherence to TB treatment, and • what could be done to make DOT more effective. A questionnaire was used to gather information. Ail clinics rendering TB services in Gauteng were considered in this study. Two questionnaires were sent to each of the 138 participating clinics and had to be completed by any two health workers involved in the treatment of TB patients. Only 69 of the 276 questionnaires sent, were returned completed (25%). Information gathered from the questionnaires revealed that patients seen at TB clinics in Gauteng came from various residential areas including townships, suburban rural and informal settlement. The Pearson chi squared test showed that there was no association between the percentage of patients who completed treatment and the number of patients seen at a clinic, or between the percentage of patients who completed treatment and the working hours at a particular clinic. The main cause of non-compliance shown by the results of this study was that patients discontinued treatment as soon as they felt better. Other causes of non-compliance mentioned by health workers included patient denial of having TB, ignorance, long treatment periods and many drugs that were to be taken during treatment. Health workers revealed that the main problem experienced in giving treatment to TB patients was that of deiaulting. The majority of these respondents suggested education as one way of making DOT more effective. In terms o f this study, it can be concluded that education on TB at various levels namely the patient, the health care worker and the community, is recommended. Education on the disease TB and its optimal treatment will improve patient compliance, decrease defaulting in delivering TB drugs to patients and make DOT more effective.