Quality of DOTS Adherence Counselling among Hospitalized Tuberculosis Patients

Setting: Non-adherence to tuberculosis treatment is a risk factor for multidrug-resistant tuberculosis (MDR-TB). In 2015, 480,000 cases of MDR-TB were notified worldwide, leading to 250,000 deaths. Aim: The quality of the Directly Observed Treatment (DOT) adherence counselling among patients with drug resistant and sensitive was assessed. Methods: A hospital based crossectional analytical study was conducted at the national TB hospital in Windhoek among patients with MDR-TB and drug susceptible TB (DS-TB). The quality of adherence counselling was assessed against the WHO counselling guidelines using an interviewer-administered questionnaire. Quality was measured by completeness, duration and frequency of the adherence counselling sessions or program as well as patient satisfaction and preferences. Quantitative and qualitative data were by descriptive statistics in SPSS v23 and thematic analysis respectively. Results: Of the 50 patients, 60% were male, 76% were aged <45 years and 92% perceived the direct observation of TB treatment as good or excellent. Only 40% of the patients received DOT adherence counselling over the last three months and 16% had not received counselling since admissions. The patient-related factors affecting the quality of DOT adherence counselling were forgetfulness (22%) and/or treatment cessation upon feeling better (12%), limited access to DOT services in the community versus the health facility and lack of individual versus group counselling as well as comprehension of languages and messages used during counselling. Conclusions: The quality of DOT adherence counselling among hospitalized TB patients is sub-optimal. There is need for a standard operating procedure and guidelines for effective adherence counselling among TB patients to optimize treatment outcomes.