RESEARCH ARTICLE


Psychosocial Support Improves Treatment Adherence Among MDR-TB Patients: Experience from East Kazakhstan



G. Kaliakbarova1, S. Pak1, N. Zhaksylykova2, G. Raimova2, B. Temerbekova3, S. van den Hof*, 4, 5
1 KNCV Representative Office in Central Asia, Almaty, Kazakhstan
2 Regional tuberculosis dispensary of Semei city, East Kazakhstan oblast, Kazakhstan
3 Oblast tuberculosis dispensary of Oskemen city, East Kazakhstan oblast, Kazakhstan
4 KNCV Tuberculosis Foundation, The Hague, The Netherlands
5 Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, The Netherlands

Article Information


Identifiers and Pagination:

Year: 2013
Volume: 7
First Page: 60
Last Page: 64
Publisher Id: TOIDJ-7-60
DOI: 10.2174/1874279301307010060

Article History:

Received Date: 19/10/2012
Revision Received Date: 16/1/2013
Acceptance Date: 16/1/2013
Electronic publication date: 19/4/2013
Collection year: 2013

© 2013 Kaliakbarova et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: * Address correspondence to this author at the KNCV Tuberculosis Foundation, P.O. Box 146, 2501 CC The Hague, The Netherlands. Tel: +31 70 4270985; Fax: +31 70 3584004; E-mail: vandenhofs@kncvtbc.nl


Abstract

A novel patient–oriented treatment delivery program was introduced for multi-drug resistant tuberculosis (MDR-TB) patients at high risk of treatment default in East Kazakhstan region, The Republic of Kazakhstan. In parallel interventions were introduced to improve programmatic and clinical management for all MDR-TB patients. To assess the effects of the patient support program on patient default rates, we analyzed the characteristics of MDR-TB patients referred to the psychosocial support (PSS) program, treatment adherence before and during the intervention for patients referred to the patient support program.

In 2010, the total number of MDR-patients starting second-line drug MDR-TB treatment was 426. The PSS program supported 228 (53%) patients considered to be at high risk of treatment default. The program contributed to strengthening of management of all MDR-TB patients during the ambulatory, continuation phase of treatment. The proportion of drug doses taken under direct observation improved from 48% to 97%, while division of intake of second-line anti-TB drugs in 2-3 portions per day decreased from 20% in 2009 to 0%. Interruptions of anti-TB drugs for at least one day decreased from 18% to 4% among all MDR-TB patients. Among patients included in the PSS program, no treatment default was observed and only one patient missed doses of treatment.

In conclusion, our patient–oriented support program was successful in reducing rates of treatment default among MDRTB patients.

Keywords: Kazakhstan, MDR-TB, patient support.