Number of people testing positive for tuberculosis who adhere to treatment
Background
High-quality treatment and care of tuberculosis (TB) relies on the following: laboratories and X-rays, input from skilled clinicians, a reliable supply of drugs, adequate health education, provision of care, and good follow-up and information systems for disease surveillance—in other words, an effectively operating health system. Ensuring adherence to treatment for TB is very important because it prevents transmission to others. Models that involve the family and community members can address barriers to adherence among those suffering with TB. These barriers include medical expenses; stigma associate with the illness; communication breakdowns between providers and patients; and limited health literacy, health workforce, and drug procurement. Community, family, and patient organizations all play a key role in improving adherence to TB treatment. Participation in patient organizations supported by community health workers has been shown to affect self-management of chronic diseases and the creation and maintenance of healthy habits. Community-based organizations and community workers should use this indicator to monitor progress towards managing TB within communities by motivating adherence to treatment, regardless of HIV status. TB is the leading cause of morbidity and mortality among people living with HIV. Community workers can support the health system by tracing TB patients lost to follow-up, referring those suspected to screening, referring TB patients to treatment, and following up to ensure adherence. This indicator can be used to track progress of these activities because these activities lead to improved adherence to treatment.
Numerator
Number of adults and children diagnosed with TB who have kept all TB appointments and taken all pills as prescribed during the reporting period
Unit of measure
Number
Calculation
Sum results across reporting period
Method of measurement
Community workers can improve adherence by accompanying TB patients to their appointments, and they can also motivate treatment uptake by counting pills. The community worker can ask the patient to self-report whether they attended all appointments as required for treatment and then follow up with the facility workers to ensure that these patients have indeed come for treatment services and prescriptions. The community worker can also refer to the prescription to ascertain whether the patient has been taking drugs as instructed, based on the date that the pills were prescribed. This approach can be invasive, so community workers should engage with caution and obtain consent before checking pill bottles; community workers should never force treatment uptake. They should also be trained on which symptoms to look for in patients who may have TB, so they may refer patients for screening. Patients should have decision-making power over whether to take their medication three times or once daily. However, it should be noted that those who choose to take their medication three times daily, versus once a day, tend to have better treatment adherence.
There is no ideal method for measuring adherence behavior, but a variety of strategies have proven effective in approximating true adherence rates. Another measurement approach is to ask patients to rate their adherence to TB treatment, or the adherence of their TB-positive children on a scale. Adherence methods provide only an estimate of a patient’s true behavior. Community workers should engage with caution when handling and gathering this information, because TB status has been shown to lead to discrimination and stigma. Confidentiality should be maintained at all costs. Questions related to child treatment adherence should be directed to caregivers.
Data source
Community extension workers employed by programs for vulnerable children collect information related to TB through graduation checklists, vulnerable children service forms, caregiver/household head service forms, referral forms for the vulnerable household, and child counseling session forms. Community health workers collect this information in forms that manage the health status of mothers and their children, including disaggregation for HIV-positive mothers. TB cases are also managed through monthly community health worker (CHW) reports and HIV care and antiretroviral treatment (ART) transfer and referral forms by community health workers of HIV programs.
Disaggregation
- Age (<1 year, 1–4 years, 5–9 years, 10–14 years, and 15–19 years for children; 20–24 years, 25–49 years, and 50+ years for adults)
- Sex
- Pregnancy/lactation status
- Key population type (sex workers, men who have sex with men, people who inject drugs, transgender people)
Data quality considerations
The overall number reported for this indicator should be equal to the sum of the numbers of people in each disaggregation type. Only one type of age disaggregation should be used throughout, and overlap should be avoided.
Reporting frequency
Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.
Data element
TB treatment adherence
Category
Vulnerable Children, Home-Based Care, Key Populations, Prevention of Mother-to-Child Transmission
References
Garner, P., Smith, H., Munro, S., & Volmink, J. (2011). Promoting adherence to tuberculosis treatment. Retrieved from http://www.who.int/bulletin/volumes/85/5/06-035568/en/
Sabate, E. (2015, December 21). Adherence to Long-Term Therapies: Evidence for Action. Retrieved from http://www.who.int/chp/knowledge/publications/adherence_report/en/
