Barriers and Enablers to All-Oral Multi-Drug Resistance Tuberculosis Treatment Adherence in Traditional Authorities Chimwala and Chowe, Mangochi District, Malawi

Margaret Nyalugwe¹, Towera Maleta², Evetta Chisope³

1. Ministry of Health, Mangochi District Hospital
2. Kamuzu University of Health Sciences
3. Ministry of Health, Mangochi District Hospital
   *Corresponding Author: Margaret Nyalugwe; E-mail: nyalugwemag@gmail.com

Abstract
Background
The Malawi National Tuberculosis Program (MNTP) switched the MDR-TB treatment regimen from a combination of injectable and oral anti-TB drugs to an all-oral regimen in 2018. This has increased the pill burden and increased the treatment period from 12 to 18 months. The change was necessitated by the need to minimize amikacin-induced side effects which include vertigo, convulsions, and numbness. However, the longer treatment period and pill burden may affect treatment adherence.
Objective
The purpose of the study was to assess factors that influence adherence to the all-oral drugs for MDR-TB.
Methods
This descriptive qualitative study employed 10 in-depth interviews, 2 focus group discussions and 7 key informant interviews with patients, guardians and health workers. Participants were identified through purposive sampling from Traditional Authorities Chowe and Chimwala in Mangochi district. Data analysis was done through a thematic approach.
Results
Patients expressed satisfaction with the newly-introduced oral treatment for MDR-TB owing to the fewer side effects the treatment has, absence of pain from injections, desire to accomplish plans, delivery of drugs close to patients through drones, and home visits by health care workers. However, some patients highlighted barriers to adherence such as delayed food provision, and delayed transport refunds by the Malawi National Tuberculosis Control Program through its partners. Other barriers were medication stockouts, bad weather, and traveling away from home. Participants recommended that to improve adherence, interventions should include involving ex-MDR-TB patients and guardians in giving out MDR-TB adherence messages, and intensifying community sensitisation on MDR-TB.
Conclusion
MDR-TB treatment non-adherence is associated with patient factors, economic factors, access to health facility factors and environmental factors. Addressing the barriers is key to preventing MDR-TB relapse and new infections.