Determinants of tuberculosis treatment adherence among patients taking anti-TB drugs in Borama, Somaliland

Abstract

Background: Tuberculosis (TB) treatment non-adherence poses significant challenges, leading to complications, disease transmission, and drug resistance. This study aimed to identify the determinants of TB treatment adherence among adult patients attending the Borama Regional Hospital (BRH) in Somaliland. Methods: A cross-sectional study was conducted at BRH. Data were collected using a structured questionnaire, which included a direct question on missed doses (self-report), pill counts, and a validated 8-item Self-Administered Questionnaire to measure adherence. Statistical analysis included descriptive statistics, chi-square tests, independent t-tests, and binary and multivariable logistic regression using SPSS version 26 to identify adherence-related factors. Adherence was defined as taking at least 95% of prescribed medications in the last 30 days based on a composite measure of self-report, pill count, and the self-administered questionnaire. Results: Of the 167 participants, 74.9% demonstrated adherence to Tuberculosis (TB) treatment. Multivariable logistic regression revealed that being employed (Adjusted Odds Ratio [AOR]: 0.058, 95% CI: 0.014–0.451) and self-employed (AOR: 0.201, 95% CI: 0.050–0.981) were associated with lower odds of adherence compared to being non-employed. Conversely, correctly following overall medical advice (AOR: 2.023, 95% CI: 1.832, 4.729), experiencing stigma (AOR: 3.744, 95% CI: 1.610–7.485), and traveling a long distance to the health facility (AOR: 7.526, 95% CI: 3.472–9.419) were associated with higher odds of adherence. Good housing conditions had a protective effect against non-adherence (AOR: 0.071, 95% CI: 0.21–0.531). Conclusion: This study identified several factors significantly associated with TB treatment adherence in Borama. To improve treatment adherence, interventions should focus on addressing stigma, promoting access to healthcare, addressing socioeconomic determinants including housing, and addressing the financial and logistical limitations experienced by TB patients. They should also focus on adherence to medical advice.