Treatment adherence, social support and coping mechanisms among patients with drug-sensitive tuberculosis: a cross-sectional study in two directly-observed therapy centres in southwest Nigeria.

OBJECTIVE: To evaluate medication adherence, available social support and types of accessible support among patients with drug-sensitive tuberculosis (DS-TB). Coping mechanism(s) in TB management and associations between accessible support(s) and medication adherence were also explored. DESIGN: Prospective questionnaire-guided cross-sectional study. SETTINGS: The WHO-certified TB directly observed therapy (DOT) clinic of two tertiary hospitals in Ibadan, southwest Nigeria. PARTICIPANTS: Adult patients with DS-TB attending the TB-DOT clinic of the hospitals. OUTCOME MEASURES: Primary outcomes were level of adherence to TB regimens, available social support and type(s) of accessible support. Secondary outcomes were coping mechanisms in TB management, as well as associations between accessible support(s) and medication adherence. RESULTS: Overall, 152 (89.4%) had optimal adherence. Available social supports were ranked as family (168; 98.8%) >healthcare providers (166; 97.6%) >government (119; 70.0%) >non-governmental organisation (NGO) (118; 69.4%) >religious affiliations (81; 47.6%) >friends (65; 38.2%) >patient association (3; 1.8%). Emotional (168; 98.8%) and financial (137; 80.6%) supports were mostly accessible from family, while drug support (118; 69.4%) was largely received from NGO. Seeking emotional support from family or friends (159; 93.5%) was the most effective coping mechanism. Medication adherence was higher among patients who received health information (p=0.02) and drug support (p=0.03) from the NGO. There was no difference in medication adherence of patients with or without emotional (p=0.20) and financial support (p=0.53) from family, as well as from friends (p=0.31 and p>0.99, respectively). CONCLUSION: Nearly ninety per cent of DS-TB patients had optimal adherence. Family was the most available source of social support for TB management, with one hundred and approximately eighty-two per cent respectively citing emotional and financial support as most accessible from the family. Emotional support from family or friends was the most effective coping mechanism in TB management. There is generally a need for initiation and implementation of an expanded social support system for DS-TB patients as a critical step towards achieving the WHO End-TB strategy milestone target.