Factors affecting patients' compliance to anti-tuberculosis treatment in Yemen

Objectives To identify the risk factors associated with patient non-compliance to anti-tuberculosis treatment among Yemini tuberculosis (TB) patients. Methods A prospective nested case-control study was conducted. Non-compliant cases were recruited from a cohort of TB patients registered between July 2007 and June 2008 in 10 governorates. Three forms were used for data collection that covered interviewing the participants and reviewing their medical cards and TB registers. Independent variables extracted from univariate logistic regression were analysed in multivariate regression to identify independent risk factors for non-compliance. Results Descriptive statistics showed that approximately 90% of the respondents were at their most economically productive age (15-54 years; with mean (standard deviation) of 32.1 (+/- 13.6)). The response rate for the study was 87.8%. By the end of the follow-up period a total of 133 cases were identified. A non-compliance rate of 16.3% has been found. In the multivariate logistic regression analysis, factors that remained independently associated with non-compliance were: place of residence, literacy, travelling time, waiting time, employment, living status, family support, stigma, khat chewing and patients' knowledge of TB. Conclusion Results, imply existence of human resource gaps and TB staff inadequately prepared to deal with complex issues of TB patients. This study suggests that reducing travelling and waiting times for TB patients may improve compliance rates. This may be achieved by expansion of directly observed treatment short-course near to patients' homes and involving additional staff. Improved education for patients and offering free services for unemployed may also improve compliance.