IntroduÃÃo: A aderÃncia ao tratamento de doenÃas crÃnicas à uma questÃo complexa e envolve nÃo sà a responsabilidade das pessoas afetadas, mas tambÃm das equipes profissionais de saÃde e das redes sociais. Nos Ãltimos anos, a nÃo adesÃo à poliquimioterapia (PQT) foi reduzida significativamente no Brasil. No entanto, a questÃo ainda à um obstÃculo importante no controle da doenÃa, podendo levar a permanÃncia de fontes de infecÃÃo, cura incompleta, complicaÃÃes irreversÃveis e multiresistÃncia. MÃtodos: Realizamos um estudo de base populacional em 78 municÃpios pertencentes a uma Ãrea endÃmica (cluster 1) de hansenÃase, no norte do estado de Tocantins. Tocantins à o estado com os maiores Ãndices de taxa de detecÃÃo anual (88.54/100.000 na populaÃÃo geral e 26.48/100.000 em <15 anos em 2009). Aplicou-se questionÃrio estruturado com perguntas relativo a caracterÃsticas sÃciodemogrÃficas, clÃnicas, relacionadas ao serviÃo e comportamento. Para a anÃlise de fatores de risco definiu-se faltoso como indivÃduos que nÃo completaram as doses supervisionadas em 7 meses (PB) e em 13 meses (MB), e abandono o paciente que nÃo compareceu nos Ãltimos 12 meses à unidade de saÃde onde faz o tratamento. Resultados: Do total de 936 indivÃduos incluÃdos na anÃlise, 491 (52,5%) eram do sexo masculino. A idade variou de 5 a 99 anos (mÃdia = 42,1 anos). Duzentos e vintecinco (24,0%) eram analfabetos. No total, 497 (55,6%) foram classificados como PB, e 395 (44,1%) como MB. Foram identificados 28 (3,0%) pacientes que abandonaram PQT; 16 abandonos foram detectados pela revisÃo do sistema de informaÃÃo SINAN, e um adicional de 12 abandonos no local nos prontuÃrios dos pacientes durante o trabalho de campo. No total, 147/806 (18,2%) foram identificados como faltosos. O abandono foi significativamente associado com: baixo nÃmero de cÃmodos por domicÃlio (OR = 3,43; intervalo de confianÃa de 95%: 0,98-9,69, p = 0,03); mudanÃa de residÃncia apÃs o diagnÃstico (OR = 2,90; 0,95-5,28; p = 0,04) e baixa renda familiar (OR = 2,42; 1,02-5,63; p = 0,04). Falta Ãs doses supervisionadas mostrou associaÃÃo com: baixo nÃmero de cÃmodos por domicÃlio (OR = 1,95; 0,98-3,70; p = 0,04); dificuldade em engolir remÃdios da PQT (OR = 1,66; 1,03-2,63; p = 0,02); falta temporÃria de PQT nos centros de saÃde (OR = 1,67; 1,11-2,46; p = 0,01) e mudanÃa de residÃncia apÃs o diagnÃstico (OR = 1,58; 1,03-2,40; p = 0,03). A regressÃo logÃstica identificou que a falta temporÃria de PQT foi um fator de risco independente para os faltosos (OR ajustada = 1,56; 1,05-2,33; p = 0,03), e o tamanho da residÃncia foi fator de proteÃÃo (OR ajustada = 0,89 por cada quarto adicional; 0,80-0,99, p = 0,03). O tamanho da residÃncia tambÃm foi independentemente associada à falta no tratamento (OR ajustada = 0,67; 0,52-0,88; p = 0,003). AlÃm disso, foram identificados 334 (35,6%) participantes que disseram que tinham interrompido a PQT pelo menos uma vez. O tempo mÃdio de interrupÃÃo indicado pelos participantes foi de 15 dias, com um mÃximo de trÃs anos (variaÃÃo interquartil: 6-30 dias). A razÃo mais comum para a interrupÃÃo dada pelos pacientes foi a nÃo disponibilidade de medicamentos no respectivo centro de saÃde (211; 62,9%), seguido por esquecimento (44; 12,0%) e efeitos adversos à PQT (28; 8,3%). ConclusÃes: O estudo mostra que ainda existem desafios a serem enfrentados em relaÃÃo à adesÃo à PQT no Brasil. Como conseqÃÃncia dos esforÃos realizados pelo programa de controle de hansenÃase do Estado do Tocantins, fatores relacionados ao serviÃos desempenharam um papel menor, apesar de escassez intermitente de fornecimento de medicamentos. Uma abordagem integrada à necessÃria para melhorar ainda mais o controle, focando nos grupos populacionais mais vulnerÃveis, como as populaÃÃes carentes e migrantes. Produtores da PQT devem considerar outras formulaÃÃes orais mais facilmente aceitas pelos pacientes. Considerando as conseqÃÃncias da baixa adesÃo ao tratamento, tais como o possÃvel desenvolvimento de resistÃncia do Mycobacterium leprae contra os antibiÃticos da PQT, e persistÃncia de fontes de transmissÃo em comunidades, futuros estudos devem ser aprofundados para melhorar a aderÃncia à PQT, principalmente em regiÃes hiperendÃmicas / Background: Adherence to treatment of chronic diseases is a complex issue and involves not only responsibility of the diseased persons, but also the health professional teams and the patientsâ social networks. In the last years, non-adherence to multidrug therapy (MDT) against leprosy has been reduced significantly in Brazil. However, low adherence to MDT is still an important obstacle of disease control, and may lead to remaining sources of infection, incomplete cure, irreversible complications, and multidrug resistance. Methods: We performed a population-based study in 78 municipalities pertaining to a leprosy hyperendemic cluster in northern Tocantins State, central Brazil. Tocantins is the State with highest leprosy detection rates (annual detection rate of 88.54/100.000 in the general population, and of 26.48/100.000 in <15 year-olds in 2009). We reviewed the database of the National Information System for Notifiable Diseases (Sistema de InformaÃÃo de Agravos de NotificaÃÃo â SINAN), and applied structured questionnaires on leprosy-affected individuals regarding socio-demographic, clinical, service-related and behavior-related characteristics. Two different outcomes for assessment of risk factors were used: defaulting (defined as individuals with incomplete MDT not presenting to the health care center for monthly supervised treatment for >12 months); and interruption of MDT (defined as duration PB treatment > 7 months; and of MB treatment > 13 months). In addition, we asked participants who said that they had interrupted MDT at least once in an open question about their reasons for interrupting. Results: Of the total of 936 individuals included in data analysis, 491 (52.5%) were males; the age ranged from 5 to 99 years (mean=42.1 years). Two-hundred and twenty-five (24.0%) were illiterate. In total, 497 (55.6%) were classified as PB, and 395 (44.1%) as MB leprosy. We identified 28 (3.0%) patients who defaulted MDT; 16 defaulters were included by reviewing the SINAN data information system, and an additional 12 locally in the patientsâ charts during field work. In total, 147/806 (18,2%) interrupted MDT. Defaulting was significantly associated with: low number of rooms per household (OR=3.43; 95% confidence interval: 0.98â9.69; p=0.03); moving to another residence after diagnosis (OR=2.90; 0.95â5.28; p=0.04); and low family income (OR=2.42; 1.02â 5.63: p=0.04). Interruption of treatment was associated with: low number of rooms per household (OR=1.95; 0.98â3.70; p=0.04); difficulty in swallowing MDT drugs (OR=1.66; 1.03â2.63; p=0.02); temporal non-availability of MDT at the health center (OR=1.67; 1.11â2.46; p=0.01); and moving to another residence (OR=1.58; 1.03â2.40; p=0.03). Logistic regression identified temporal nonavailability of MDT as an independent risk factor for treatment interruption (adjusted OR=1.56; 1.05â2.33; p=0.03), and residence size as a protective factor (adjusted OR=0.89 per additional number of rooms; 0.80â0.99; p=0.03). Residence size was also independently associated with defaulting (adjusted OR=0.67; 0.52â0.88; p=0.003). In addition, we identified 334 (35.6%) participants who said that they had interrupted MDT at least once. The median time of interruption stated by study participants was 15 days, with a maximum of three years (interquartile range: 6-30 days). The most common reason for interruption given by these was non-availability of medication at the respective health care centre (211; 62.9%). Others forgot to take the medicine (44; 12.0%) or interrupted due to drug-related adverse events (28; 8.3%). Conclusions: The study shows that there are still challenges to be tackled regarding MDT in Brazil. As a consequence of the efforts done by the Tocantins State Leprosy Control Program, healthservice related factors played a minor role, despite intermittent shortage of drug supply. An integrated approach is needed for further improving control, focusing on the most vulnerable population groups such as the socio-economically underprivileged and migrants. MDT producers should consider oral drug formulations that may be more easily accepted by patients. Considering the consequences of low adherence to treatment, such as possible development of MDT resistance, and persisting sources of transmission, future in-depth studies are needed to improve further adherence, mainly in hyperendemic regions

HIV/AIDS is the world's most urgent public health challenge. It is the leading cause of death for young adults worldwide. There is as yet no vaccine and no cure. The high unemployment rate and poverty experienced in South Africa contribute to the high HIV/AIDS infection levels experienced in the country. With the vast majority of HIV/AIDS cases and the growth in the number of people infected who will look towards publicly funded hospitals for medical care, the financial strain on government hospitals and pharmacies will be severe, not only as a result of the sheer number of people seeking healthcare, but also because healthcare for HIV/AIDS patients is more expensive than for most other conditions. Antiretroviral treatment is the main type of treatment for HIV/AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a patient's life. Antiretroviral treatment has complex and rigorous dosing requirements. The aim of antiretroviral treatment is to keep the amount of HIV/AIDS in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV/AIDS might have caused already. Medication compliance means taking the medications exactly as prescribed by the doctor for the amount of time intended. Medication noncompliance, on the other hand, means taking medications in any way other than what the doctor prescribed. While noncompliance may not seem like a big deal, it can have serious consequences. The challenge of optimizing adherence to anti-retroviral treatment remains paramount in the treatment of HIV/AIDS. The purpose of this study is to establish the cost of a patient defaulting anti-retroviral treatment per month, and to determine the financial and economic impact that defaulting patients has on General de la Rey and Thusong Hospital Complex Pharmacies. The study further aims to prove that the risk of patient defaulting is a barrier to achieve organisational excellence through healthcare delivery. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2009.

HIV/AIDS is the world's most urgent public health challenge. It is the leading cause of death for young adults worldwide. There is as yet no vaccine and no cure. The high unemployment rate and poverty experienced in South Africa contribute to the high HIV/AIDS infection levels experienced in the country. With the vast majority of HIV/AIDS cases and the growth in the number of people infected who will look towards publicly funded hospitals for medical care, the financial strain on government hospitals and pharmacies will be severe, not only as a result of the sheer number of people seeking healthcare, but also because healthcare for HIV/AIDS patients is more expensive than for most other conditions. Antiretroviral treatment is the main type of treatment for HIV/AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a patient's life. Antiretroviral treatment has complex and rigorous dosing requirements. The aim of antiretroviral treatment is to keep the amount of HIV/AIDS in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV/AIDS might have caused already. Medication compliance means taking the medications exactly as prescribed by the doctor for the amount of time intended. Medication noncompliance, on the other hand, means taking medications in any way other than what the doctor prescribed. While noncompliance may not seem like a big deal, it can have serious consequences. The challenge of optimizing adherence to anti-retroviral treatment remains paramount in the treatment of HIV/AIDS. The purpose of this study is to establish the cost of a patient defaulting anti-retroviral treatment per month, and to determine the financial and economic impact that defaulting patients has on General de la Rey and Thusong Hospital Complex Pharmacies. The study further aims to prove that the risk of patient defaulting is a barrier to achieve organisational excellence through healthcare delivery. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2009.

The study investigated the knowledge levels of clients on long-term tuberculosis (TB) treatment at Kwekwe General Hospital, Zimbabwe. A quantitative, descriptive research design was chosen and data was collected using a structured questionnaire with a convenience sample of 60 clients on TB treatment and 10 professional nurses. The major findings of the study were that although clients had some knowledge about their condition, there was a lack of knowledge regarding critical aspects such as information on drug-resistant TB and the Directly Observed Therapy Short Course. The professional nurses experienced constraints such as insufficient time for appropriate health education and home visits. Based on the study findings and conclusions, several recommendations were made. / Health Studies / Thesis(M.A(Health Studies))

The purpose of the study was to investigate the factors associated with the interruption of tuberculosis treatment in the Swakopmund district of Namibia. A descriptive cross-sectional survey was conducted. Data was collected using a structured questionnaire administered by interviewers. The population consisted of both treatment interrupters and non-interrupters. The total sample was 143 respondents. The findings revealed that three factors were significantly associated with TB treatment interruption, namely a lack of formal education (p = 0.032), lack of access to media (p = 0.017), and clinic opening times (p = 0.000). Recommendations made include improving the support given to TB patients, increasing their understanding of TB and adopting new research and technology. / Health Studies / M.A. (Public Health)

<p>Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The&nbsp / global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa,&nbsp / one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in&nbsp / Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many&nbsp / parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate&nbsp / the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using&nbsp / in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible&nbsp / participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient&rsquo / s experiences of the illness / socio- economic / community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service&nbsp / factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in&nbsp / Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these&nbsp / factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the&nbsp / study are made. </p>

<p>Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The&nbsp / global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa,&nbsp / one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in&nbsp / Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many&nbsp / parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate&nbsp / the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using&nbsp / in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible&nbsp / participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient&rsquo / s experiences of the illness / socio- economic / community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service&nbsp / factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in&nbsp / Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these&nbsp / factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the&nbsp / study are made. </p>

The study investigated the knowledge levels of clients on long-term tuberculosis (TB) treatment at Kwekwe General Hospital, Zimbabwe. A quantitative, descriptive research design was chosen and data was collected using a structured questionnaire with a convenience sample of 60 clients on TB treatment and 10 professional nurses. The major findings of the study were that although clients had some knowledge about their condition, there was a lack of knowledge regarding critical aspects such as information on drug-resistant TB and the Directly Observed Therapy Short Course. The professional nurses experienced constraints such as insufficient time for appropriate health education and home visits. Based on the study findings and conclusions, several recommendations were made. / Health Studies / Thesis(M.A(Health Studies))

Magister Public Health - MPH / Background: Tuberculosis (TB) is a resurgent disease in many parts of the world, fuelled by HIV/AIDS and poverty. According to WHO, over two billion people were estimated to be infected by TB globally, 9.4 million new cases of TB were reported, while about 1.7 million people were estimated to have lost their lives to TB in 2009 (WHO, 2010). The global defaulter rate for TB was estimated at about 9% in 2007 (WHO, 2007). With Africa remaining the global epicentre of the TB epidemic, the epidemic in Sub-Saharan Africa, one of the worst affected areas in the world, shows no evidence of decline (WHO, 2008). According to the 2009 MOHSS annual report, 1300 people lost their lives to TB in Namibia (MOHSS, 2010). The introduction of TB treatment saves many lives globally. However, despite this effort, TB patients have been reported to default treatment in many parts of the world including Namibia. Namibia reported a defaulter rate of 10% above the national target of less than 5% (Maletsky, 2008). Aim: This study aimed to investigate the factors that contribute to treatment defaulting amongst TB patients at a major health centre in Windhoek district, Namibia. Methodology: A descriptive qualitative study using in-depth interviews was conducted among ten TB defaulters. Key informant interviews were also conducted with the two TB nurses based at the health centre. Eligible participants were purposively selected. A thematic content analysis of transcribed data was conducted where themes related to patient’s experiences of the illness; socio- economic; community, family, cultural and religious as well as health system factors were drawn out. Results: The study results indicate that defaulting TB treatment is a big challenge to TB management. The reasons for defaulting given by respondents were complex and included patient factors such as medication related factors, lack of knowledge and information as well as alcohol abuse. The findings also revealed unemployment as a major socio-economic factor that contributes to defaulting. In addition, the study shows that community, family, religious and cultural factors such as poor family support, work-related factors and religious and cultural beliefs have an influence on defaulting. Accessibility to health care services, sharing of the TB department with ART patients and attitudes of health workers were identified as health service factors that influence treatment defaulting. This study also highlights the relationship between some of these factors. Conclusion: The study concludes that no single factor contributed to treatment defaulting amongst TB patients in the selected health centre in Windhoek district and this concurred with the literature. There are many different factors at different levels that have an influence on TB treatment defaulting. An interrelationship between personal, socio- economic, community, family, religious and cultural as well as health services- related factors was evident What makes it more complex is that these factors also impact on each other and therefore a holistic approach in the management of TB is required to address these factors. Recommendations based on the findings of the study are made. / South Africa

The purpose of the study was to investigate the factors associated with the interruption of tuberculosis treatment in the Swakopmund district of Namibia. A descriptive cross-sectional survey was conducted. Data was collected using a structured questionnaire administered by interviewers. The population consisted of both treatment interrupters and non-interrupters. The total sample was 143 respondents. The findings revealed that three factors were significantly associated with TB treatment interruption, namely a lack of formal education (p = 0.032), lack of access to media (p = 0.017), and clinic opening times (p = 0.000). Recommendations made include improving the support given to TB patients, increasing their understanding of TB and adopting new research and technology. / Health Studies / M.A. (Public Health)