Nonadherence to anti-tuberculosis treatment, reasons and associated factors among pulmonary tuberculosis patients in the communities in Indonesia

BACKGROUND: Tuberculosis (TB) is the world’s major public health problem. We assessed the proportion, reasons, and associated factors for anti-TB treatment nonadherence in the communities in Indonesia. METHODS: This national coverage cross-sectional survey was conducted from 2013 to 2014 with stratified multi-stage cluster sampling. Based on the region and rural-urban location. The 156 clusters were distributed in 136 districts/cities throughout 33 provinces, divided into three areas. An eligible population of age ≥15 was interviewed to find TB symptoms and screened with a thorax x-ray. Those whose filtered result detected positive followed an assessment of Sputum microscopy, LJ culture, and Xpert MTB/RIF. Census officers asked all participants about their history of TB and their treatment—defined Nonadherence as discontinuation of anti-tuberculosis treatment for <6 months. Data were analyzed using STATA 14.0 (College Station, TX, USA). RESULTS: Nonadherence to anti-TB treatment proportion was 27.24%. Multivariate analysis identified behavioral factors significantly associated with anti-TB treatment nonadherence, such as smoking (OR = 1.78, 95% CI (1.47–2.16)); place of first treatment received: government hospital (OR = 1.45, 95% CI:1.06–1.99); private hospital (OR = 1.93, 95% CI: 1.38–2.72); private practitioner (OR = 2.24, 95% CI: 1.56–3.23); socio-demographic and TB status included region: Sumatera (OR = 1.44, 95% CI: 1.05–1.98); other areas (OR = 1.84, 95% CI: 1.30–2.61); low level of education (OR = 1.60, 95% CI: 1.27–2.03); and current TB positive status (OR = 2.17, 95% CI: 1.26–3.73). CONCLUSIONS: Nonadherence to anti-TB drugs was highly related to the personal perception of the respondents, despite smoking, current TB status, a place for the first treatment, education, and region. The position of the first TB treatment at the private practitioner was significantly associated with the risk of Nonadherence to treatment.