Anti-TB treatment non-adherence predictors: A multi-center cross-sectional study in Kandahar, Afghanistan.

BACKGROUND: Adherence to anti-TB treatment in low- and middle-income countries (LMICs), including Afghanistan, is critical for global TB control.

OBJECTIVES: We aimed to determine anti-TB treatment non-adherence prevalence and its predictors in Kandahar, Afghanistan.

METHODS: We conducted a multi-center cross-sectional study of 579 TB patients in Kandahar, using a systematic random sampling method, and collected their data on sociodemographic attributes, clinical factors, and mental health. The eight-item Tuberculosis Medication Adherence Questionnaire (TBMAQ) was used for labeling TB patients as adherent or non-adherent. We assigned a score of ≤4 (the cut-off) as non-adherence. We performed the multivariable logistic regression to probe significant predictors of non-adherence.

RESULTS: The non-adherence rate in this study was 66.8% (95% CI: 62.9-70.5). Being uneducated (AOR = 1.66, 95 % CI: 1.09-2.53), having a comorbid medical condition (AOR = 2.57, 95 % CI: 1.39-4.74), feeling stigmatized for having TB (AOR = 9.25, 95 % CI: 4.72-18.1), and having a comorbid depression (AOR = 1.77, 95 % CI: 1.16-2.71) were associated with non-adherence.

CONCLUSION: Anti-TB treatment adherence needs to be prioritized among TB patients overall, particularly in those with a low level of education, comorbidity, perceived TB-related stigma, and comorbid depression with consistent evidence of increased non-adherence.