# Tuberculosis treatment adherence and associated factors in the Butha-Buthe district, Lesotho: a retrospective cohort study

## TL;DR

This study examines poor TB treatment adherence in Lesotho's Butha-Buthe district and identifies factors like age and social support that influence it.

## Contribution

The study provides district-specific insights into TB treatment adherence and identifies modifiable factors to improve outcomes.

## Key findings

- The overall TB treatment adherence rate was 37.20% in Butha-Buthe district.
- Age ≥60 years, mine workers, and pulmonary TB patients showed lower adherence.
- Social support from family, friends, and spouses was associated with better treatment adherence.

## Abstract

Lesotho remains one of the world's 30 high-tuberculosis (TB) burden countries. In Butha-Buthe district, unfavourable TB treatment outcomes were higher than those set forth by the WHO. This study's objective was to evaluate TB treatment adherence and treatment resistance among patients enrolled in the 12 health facilities in Butha-Buthe.

data were collected from the medical records of patients with sputum smear-positive TB and extra-pulmonary forms of TB between January 2015 and December 2020. Results were presented in frequencies and percentages. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with treatment adherence.

among 1,792 patients who were enrolled, 1,320 were included in the study. The overall mean TB treatment adherence rate was estimated at 37.20%. Factors found to be associated with treatment adherence in multivariate analysis were age ≥60 years (aOR: 0.59, 95%CI: 0.54- 0.66; P<0.001), being a mine worker (aOR 1.09, 95%CI: 1.03-1.14; P<0.001), having pulmonary TB (aOR: 1.23, 95%CI: 1.17-1.29, P<0.001), being in the continuation phase of the treatment (aOR 1.38, 95%CI: 1.33, 1.45; P<0.001) and category 2 (aOR 0.93, 95%CI: 0.88-0.99; P = 0.016). Regarding TB contact support, family members (aOR: 1.08, 95%CI: 1.03-1.14; P<0.001), friends (aOR 1.30, 95%CI: 1.19-1.41; P<0.001), spouses (aOR: 1.24, 95%CI 1.16-1.34; P<0.001), and unreported contacts (aOR 1.18, 95%CI: 1.09-1.27; P = 0.015) all showed increased TB adherence.

the overall adherence to TB therapy was poor in Butha-Buthe district. Lesotho urgently needs district-level strategies to improve TB treatment adherence and reduce treatment resistance.