Factors Associated with Medical Follow-Up Adherence for Patients on All-Oral Regimen for Multidrug-Resistant Tuberculosis in Shenzhen, China

Hui Li,1,&ast; Hailin Zhang,1,&ast; Juan Xiong,2,&ast; Yi Wang,1 Weiyu Wang,1 Jingjing Wang,1 Yi Lin,1 Peize Zhang1 1Department of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, Shenzhen, People’s Republic of China; 2School of Public Health, Health Science Center, Shenzhen University, Guangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yi Lin; Peize ZhangDepartment of Pulmonary Medicine & Tuberculosis, The Third People’s Hospital of Shenzhen, No. 29, Bulan Road, Longgang District, Shenzhen, Guangdong, 518112, People’s Republic of ChinaTel +86-0755-6122 2333Fax +86 0755 6123 8928Email 514195263@qq.com; 82880246@qq.comPurpose: The aim of this study is to identify factors affecting medical follow-up adherence of pulmonary multidrug-resistant tuberculosis (MDR-TB) patients on an all-oral regimen in Shenzhen, China to enhance intervention measures for increased treatment success.Methods: A cohort study was conducted in The Third People’s Hospital of Shenzhen on MDR-TB patients switched to an all-oral regimen to evaluate effectiveness following the WHO’s recommendation in late 2018. We recruited patients in the group for an opinion survey on medical follow-up adherence from May 2019 to June 2020. The survey was designed with socio-demographic questions in collecting baseline characteristics and importance and Likert closed-ended questions for measuring opinions and relevance of different factors to adherence. Linear regression model was used to analyze data collected.Results: The findings revealed that gender difference (P = 0.828) had no correlation with adherence. Marital status (P = 0.014), financial situation (P < 0.001) and difficulties encountered with medical appointment booking procedures (P = 0.001) were significantly associated with medical follow-up adherence. Single (including widowed and divorced) patients, those with low household income and patients having difficulties making online medical appointment booking, were at higher risk of defaulting from routine MDR-TB medical follow-up.Conclusion: Our survey revealed that financial burden, being single and a non-user friendly medical appointment booking system are the main barriers to patients’ medical follow-up compliance. More financial assistance, better patient support and simplifying medical appointment booking procedures are facilitators of better treatment adherence.Keywords: MDR-TB, patient care, treatment adherence, all-oral regimen, patient suppor