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

Introduction: Lesotho remains one of the world's 30 high-tuberculosis (TB) burden countries. In Butha-Buthe district, unfavourable TB treatment outcomes were higher than that 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. Methods: 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. Results: 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. Conclusion: 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.