Patients' Perceptions of Compliance with Tuberculosis Medication in Lamongan

Treatment non-adherence in tuberculosis (TB) patients is a challenge in TB treatment. This research was an observational analysis study with a cross-sectional design. The population of this study were all tuberculosis patients at Karanggeneng Community Health Center, Lamongan from January to September 2018 who were still undergoing treatment process. Total sampling technique was utilized which obtained 40 patients. The data were collected through a closed questionnaire sheet of the method applied by the MMAS (Morisky Medication Adherence Scale). Then, the data were analyzed by editing, coding, scoring and tabulating. The results showed that 92% of patients adhered to Tuberculosis treatment and their influential perceptions included patients’ belief, family support, and motivation from health personnel. Treatment supporter is very influential on the success of Tuberculosis therapy.


INTRODUCTION
Indonesia is a tropical climate country where it is more susceptible to contracting infectious diseases compared to temperate countries. In the tropical country, environmental conditions tend to have high humidity which affects high biological growth as a support for biodiversity including pathogens, hosts and vectors. In addition, low public awareness results in poor control of infectious and tropical diseases. One of the tropical diseases is Tuberculosis (TBC) 1. Pulmonary tuberculosis (TB) is an infectious disease caused by Mycrobacterium tuberculosis infection in the lower respiratory tract. Pulmonary tuberculosis is still a current issue of community health besides being a global health issue in foreign countries. The World Health Organization (WHO) reported that there were 22 countries included in high burden categories for Tuberculosis (high Burden of TBC Number). A total of 8.9 million TB patients with a percentage of 80% in 22 developing countries had 3 million deaths per year and one person could be infected by Tuberculosis per second. Indonesia is currently ranked among the fifth countries with the highest TB burden in the world 2. Globally, TB is the leading cause of infectious diseases death for more than 1.5 million people in Indonesia 3.
Treatment non-adherence in tuberculosis (TB) patients is a challenge in TB treatment. Directly observed treatment (DOT) or direct medication surveillance to monitor and ensure adherence still has several limitations in countries with high incidence of tuberculosis. Most digital technology compliance emphasizes the medication reminder function; however, two-way communication platforms should provide face-to-face meeting between health worksers and patients and focus on improving treatment adherence. Ensuring adherence to treatment is a critical activity for ending TB epidemic. Although directly observed treatment (DOT) is considered the most effective strategy to ensure medication adherence, it still has limitations of poor implementation including expensive travel costs, time consumption, invasion privacy and disruption of patient lifestyle 3.
Bishara, et al., (2014) stated that because the incidence of TB had decreased in developed countries, the diagnosis and treatment of latent TB infection (LTBI) had become increasingly important.
It is estimated that 5-10% of people with LTBI continue to spread the TB virus; therefore, the important role of LTBI treatment in eliminating TB must be addressed. However, it was found that the level of adherence of LTBI was low and non-adherence was a major barrier in achieving the full benefit of LTBI treatment.
A survey that was conducted at one of the community health centers (Puskesmas) in the Lamongan from January to September 2018 had found 54 tuberculosis patients. Thirthy-seven (37) out of 54 patients or 68.5% of the patients routinely sought treatment, 2 patients (3.7%) failed in the treatment, 14 patients (25.92%) succeeded in the treatment, and 1 patient (1.85%) exposed to Multy Drugs Resistance (MDR). Based on the preliminary survey, it was found that some patients had failed in the treatment. To increase patient adherence in taking medication regularly, the role of treatment supporters is very important. This is because they support TB patients to seek regular medication until

RESULTS
The results of the research exposed the characteristics of respondents as shown in table 1.  Table 1 showed that more than half of the respondents were male (67.5%). Treatment adherence to tuberculosis patients is shown in Figure 1 illustrating that the majority of respondents (92%) were adherent in carrying out TB treatment.  Table 1 showed that more than half of the respondents were male (67.5%). Budi et al., (2018) revealed that there was a relationship between gender and the incidence of tuberculosis, in which men had a 1.8 times risk of contracting tuberculosis than women with a 64% probability. Men have higher mobility than women so that they are more likely to be exposed to the disease. Another factor is a poor lifestyle such as smoking and consuming alcohol which makes it easier for them to be infected with pulmonary tuberculosis 6. Characteristics of respondents based on age indicated that the majority of patients (85%) were at productive age, 20-59 years. Productive age is very vulnerable to the transmission because people tend to interact with others. They also have high mobility which enables them to transmit their disease to other people as well as the surrounding environment 7. Risk factors which affect infection of tuberculosis in Indonesia were education, ownership index, cooking fuel, room conditions and smoking behavior 8 .
Treatment adherence to tuberculosis patients is shown in Figure 1 illustrating that the majority of respondents (92%) were adherent in carrying out TB treatment. Treatment adherence was an important part of chronic disease management 9 . Excellent treatment adherence contributed to a reduction in morbidity and mortality 10. Poor drug adherence incresed resistance to TB treatment 11 . Treatment non-adherence in patients is mainly due to lack of access or forgetfulness. Nonadherence can often be a choice that is deliberately made by the patient. Other factors that affected patient compliance were belief, communication, and empathy which are not easily measured by current administrative databases 13 . Non-adherent patients (8%) stated that they did not have a supporter to remind them to take the medicine according to the time. Besides, they were the lack of motivation from the family especially in carrying out routine control to the doctor when the therapy period needed to be renewed.
Adherence to treatment depends on a variety of factors, including individual characteristics and interactions with healthcare providers. Non-adherence in treatment led to failure of therapeutic goals 14 .
Completion of anti-tuberculosis treatment is very important for TB patients, as well as an effort to control Tuberculosis globally. However, there was no standard measure to monitor adherence to tuberculosis treatment 15 .
Knowledge, social support, side effects and long treatment duration are factors that hinder treatment adherence. Distance to health facilities, good communication and attitudes from health service providers are factors of good medication adherence. Comprehensive education from health workers would increase patient enthusiasm for treatment 16 .

CONCLUSION
Almost all tuberculosis patients at Kranggeneng Community Health Center, Lamongan are adhere to treatment. Adherence to taking medication is affected by the role of the family, belief in the success of therapy and the role of health workers.