Perhaps, the complexity of TB treatment adherence can be best understood against key adherence barriers. Obstacles to TB medication adherence can be found on both the demand and the supply side of TB care.
Supply-side factors can be inadequate drug stocks at the point of care, long waiting times and long distances to health facilities to access care. However, supply-side factors are only a fraction of the problem.
Demand-side barriers to TB medication adherence are to a large extent, drivers to non-adherence. These obstacles include lack of understanding by patients regarding the importance of treatment adherence, lack of support from family and community and poverty.
The inability to pay for the costs of TB care is a key problem faced by TB patients in poverty. TB care costs that TB patients have to cover out-of-pocket are not only direct medical care costs such as X-ray tests but also indirect treatment costs including travel, accommodation, nutritional supplements, and income loss.
A recent study measured catastrophic costs due to tuberculosis treatment in Vietnam. According to this study, “the proportion of households experiencing catastrophic total costs due to TB in Vietnam is high, which poses a barrier to TB diagnosis and treatment.”
Patients who stop TB medication before completion can leave them infectious and symptomatic. This feeds a vicious circle of more people being infected, longer treatment regimes for the patient and higher costs for health providers and patients.
What if we could provide the TB patient with a novel and tangible financial incentive to complete TB treatment?
This is what the HIT Foundation is planning to do in collaboration with the National Lung Hospital (NLH) and the National TB Program (NTP) in Vietnam.
Integrating financial incentives in medication adherence programs has been shown to work. We are building on the available evidence and on our experience so far in Viet Nam to implement a solution that has the potential to make the difference. Tackling the problem at source!