Adhésion au traitement antituberculeux et à la thérapie antirétrovirale chez les patients Co-infectés TB/VIH des formations sanitaires formelles et informelles de la ville de Douala

Objectif : Analyser les facteurs d’adhésion au traitement antituberculeux et à la thérapie antirétrovirale chez les patients co-infectés TB/VIH dans les formations sanitaires formelles et informelles de la ville de Douala.

Méthode : En 2019, nous avons mené une étude cas-témoins sur une durée de 10 mois dans les FOSA formelles et informelles de la ville de Douala. Un échantillon de convenance de 42 patients (07 venant des FOSA informelles et 35 venant des FOSA formelles) co-infectés TB/VIH a été réalisé pour des raisons d’accessibilité. Après l’obtention d’un consentement éclairé des patients co-infectés, nous les avons administrés un questionnaire. Les données recueillies ont fait l’objet d’un traitement à l’aide des logiciels SPSS-22, Microsoft Excel et Microsoft Word.

Résultats et discussion : Pendant la période de collecte nous avons eu 07 cas de co-infection TB/VIH dans les FOSA informelles qui ont été référé dans les CDT (Laquintinie n = 1, Ad lucem bonamoussadi n = 1, Dispensaire catholique barcelone n = 1, Cité des Palmiers n = 2, Mboppi n = 2). Nous avons ainsi eu 35 cas dans les FOSA formelles (Laquintinie n = 5, Ad lucem bonamoussadi n = 5, Dispensaire catholique barcelone n = 5, Cité des Palmiers n = 10, Mboppi n = 10). Parmi les 07 patients co-infectés TB/VIH venant des FOSA informelles, 71,4% appartenaient au groupe d’âge compris entre 31 et 40 ans. Les facteurs liés aux patients enquêtés et les facteurs liés au traitement n’influencent pas l’adhésion au traitement. L’association n’est pas statistiquement significative au seuil de significativité de 5%. La valeur de p est de 0,001, il ressort clairement que, concernant les facteurs liés à l’environnement thérapeutique, seule la raison de la consultation dans la formation sanitaire influence l’adhésion au traitement des patients enquêtés. L’association est statistiquement significative au seuil de significativité de 5%.

Conclusion : Les principaux résultats montrent que la majorité des patients venant des formations sanitaires formelles et informelles adhéraient aux différents traitements. Il n’y a pas de différence dans l’adhésion aux traitements dans les deux groupes.

Mots clés : Adhésion, traitement antituberculeux, thérapie antirétrovirale, patient, co-infection TB/VIH, formation sanitaire formelle, formation sanitaire informelle.

English
Abstract

Context: Tuberculosis and HIV remains the principal determinants of morbidity and mortality in the developing world. Restricted access to proper health services with respect to these transmissible infections as per the poorer masses has played a great obstacle and challenge in obtaining the 2030 sustainable development Goal. Late diagnosis and testing of patients co-infected with TB/HIV has been the principal cause of deaths and increase mortality amongst these group of people. As a matter of facts, an estimated 10.4million infections were detected in 2015 with only 6.1 million cases recorded and notified giving a drastic difference of 4.3 million cases still not notified.

Objective: Analyzing the adherence factors with respect to anti-tuberculosis treatment and anti-retroviral therapy amongst patients co-infected with TB/HIV in the Formal and informal health facilities within the city of Douala.

Method: In 2019, an epidemiological survey was carried out based on firsthand knowledge from patients during a period of 10months within the formal and informal health facilities in the city of Douala. A total of 42 samples were collected based on confidence and public health ethics from patients co-infected with TB/HIV (7, of the 42 samples came from patients in the informal health facilities and 35 came from those in the formal health facilities) was realized with issues of accessibility. With mutual consent from both the patients co-infected with TB/HIV and the surveillance team, a questionnaire was administered to them. After wish, the data and statistics obtained were analyzed with the used and help of SPSS-22, Microsoft Excel and Microsoft Word.

Results and Discussion: During the collection period, we had 7 cases of co-infection TB/HIV coming from the informal health facilities which were however referred to the CDT(Laquintinie n=1, Ad lucem bonamoussadi n=1, Dispensaire Catholique Barcelone n=1, Cité des palmiers n=2, Mboppi n=2. However, we had 35 cases coming from the formal health facilities (Laquintinie n=5, Ad lucem bonamoussadi n=5, Dispensaire Catholique Barcelone n=5, Cité de palmiers n=10, Mboppi n=10). Amongst the 7 patients co-infected with TB/HIV coming from the informal health facilities,71.4% of these patients belonged to the age group between 31 to 40 years old. The factors linked to patient and the factors linked to treatment of these patients were increasingly a challenge to their adherence to treatment. The association is not statistically significant to the significance of 5%. The p-value is 0.001, proving that concerning the factors linked to the therapeutical environment, adherence to treatment by the patients screened was greatly influenced by the consultation in the health facilities. The association is statistically significant at the 5% significance.

Conclusion: The results obtained, shows that most patients coming from both the formal and informal health facilities adhere to treatment differently giving us a major result of no difference in adherence to treatment.

Key Words: Adherence, anti-tuberculosis treatment, anti-retroviral therapy, co-infection TB/VIH, formal health facilities, informal health facilities.