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Nonadherence to Antituberculosis Medications: The Impact of Stigma and Depressive Symptoms

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  • 1 School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China;
  • | 2 Bao’an Central Hospital of Shenzhen, Shenzhen, P.R. China;
  • | 3 Center for Disease Control and Prevention, Wuhan, P.R. China

Medication nonadherence is common among tuberculosis (TB) patients in China and is of great concern. Herein, we determined the incidence of nonadherence in TB patients in central China and the impact of stigma and depressive symptoms on adherence; these issues are relatively unexplored. A cross-sectional survey was performed, and 1,342 TB patients were recruited from TB dispensaries in three counties in Hubei province using a multistage sampling method. The patients completed structured questionnaires that addressed medication adherence, TB-related stigma, and depressive symptoms. The independent effects of stigma and depressive symptoms on adherence were determined via multinomial logistic regression analysis. The mean medication adherence score was 6.03 ± 1.99. The percentage of TB patients with high, medium, and low medication adherence was 32.12%, 34.58%, and 33.31%, respectively. The impact of stigma and depressive symptoms on medication adherence was significant. TB patients with medium (odds ratios [OR]: 1.54, 95% confidence interval [CI]: 1.08–2.21) or high (OR: 5.32, 95% CI: 3.34–8.46) stigma or patients with mild (OR: 1.92, 95% CI: 1.34–2.75) or severe (OR: 3.67, 95% CI: 2.04–6.61) depressive symptoms showed a higher likelihood of having low adherence than those with low stigma or without depressive symptoms. TB-related stigma and depressive symptoms were common among TB patients in China, as was nonadherence, and independently associated with their adherence behavior. Social and psychological interventions that combat stigmatization and depression in TB patients should be adopted and optimized to improve medication adherence.

Author Notes

Address correspondence to Yanhong Gong or Zuxun Lu, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Rd., Wuhan 430030, P. R. China. E-mails: gongyanhong@hust.edu.cn or zuxunlu@yahoo.com

Financial support: This project was funded by Young Scholars Fund of the Health and Family Planning Commission of Hubei Province (No. QJX2012-25) and Major Program of National Fund of Philosophy and Social Science (No. 15ZDC037).

Authors’ addresses: Shijiao Yan, Xiaoxv Yin, Zuxun Lu, and Yanhong Gong, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, E-mails: iamjiaoha@126.com, yxx@hust.edu.cn, zuxunlu@yahoo.com, and gongyanhong@hust.edu.cn. Shengchao Zhang, Bao’an Central Hospital of Shenzhen, Shenzhen, China, E-mail: pocoo@126.com. Yeqing Tong, Center for Disease Control and Prevention, Wuhan, China, E-mail: 63382251@qq.com.

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