abstract: 'Background: Non-adherence to tuberculosis (TB) treatment is an important

  barrier for TB control programs because incomplete treatment may result

  in prolonged infectiousness, drug resistance, relapse, and death. The

  aim of the present study is to explore enablers and barriers in the

  management of TB treatment during the first five months of treatment in

  Addis Ababa, Ethiopia.

  Methods: Qualitative study which included 50 in-depth interviews and two

  focus groups with TB patients, their relatives and health personnel.

  Results: We found that loss of employment or the possibility to work led

  to a chain of interrelated barriers for most TB patients. Daily

  treatment was time-consuming and physically demanding, and rigid

  routines at health clinics reinforced many of the emerging problems.

  Patients with limited access to financial or practical help from

  relatives or friends experienced that the total costs of attending

  treatment exceeded their available resources. This was a barrier to

  adherence already during early stages of treatment. A large group of

  patients still managed to continue treatment, mainly because relatives

  or community members provided food, encouragement and sometimes money

  for transport. Lack of income over time, combined with daily

  accumulating costs and other struggles, made patients vulnerable to

  interruption during later stages of treatment. Patients who were poor

  due to illness or slow progression, and who did not manage to restore

  their health and social status, were particularly vulnerable to

  non-adherence. Such patients lost access to essential financial and

  practical support over time, often because relatives and friends were

  financially and socially exhausted by supporting them.

  Conclusion: Patients'' ability to manage TB treatment is a product of

  dynamic processes, in which social and economic costs and other burdens

  change and interplay over time. Interventions to facilitate adherence to

  TB treatment needs to address both time-specific and local factors.'
affiliation: 'Sagbakken, M (Corresponding Author), Univ Oslo, Sect Int Hlth, Inst
  Gen Practice \& Community Med, POB 1130, NO-0318 Oslo, Norway.

  Sagbakken, Mette, Univ Oslo, Sect Int Hlth, Inst Gen Practice \& Community Med,
  NO-0318 Oslo, Norway.

  Frich, Jan C., Univ Oslo, Res Unit Gen Practice, Inst Gen Practice \& Community
  Med, NO-0318 Oslo, Norway.

  Bjune, Gunnar, Univ Oslo, Sect Int Hlth, Inst Gen Practise \& Community Med, NO-0318
  Oslo, Norway.'
article-number: '11'
author: Sagbakken, Mette and Frich, Jan C. and Bjune, Gunnar
author-email: 'mette.sagbakken@medisin.uio.no

  j.c.d.frich@medisin.uio.no

  g.a.bjune@medisin.uio.no'
author_list:
- family: Sagbakken
  given: Mette
- family: Frich
  given: Jan C.
- family: Bjune
  given: Gunnar
da: '2023-09-28'
doi: 10.1186/1471-2458-8-11
files: []
issn: 1471-2458
journal: BMC PUBLIC HEALTH
keywords-plus: 'DIRECTLY OBSERVED THERAPY; PATIENT COMPLIANCE; RURAL DISTRICT; TB
  CLUBS;

  COMMUNITY; OPPORTUNITIES; AFRICA; DOTS; CARE; DETERMINANTS'
language: English
month: JAN 11
number-of-cited-references: '46'
orcid-numbers: Frich, Jan C./0000-0001-9079-7508
papis_id: efcdd653a5c199ee374205bd213bebea
ref: Sagbakken2008barriersenablers
times-cited: '75'
title: 'Barriers and enablers in the management of tuberculosis treatment in Addis
  Ababa, Ethiopia: a qualitative study'
type: article
unique-id: WOS:000253869300001
usage-count-last-180-days: '1'
usage-count-since-2013: '10'
volume: '8'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2008'