Author(s):
Nadia Farhanah Syafhan, Adelia Suvina Febrila, Sri Wulandah Fitriani
Email(s):
nadia.farhanah@farmasi.ui.ac.id
DOI:
10.52711/0974-360X.2025.00622
Address:
Nadia Farhanah Syafhan1,2*, Adelia Suvina Febrila1, Sri Wulandah Fitriani2
1Faculty of Pharmacy, Universitas Indonesia, Depok, West Java, 16424, Indonesia.
2Pharmacy Installation, Universitas Indonesia Hospital, Depok, West Java, 16424, Indonesia.
*Corresponding Author
Published In:
Volume - 18,
Issue - 9,
Year - 2025
ABSTRACT:
Drug-sensitive tuberculosis (DSTB) is an infectious disease primarily caused by Mycobacterium tuberculosis without evidence of resistance to Rifampicin and Isoniazid. In 2022, the World Health Organization (WHO) reported the highest number of new TB cases ever recorded, totalling 7.5 million, with Indonesia having the second highest incidence globally, accounting for 10% of the cases. Assessing medication adherence is a crucial aspect of medicines optimization. Understanding factors that influence adherence to anti-TB drugs (ATD) is important for improving treatment outcomes. This research aimed to analyse medication adherence to ATD and its factors at Universitas Indonesia Hospital (UIH). This retrospective cross-sectional study was conducted at UIH assessing data in the medical records of adult DSTB patients over a two-year period (1st January 2022 – 31st December 2023). Medication adherence was assessed using the Proportion of Days Covered (PDC) analysis, and the relationships between variables were analysed by Fisher’s Exact Test, followed by multivariate logistic regression analysis to control various factors. The research found that among 103 outpatients with DSTB, 94 (91.3%) patients had high adherence (PDC =90%), 8 (7.8%) patients had moderate adherence (PDC 80–89%), and only 1 (0.9%) patient was non-adherent (PDC <80%) to ATD. Fisher’s Exact Test revealed a significant relationship between gender and medication adherence (p = 0.044). Multivariate logistic regression analysis indicated that patients with a Charlson’s Comorbidity Index (CCI) score of 0 were 8.951 times more likely to exhibit high medication adherence compared to those with a higher CCI score (aOR = 8.951; 95% CI 0.842–95.175; p = 0.044). The severity of comorbidities was statistically significant related to medication nonadherence. These findings suggest that adherence to ATD is significantly impacted by comorbidity severity, underscoring the need for targeted educational interventions to improve adherence, particularly among patients with severe comorbidities, especially during the advanced phase of treatment.
Cite this article:
Nadia Farhanah Syafhan, Adelia Suvina Febrila, Sri Wulandah Fitriani. Medication Adherence in Drug-Susceptible Tuberculosis Outpatients: A Cross-Sectional Study at Universitas Indonesia Hospital Using Proportion of Days Covered (PDC) Analysis. Research Journal of Pharmacy and Technology. 2025;18(9):4337-6. doi: 10.52711/0974-360X.2025.00622
Cite(Electronic):
Nadia Farhanah Syafhan, Adelia Suvina Febrila, Sri Wulandah Fitriani. Medication Adherence in Drug-Susceptible Tuberculosis Outpatients: A Cross-Sectional Study at Universitas Indonesia Hospital Using Proportion of Days Covered (PDC) Analysis. Research Journal of Pharmacy and Technology. 2025;18(9):4337-6. doi: 10.52711/0974-360X.2025.00622 Available on: https://www.rjptonline.org/AbstractView.aspx?PID=2025-18-9-42
REFERENCES:
1. World Health Organization (WHO). Global Tuberculosis Report. World Health Organization. 2023a.
2. World Health Organization. Summary of Tuberculosis Data (Indonesia). World Health Organization. 2023b.
3. Ministry of Health of the Republic of Indonesia. Strategi Nasional Penanggulangan Tuberkulosis di Indonesia 2020-2024. Ministry of Health of the Republic of Indonesia. 2020b.
4. National Institute for Health and Care Excellence (NICE). Medicines Optimisation Overview. National Institute for Health and Care Excellence. 2017.
5. World Health Organization (WHO). Adherence to Long-Term Therapies: Evidence for Action. World Health Organization. 2003.
6. Ministry of Health of the Republic of Indonesia. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Tuberkulosis. Ministry of Health of the Republic of Indonesia. 2020a.
7. Papeo, D. R. P., Immaculata, M., and Rukmawati, I. Hubungan Antara Kepatuhan Minum Obat (MMAS-8) Dan Kualitas Hidup (WHOQOL-BREF) Penderita Tuberkulosis Di Puskesmas Di Kota Bandung. Indonesian Journal of Pharmaceutical Education. 2021; 1(2): 86-97.
8. Syaifiyatul, H., Humaidi, F., and Anggarini, D. R. Kepatuhan Minum Obat Anti Tuberkulosis Pada Pasien Tbc Regimen Kategori I Di Puskesmas Palengaan. Jurnal Ilmiah Farmasi Attamru (JIFA). 2020; 1(1): 7-14.
9. Sutarto, S., Fauzi, Y. S., Indriyani, R., RW, D. W. S., and Wibowo, A. Efikasi Diri pada Kepatuhan Minum Obat Anti Tuberkulosis (OAT). Jurnal Kesehatan. 2019; 10(3): 405-412.
10. Open Data Kota Depok. Tingkat Kematian karena Tuberkulosis. Portal Statistik Kota Depok. 2023a. https://satudata.depok.go.id/opendatadepok2022/User/preview_dataset/2a594bdf- fc90-4b7f-9498-b7bf59fabf2f
11. Open Data Kota Depok. Tingkat Prevalensi Tuberkulosis. Portal Statistik Kota Depok. 2023b. https://satudata.depok.go.id/opendatadepok2022/User/preview_dataset/72be1bc3- b1e6-46a0-be72-a4dbde74e80e
12. Anghel, L. A., Farcas, A. M., and Oprean, R. N. An overview of the common methods used to measure treatment adherence. Medicine and Pharmacy Reports. 2019; 92(2): 117–122. https://doi.org/10.15386/mpr-1201
13. Odegaard, K. M., Lirhus, S. S., Melberg, H. O., Hallén, J., and Halvorsen, S. Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014–2020. ESC Heart Failure. 2023, 10(1), 405-415.
14. Charlson, M. Charlson Comorbidity Index (CCI). 2024. https://www.mdcalc.com/calc/3917/charlson-comorbidity-index-cci
15. Bea, S., Lee, H., Kim, J. H., Jang, S. H., Son, H., Kwon, J. W., and Shin, J. Y. Adherence and associated factors of treatment regimen in drug-susceptible tuberculosis patients. Frontiers in pharmacology. 2021; 12: 625078.
16. Adisa, R., Ayandokun, T. T., and Ige, O. M. Knowledge about tuberculosis, treatment adherence and outcome among ambulatory patients with drug-sensitive tuberculosis in two directly-observed treatment centres in Southwest Nigeria. BMC Public Health. 2021; 21: 1-14.
17. Kiros, Y. K., Teklu, T., Desalegn, F., Tesfay, M., Klinkenberg, E., and Mulugeta, A. Adherence to anti-tuberculosis treatment in Tigray, Northern Ethiopia. Public health action. 2014; 4(3): 31-36.
18. Kwon, S. H., Nam, J. H., Kim, H. L., Park, H. Y., and Kwon, J. W. Real-world association of adherence with outcomes and economic burden in patients with tuberculosis from South Korea claims data. Frontiers in Pharmacology. 2022; 13: 918344.
19. Ki, M. S., Jeong, D., Kang, H. Y., Choi, H., Sohn, H., and Kang, Y. A. Real-world impact of the fixed-dose combination on improving treatment outcomes of drug- susceptible tuberculosis: a comparative study using multiyear national tuberculosis patient data. BMJ Open Respiratory Research. 2023; 10(1): e001758.
20. Byndoor, Y., Sagar, T.V., Patil, R.H., Veeraiah, D. Vitamin D as Supplementary Treatment for Newly Diagnosed Pulmonary Tuberculosis patients. Research Journal of Pharmacy and Technology. 2023; 16(10). DOI: 10.52711/0974-360X.2023.00798
21. Lawrence Flick Memorial Tuberculosis Clinic. Guidelines for The Management of Adverse Drug Effects of Antimycobacterial Agents. Philadelphia Tuberculosis Control Program. 1998.
22. Prasad, R., Singh, A., and Gupta, N. Adverse drug reactions in tuberculosis and management. Indian Journal of Tuberculosis. 2019; 66(4): 520-532.
23. Ghori, S.S., Quddus, M.A., Khalid, H. A Clinical Study of Acute Kidney Injury on using Antituberculosis Drugs in Geriatrics. Research Journal of Pharmacy and Technology. 2017: 10 (6). DOI: 10.5958/0974-360X.2017.00308.0
24. Boopathi, D., Akshatha J.S., Buggi, U., Sudarsan, P., Mani, D. Prolonged Isoniazid-induced Psychosis in a patient on DOTS Therapy – A Case Report. Research Journal of Pharmacy and Technology. 2020. 13(11). DOI: 10.5958/0974-360X.2020.00921.X
25. Nezenega, Z. S., Perimal-Lewis, L., and Maeder, A. J. Factors influencing patient adherence to tuberculosis treatment in Ethiopia: a literature review. International journal of environmental research and public health. 2020; 17(15): 5626.
26. Daksa, M. D., and Kebede, T. M. (2016). Patients’ adherence to anti-tuberculosis medicines and associated factors for non-adherence at a tertiary teaching hospital, South West Ethiopia. European Journal of Therapeutics. 2016; 22(2): 55-62.
27. Lee, S. C., Lee, J. K., Lee, J. M., Park, S. C., and Han, C. H. Impact of the cost exception policy on long-term treatment interruption among pulmonary tuberculosis patients in South Korea: a nationwide population-based study. 2022.
28. Sankarviriti, U., Surakala, S.L., Sidhanadam, A.S., Peela, N. Influence of HIV, Malnutrition and Patient Non-Compliance on the Prevalence and Prognosis of Tuberculosis: A Fatal Infectious Disease. 2015; 8(10). DOI: 10.5958/0974-360X.2015.00244.9
29. Chang, T. E., Park, S., Yang, Q., Loustalot, F., Butler, J., and Ritchey, M. D. Association between long-term adherence to class-I recommended medications and risk for potentially preventable heart failure hospitalizations among younger adults. PLoS One. 2019; 14 (9): e0222868. doi:10.1371/journal.pone.0222868
30. Lolong, D. B., Aryastami, N. K., Kusrini, I., Tobing, K. L., Tarigan, I., Isfandari, S., ... and Ariati, Y. Nonadherence to anti-tuberculosis treatment, reasons and associated factors among pulmonary tuberculosis patients in the communities in Indonesia. Plos one. 2023; 18(8): e0287628.
31. Koo, H. K., Min, J., Kim, H. W., Lee, J., Kim, J. S., Park, J. S., and Lee, S. S. Prediction of treatment failure and compliance in patients with tuberculosis. BMC infectious diseases. 2020; 20: 1-7.
32. Ali, A. O. A., and Prins, M. H. Patient characteristics associated with non-adherence to tuberculosis treatment: a systematic review. Journal of Tuberculosis Research. 2020; 8(2): 73-92.
33. Pinho, S. T. R., Rodrigues, P., Andrade, R. F. S., Serra, H., Lopes, J. S., and Gomes, M. G. M. Impact of tuberculosis treatment length and adherence under different transmission intensities. Theoretical population biology. 2015; 104: 68-77.
34. Munro, S. A., Lewin, S. A., Smith, H. J., Engel, M. E., Fretheim, A., and Volmink, J. Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS medicine. 2007; 4(7): e238.
35. Lai, J. M. L., Yang, S. L., and Avoi, R. Treating more with less: Effectiveness and event outcomes of antituberculosis fixed-dose combination drug versus separate-drug formulation (Ethambutol, Isoniazid, Rifampicin and Pyrazinamide) for pulmonary tuberculosis patients in real-world clinical practice. Journal of global infectious diseases. 2019; 11(1): 2-6.
36. Kautsar, A. P., and Intani, T. A. Kepatuhan dan Efektivitas Terapi Obat Anti Tuberkulosis (OAT) Kombinasi Dosis Tetap (KDT) dan Tunggal pada Penderita TB Paru Anak di Salah Satu Rumah Sakit di Kota Bandung. Jurnal Farmasi Klinik Indonesia. 2016; 5(3): 215-224.
37. Godman, B., McCabe, H., D Leong, T., Mueller, D., Martin, A. P., Hoxha, I., ... and Meyer, J. C. Fixed dose drug combinations–are they pharmacoeconomically sound? Findings and implications especially for lower-and middle-income countries. Expert review of pharmacoeconomics and outcomes research. 2020; 20(1): 1-26.
38. Fatima, J., Sadiq, S. M., Ahmed, S., Khan, R., Uddin, M.N. Patient Medication Adherence and the Health Outcome. Asian Journal of Pharmaceutical Research. 2018; 8(2). DOI: 10.5958/2231-5691.2018.00013.8
39. Syafhan, N.F., Donnelly, R., Harper, R., Harding, J., Mulligan, C.M., Hogg, A., Scott, M., Fleming, G., Scullin, C., Hawwa, A.F., Chen, G., Parsons, C., McElnay, J.C. Adherence to metformin in adults with type 2 diabetes: a combined method approach. Journal of Pharmaceutical Policy and Practice. 2022; 15(61).
40. Franchi, C., Ardoino, I., Ludergnani, M., Cukay, G., Merlino, L., and Nobili, A. Medication adherence in community-dwelling older people exposed to chronic polypharmacy. J Epidemiol Community Health. 2021; 75(9): 854-859.
41. Thamineni, R., Peraman, R., Chenniah, J., Meka, G., Munagala, A. K., Mahalingam, V. T., and Ganesan, R. M. Level of adherence to anti-tubercular treatment among drug-sensitive tuberculosis patients on a newly introduced daily dose regimen in South India: A cross-sectional study. Tropical medicine and international health: TM and IH. 2022; 27(11): 1013–1023. https://doi.org/10.1111/tmi.13824
42. Boopathi, D., Akshatha J.S., Buggi, U., Siva, H., Arun K.P., Mani, D. Analysis of Adverse Drug Reactions associated with Anti-tubercular drugs – A Retrospective Study. Research Journal of Pharmacy and Technology. 2022. 15(4). DOI: 10.52711/0974-360X.2022.00246
43. Starshinova, A., Nazarenko, M., Belyaeva, E., Chuzhov, A., Osipov, N., and Kudlay, D. Assessment of Comorbidity in Patients with Drug-Resistant Tuberculosis. Pathogens. 2023; 12(12): 1394.
44. Shaik, R.A., Jaffer, S., Fatima, S.H. Study on Prevalence of Adverse Drug Reactions and Drug-Drug Interactions and Co-Morbid Conditions of Patients Suffering from Tuberculosis. Research Journal of Pharmacy and Technology. 2021.
45. Hoftijzer, S. Facilitators and barriers of adherence to multi-morbid exacerbation action plans in COPD patients with comorbidities: a qualitative study (Master's thesis, University of Twente). 2020.
46. Thanmayi, G., Shanmugasundaram, P., Geetha, P. Role of Clinical Pharmacist in Improving Patients Compliance including Risk Factors among Tuberculosis Patients. Research Journal of Pharmacy and Technology. 2017. 10(19). DOI: 10.5958/0974-360X.2017.00521.2
47. Syafhan, NF., Azzam, S.,Williams, S.D.,Wilson, W., Brady, J., Lawrence, P., McCrudden, M., Ahmed, M., Scott, M.G., Fleming, G., Hogg, A., Scullin, C., Horne, R., Ahir, H., McElnay, J.C. General practitioner practice-based pharmacist input to medicines optimisation in the UK: pragmatic, multicenter, randomised, controlled trial. Journal of Pharmaceutical Policy and Practice. 2021. 14(1). https://doi.org/10.1186/s40545-020-00279-3.
48. Zine, S., Patankar, S.A., Raopati, S.S. Rise of Antibiotic Resistance in Tuberculosis. Research Journal of Pharmacy and Technology. 2018. 11(7). DOI: 10.5958/0974-360X.2018.00588.7
49. Kristina, S.A., Andayani, T.M., Wulandari, G.P. A Systematic Review of the Direct and Indirect Costs among Tuberculosis Patients. Research Journal of Pharmacy and Technology. 2020; 13(1). DOI: 10.5958/0974-360X.2020.00089.X