Qualitative study of perceived causes of tuberculosis treatment default among health care workers in Morocco.
METHODS
In Morocco, tuberculosis (TB) treatment default is increasing in some urban areas.


OBJECTIVE
To provide a detailed description of factors that contribute to patient default and solutions from the point of view of health care professionals who participate in TB care.


METHODS
In-depth interviews were conducted with 62 physicians and nurses at nine regional public pulmonary clinics and local health clinics.


RESULTS
Participants had a median of 24 years of experience in health care. Treatment default was seen as a result of multilevel factors related to the patient  (lack of means, being a migrant worker, distance to treatment site, poor understanding of treatment, drug use, mental illness), medical team (high patient load, low motivation, lack of resources for tracking defaulters), treatment organization (poor communication between treatment sites, no  systematic strategy for patient education or tracking, incomplete record keeping), and health care system and society. Tailored recommendations for low- and higher-cost interventions are provided.


CONCLUSIONS
Interventions to enhance TB treatment completion should take into account the  local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
D
D
Kizub
I
I
Ghali
R
R
Sabouni
J E
JE
Bourkadi
K
K
Bennani
R
R
El Aouad
K E
KE
Dooley
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D023801:Directly Observed Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D009726:Nurses / Q000523:psychology*; D010465:Perception; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D018570:Risk Assessment; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents