Influence of Side Effect and Medication Adherence to Incidence of Tb

Drug Resistance in RSUP H. Adam Malik Medan 2018

Evi Sriwahyuni

, Rahayu Lubis

, and Fazidah Aguslina Siregar

Department of Epidemiology, Faculty of Public Health, Universitas Sumatera Utara,

Jl. Universitas No. 21 Kampus USU, Medan 20155, Indonesia

Keywords: side effects, medication adherence, TB drug resistance

Abstract: TB drug resistance is a condition where the Mycobacterium tuberculosis bacteria can no longer be killed

with one or more anti-TB drugs. The study aims to analyze side effect and medication adherence with TB

patients on the incidence of TB drug resistance in RSUP H. Adam Malik Medan 2018. This type of

research is analytic observation research with case-control research design with a total sample of 82 people

obtained by Purposive Sampling. Data were obtained through interviews with questionnaires and medical

record. Based on the results of multivariate analysis showed that side effect and medication adherence affect

the incidence of TB drug resistance. Information related to the risk of TB drug resistance as a side effect and

medication adherence was expected to reduce TB drug resistance.

1 INTRODUCTION

In 2013, there were 6,800 new cases of TB with

Multi-Drug Resistance (MDR TB) in Indonesia. It

was stated that 2% of new TB cases and 12% of TB

cases were re-treated as MDR TB cases. More than

55% of MDR TB patients have not been diagnosed

or received the good and correct treatment. MDR TB

cases in Indonesia tend to increase from 2009 to

2014 (Ministry of Health, 2015).

MDR TB is a disease with ongoing treatment.

Treatment of MDR TB patients is more difficult to

treat with a success rate of around 50% and the cost

of treatment for patients with MDR TB can be up to

100 times more expensive than ordinary TB

(Aditama, 2000). An adult TB patient is estimated to

lose an average working time of 3 to 4 months and

can result in a loss of annual household income of

20-30%. If the person dies, they can lose around 15

years of income (Ministry of Health, 2011).

In 2015, there were 10.4 million new cases of TB

cases in the world with 480,000 multidrug-resistant

cases (World Health Organization [WHO], 2016).

Based on the WHO 2017 Global Report

Tuberculosis, in 2016 there were 600,000 new cases

resistant to rifampicin OAT, which is an OAT that is

very effective in TB treatment, and there is an

increase in cases of MDR TB to 490,000 cases

(WHO, 2017). In 2017, there were 10 million new

cases of TB cases in the world with 558,000 cases of

MDR TB (WHO, 2018).

The results of the study by Cahyaningtyas,

Perwiraningtyas and Sulasmini (2018) conducted at

the Medical Center for Lung Disease, Purwokerto,

stated that the risk factors for MDR TB were

disorderly treatment with OR = 2.3, which means

that patients who are irregularly treated have a 2.3

times chance suffer from MDR TB compared to

patients who regularly seek treatment.

The research conducted by Fauziah and Sudaryo

(2013) conducted in RSUP Persahabatan in 2013

found that the factors that influence the incidence of

MDR TB were age (OR 1.7), alcohol consumption

(OR 1.5), contact history TB (OR 2, 1), medication

compliance (OR 10.8), and diabetes mellitus (OR

2.1). Fauziah and Sudaryo (2013) said that to

support the DOTS program, TB patients should

continue to be monitored and controlled during their

treatment, especially in terms of medication

compliance.

One of the factors that cause MDR TB is a factor

that is caused by patients, namely the low

compliance with taking medication which is often

caused by drug side effects (Ministry of Health,

2015). Research results of Cahyaningtyas et al.

(2018) state that there is a correlation between OAT

side effects on TB patient adherence in TB

treatment.

Based on the report of the H. Adam Malik

Hospital Medan Medical Record Installation in

2019, there were 41 people with MDR TB in 2018

with 6 deaths in 2017.

Sriwahyuni, E., Lubis, R. and Siregar, F.

Inﬂuence of Side Effect and Medication Adherence to Incidence of Tb Drug Resistance in RSUP H. Adam Malik Medan 2018.

DOI: 10.5220/0009861100940096

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 94-96

ISBN: 978-989-758-469-5

2 METHOD OF RESEARCH

This type of research is analytic observation

research with case-control research design. The

sample in this study consisted of cases, namely

patients who had been diagnosed as TB drug

resistance patients and controls, namely patients who

had been declared cured based on data in the

medical record of 41 cases and 41 controls taken by

purposive sampling based on inclusion criteria

determined by the researcher.

The method of data collection is done by

collecting primary data obtained directly from the

sample using a questionnaire as a research

instrument and secondary data obtained from

documents in the form of medical records or TB

patient status at H. Adam Malik Hospital Medan.

Data analysis was carried out by univariate,

bivariate and multivariate analysis. Univariate

analysis was carried out to see the frequency

distribution of side effect, medication adherence,

and TB drug resistance. Whereas bivariate analysis

was carried out using the chi-square test, to see the

relationship between side effect, medication

adherence with TB drug resistance. Multivariate

analysis was carried out using logistic regression

tests to see the factors that influence TB drug

resistance with the terms p <0,25 and the most

dominant factors influencing.

3 RESULT AND DISCUSSION

H Adam Malik General Hospital Medan is a

drug-resistant Tuberculosis service implementing

hospital in Indonesia regulated in the Decree of the

Minister of Health of the Republic of Indonesia

Number HK.01.07 / Menkes / 350/2017.

According to the frequency distribution on table

1 showed that 15 patient (36,6%) with TB drug

resistance has a side effect when they consumpt the

anti-TB drugs and 35 patient (85,6%) with TB drug

resistance disobedient to consumption the anti-TB

drugs.

Table 1: Frequency Distribution of Side Effect and

Medication Adherence

Variable

Control Case

n % n %

Side Effect

No 34 82,9 26 63,4

Yes 7 17,1 15 36,6

Amount 41 50,0 41 50,0

Medication Adherence

Obedient 33 80,5 6 14,6

Disobedient 8 19,5 35 85,6

Amount 41 50,0 41 50,0

The result

of the bivariate analysis showed that

there is a relationship between a side effect and

medication adherence with TB drug resistance and

each p values of these variables are 0,046 and

<0,001.

Table 2: Relationship between Side Effect and Medication

Adherence with TB drug resistance

Variable

TB drug resistance

P Value

Control Case

n % n %

Side Effect

No 34 82,9 26 63,4 0,046 1,78

Yes 7 17,1 15 36,6

Amount 41 50,0 41 50,0

Medication Adherence

Obedient 33 80,5 6 14,6 < 0,001 4,55

Disobedient 8 19,5 35 85,6

Amount 41 50,0 41 50,0

Based on the results of multivariate

analysis on table 3 it can be seen that the factors that

influence the incidence of TB drugs resistance are

side effect (p=0,047) and medication adherence (p

<0,001), where the dominant factor influencing is

medication adherence with a regression coefficient

of 4,700, which means that TB patients who

disobedient taking drugs had a risk of 4,700 times

for TB drug resistance compared to those who

adhered to take the drug.

Table 3: Multivariate Analysis

Variable B Sig. Lower Upper

Side Effect -2,234 0,047 0,102 0,967

Medication

Adherence

4,700 <0,001 12,33 981,55

The results of this study are in accordance with

the research conducted by Cahyaningtyas et al.

(2018) conducted at the Medical Center for Lung

Disease, Purwokerto. the possibility of 2.3 times

suffering from MDR TB compared to patients who

regularly seek treatment.

The results of research by Waokicho, Kassahun,

and Alemseged (2017) were conducted at St.

Hospital. Peter Khusus TB, Addis Ababa, Ethiopia,

said that the factors at risk of influencing MDR TB

Inﬂuence of Side Effect and Medication Adherence to Incidence of Tb Drug Resistance in RSUP H. Adam Malik Medan 2018

were age, the number of rooms in one house, history

of previous treatment and HIV infection.

Rumende (2018) stated that in 2014, as many as

190,000 MDR TB patients died due to lack of access

to effective treatment. The mechanism for the

occurrence of MDR TB can be caused by genetic

factors, previous treatment history and other factors

such as diabetes mellitus. Factors associated with

previous treatment are incomplete or inadequate

treatment and non-compliance in TB treatment.

One of the factors that cause MDR TB is a factor

that is caused by patients, namely the low

compliance with taking medication which is often

caused by drug side effects (Ministry of Health,

2015). Management of TB-resistant patients Good

drugs uses appropriate treatment strategies with

second-line OAT. To treat TB Resistance Drug

patients, second-line OAT guidelines and first-line

lines that are still sensitive and quality are needed

with appropriate treatment guidelines. The more

complicated second-line OAT in management

includes the determination of drug guidelines,

dosage, method of administration, duration of

administration, calculation of needs, storage and so

on. In addition, the price of second-line OAT is far

more expensive, the potential possessed is lower,

side effects are more and more severe than the first-

line OAT.

Research results of Cahyaningtyas et al. (2018)

state that there is a correlation between OAT side

effects on TB patient adherence in TB treatment.

4 CONCLUSIONS

Based on the research that has been done, it can

be concluded that side effect and medication

adherence are related to the incidence of TB drug

resistance in H. Adam Malik Hospital Medan.

Factors that influence the incidence of TB drug

resistance are a side effect and medication

adherence, where the dominant factor influencing is

medication adherence.

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ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease