TB treatment non-adherence in São Tomé and Príncipe

SETTING: Sao Tomé and Principe (STP) is a lower middle-income country in the Gulf of Guinea that has a persistent high loss of TB patients on treatment.OBJECTIVE: To investigate factors associated with patient loss to follow-up (LTFU) and to assess health worker
 perceptions on non-adherence.DESIGN: A retrospective cohort study was conducted using data from the national database. Factors associated with LTFU were investigated using univariable and multivariable logistic regression. In-depth interviews were conducted with TB health workers
 to identify perceived barriers for treatment completion.RESULTS: A total of 822 registered patients with drug-susceptible TB were included, of whom 82 (10.0%) were lost to follow-up. Male sex (adjusted OR [aOR] 1.7, 95% CI 1.0–3.0; P = 0.048), as well as living in the
 Mé-Zóchi and Caué Districts (aOR 2.60, 95% CI 1.58–4.26; P < 0.001) were associated with an increased odds of LTFU. The main barriers to treatment completion were related to lack of food, stigma, and lack of patient information and personal support.CONCLUSION:
 The study indicates the need to address multiple issues related to LTFU during TB treatment. Enhanced efforts to personalise care, especially for information, nutrition and encouragement will better support patients in STP.