HOW FAMILY-BASED COUNSELING/EDUCATION CAN IMPACT THE HEALTH OF PATIENTS WITH TUBERCULOSIS IN ARMENIA, 2013

   Purpose: Non-adherence to tuberculosis (TB) treatment is the main cause of multi-drug resistance (MDR) development. Approximately 43% of previously-treated TB cases in Armenia become MDR-TB. This pilot intervention was designed to improve treatment adherence, diminish stigma of TB, and inform TB healthcare decision-makers about the effectiveness of brief family-based counseling/education (FBCE) with the psychological component leading to successful TB treatment outcomes.

   Methods: FBCE was conducted in three regions of Armenia, using two teams of professional psychologists and TB nurses. Regions were selected considering the TB rates and lack of training programs. Overall, 136 regular TB patients and their family members participated in 90-minutes interactive counseling sessions conducted for each TB patient and family in their homes. To evaluate FBCE effectiveness, we used two approaches: 1)administered baseline and one-month follow-up surveys and 2)compared the treatment outcomes of TB patients participated in FBCE with the national statistics on TB treatment outcomes for TB patients of same regions a year prior to intervention.

   Results: The intervention substantially improved knowledge of TB patients and family members about TB, including modes of TB transmission, common signs of TB, TB prevention, proper TB treatment, and consequences of not following the treatment plan. The mean knowledge score improved for both TB patients (from 19.2 to 21.6, p<0.001) and their family members (from 18.0 to 21.7, p<0.001), alleviating fear and anxiety related to the disease. FBCE reduced stigma of TB disease among patients and their families. The percent of patients and family members that thought TB was not negatively impacting their family relationships increased from 60% to 71%. Following FBCE, there was a notable improvement in interpersonal relationships within these families and improved support for TB patients.

TB patients who participated in the intervention had significantly better rates of successful treatment outcomes than those reported in the national statistics (96% vs. 73%), lower default/failure rates (4% vs. 22%), and lower death rates (0% vs. 5%) (Fisher’s exact test, p = 0.0004).

   Conclusion: Appropriately designed household-based educational and psychological support interventions can substantially reduce rates of MDR TB and TB mortality by improving family support and adherence of TB patients to treatment. This intervention can be effectively applied in resource poor countries and in settings where Directly Observed Therapy is ineffective or inadequate.