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Tailoring TB services for improved treatment adherence in Ghana - A mixed-methods study
Jacob Solomon Idan1, Austin Arinze Obeifum2, Aliyu Mohammed1
1Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Journal of Public Health Research
|July 6, 2026
Summary
Ghana
Area of Science:
- Public Health
- Infectious Diseases
- Health Services Research
Background:
- Tuberculosis (TB) poses a significant health burden in Ghana.
- Differentiated Service Delivery (DSD) models, successful in HIV care, have limited application for TB care in key populations.
- Current TB care in Ghana is facility-based and untailored to specific population needs.
Purpose of the Study:
- To assess the impact of the untailored, facility-based TB care model on treatment adherence.
- To explore preferences for Differentiated Service Delivery (DSD) models among key populations in Ghana.
- To identify barriers and facilitators for TB treatment adherence in vulnerable groups.
Main Methods:
- Convergent parallel mixed-methods study conducted in Ghana (October-December 2023).
- Inclusion of diverse key populations: children, informal miners, persons with HIV, prisoners, rural poor, and smokers.
- Quantitative data from 439 participants via REDCap questionnaires; qualitative data from in-depth and focus group interviews. Poisson regression used for adherence analysis.
Main Results:
- Untailored TB care, characterized by rigid schedules and lack of nutritional support, negatively impacts adherence.
- Lack of tailored services significantly associated with lower treatment adherence scores (aRR: 0.82).
- Prisoners exhibited significantly lower adherence compared to persons with HIV (aRR: 0.52).
- Strong preference for community-based DSD models (87.0%) and mobile clinics (83.1%) was observed.
Conclusions:
- The current untailored, facility-based TB care model leads to suboptimal treatment adherence.
- Key populations in Ghana strongly prefer DSD models that are community-based and mobile.
- Integration with existing HIV and child health platforms, supported by peer educators, is recommended for improved TB care.
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