Development of an Integrated Care System for Tuberculosis Patients with Substance Use and Non-Adherence to Treatment Using the Kong Krailat MODEL, Sukhothai Province.

Abstract

      This study was a Participatory Action Research aimed at examining the situation and problems of caring for tuberculosis patients with substance use and non-adherence to treatment, developing an integrated care system for this patient group using the Kong Krailat MODEL, and evaluating the outcomes of the system's implementation. The study was conducted from October 2022 to September 2024, following the PAOR process across 3 cycles. The sample consisted of 24 qualitative stakeholders from all 4 sectors and 90 tuberculosis patients with substance use and non-adherence to treatment. The research instruments included focus group discussion guides, general information forms, a system appropriateness assessment form, a pre-post comparison data collection form, a knowledge assessment form, and a satisfaction assessment form for personnel and network partners. Data were analyzed using descriptive statistics, content analysis, and pre-post comparison testing with the Independent Sample t-test, Chi-square test, Paired Sample t-test, and McNemar test.

      The results showed that the situation and problems of caring for tuberculosis patients with substance use covered 5 main dimensions: patient behavior and substance use, the public health service and treatment monitoring system, the administrative sector and legal measures, community and network partners, and family and home care. The developed system comprised 7 core activities: village public forums, medication supervision through DOT/VOT, home visit follow-up by a multidisciplinary team, environmental management, tracing of tuberculosis contacts in families and communities, coordination of compulsory substance use treatment, and treatment of comorbidities with long-acting injectable (LAI) medication, which underwent continuous refinement across all 3 cycles until achieving a sustainable management structure. The results of the system showed improvement in tuberculosis treatment outcome indicators: the rate of complete continuous medication adherence increased from 63.85±12.10 percent to 91.27±7.15 percent, and the treatment success rate increased from 54.72±14.83 percent to 86.94±8.02 percent. Substance use indicators improved across all measures, with the rate of negative urine drug screening increasing from 26.18±11.94 percent to 61.53±13.67 percent, and network partner participation indicators improved across all measures, with the rate of joint meeting attendance among all 4 sectors increasing from 47.65±12.55 percent to 84.38±10.22 percent, all statistically significant at the .05 level. Regarding personnel and network partners, knowledge scores concerning the Kong Krailat MODEL increased from a moderate level to a high level (from 9.20±1.75 to 13.68±1.25 points), statistically significant at the .05 level (t = -9.42), and satisfaction with the system was at the highest level (4.51±0.38 points, 90.20 percent).