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Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 155-156

Improving treatment adherence and outcome among TB patients under daily regimen - The way forward

1 Department of Community Medicine, Bhaarath Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu, India
2 Department of Community Medicine, Trichy SRM Medical College and Hospital and Research Centre, Trichy, Tamil Nadu, India
3 Department of Community Medicine, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India

Date of Submission19-Jun-2021
Date of Decision16-Nov-2021
Date of Acceptance05-Dec-2021
Date of Web Publication3-Aug-2022

Correspondence Address:
Dr. Anugraha John
Senior Resident, Department of Community Medicine, Bhaarath Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrntruhs.jdrntruhs_78_21

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How to cite this article:
John A, Swaminathan SS, Avirneni HT. Improving treatment adherence and outcome among TB patients under daily regimen - The way forward. J NTR Univ Health Sci 2022;11:155-6

How to cite this URL:
John A, Swaminathan SS, Avirneni HT. Improving treatment adherence and outcome among TB patients under daily regimen - The way forward. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Feb 6];11:155-6. Available from: https://www.jdrntruhs.org/text.asp?2022/11/2/155/353223

Dear Editor,

Tuberculosis (TB) is one of the most leading causes of death worldwide, with a majority of them occurring in low and middle-income countries.[1] Non-adherence to the treatment among TB patients has been recognized as an immense challenge to the entire health system of any country.[2] Therefore, adherence to treatment is not only considered the primary determinant for the successful completion of treatment, but also as a proxy indicator for the efficient functioning of a National program.[3]

Poor adherence to the treatment regimen is a major barrier to TB control in India. Studies conducted in different parts of India showed that about 45 to 93 percent of TB patients are adherent to Directly Observed Treatment, Short-course (DOTS) therapy. Non-compliance to the treatment regimen leads to treatment failure, relapse, Multi Drug Resistant Tuberculosis (MDR-TB), Extensively Drug Resistant Tuberculosis (XDR-TB), etc., requiring more prolonged & expensive therapy.[4]

Hence, accurate assessment of adherence behavior among TB patients is of prime importance for devising effective and efficient strategies that would help improve treatment adherence, which, in turn, would yield good treatment outcomes.[5]

The following strategies were devised based on such assessment of adherence behavior, which have been identified to be due to lack of family and social support, loss of wages, drug side effects, poverty, financial constraints, stigma and duration of treatment, DR-TB, transportation, alcohol addictions, and poverty as the factors related to TB treatment non-adherence. Although developing and relying on a more comprehensive adherence monitoring mechanism would have been an added strength in this assessment, however, adopting such a mechanism would have been feasible in a longitudinal study design rather than the one which is cross-sectional in nature.

These strategies can have implications not only for policy makers but also for stakeholders from multiple sectors in the unified fight against TB.

The urgent and important need for intensifying education on TB has to be recognized from the fact that, knowledge gaps related to TB are still being exhibited by the patients. The current multi-sectoral approach for education on TB involving health care providers, civil society members, religious heads, organizations, institutions, and politicians has to be further reinforced by encouraging active and sustained participation from the stakeholders.

Active dissemination of information in the communities, on how stigma and discrimination towards TB patients affect treatment adherence and outcome is required. The need for effective community participation, in reinstating right to health of TB patients by de-stigmatization and indiscrimination, has to be emphasized in the awareness campaigns.

Providing nutritional support to TB patients in the form of monthly monetary incentives is a welcome initiative. However, a greater emphasis has to be placed on the importance of such an exclusive provision and how it would benefit the patient. Putting in place continuous reminder mechanisms, spanning across the course of treatment, mainly to the patients would help in promoting the role of balanced nutrition for a better treatment outcome. These mechanisms can be implemented through counseling sessions, digital platforms, and IEC campaigns.

Supporting feasibility model studies is essential. This is to explore the effectiveness of innovative nutritional support systems such as the supply of appropriate food items for TB patients through the Public Distribution System or Integrated Child Development Services (ICDS) or in providing home delivery services by linking local/online retailers to the Direct Benefit Transfer Scheme.

Boosting and highlighting the availability of various services under National Tuberculosis Elimination Programme (NTEP) such as free diagnosis & treatment, travel allowances or subsidies, nutritional support in the form of monetary incentives through the Direct Benefit Transfer Scheme and other services is very much important. This would help in an overall improvement in the utilization of services under NTEP with the best treatment outcome.

Exploring the feasibility of equitable inclusion of TB patients under existing social protection schemes would be needed. Such an inclusion would not only alleviate their economic burden but also would help in improving their treatment adherence.

Maintaining flexible timings for providing DOT services at the primary health center would effectively and efficiently aid the patients to maintain continuity in the timely re-filling of TB drugs.

Promoting research for understanding the role of family members in an effective treatment completion among TB patients would be needed to assess and address various areas related to TB treatment such as side effects—adherence, psychosocial behaviors—adherence, counseling interventions, and others.

To conclude, adopting these multi-pronged strategies and bringing together stakeholders from multiple sectors would have the potential to alter and thereby improve adherence among TB patients. This would eventually result in good treatment outcomes and therefore create an impact on the transmission of TB in the community. Hence, sustaining efforts in this direction can be the way forward.

Financial support and sponsorship

Puducherry state RNTCP OR Committee - Research grant.

Conflicts of interest

There are no conflicts of interest.

  References Top

Farzianpour F, Kooshad MA. Study of the status of Tuberculosis Control Programme based on the implementation of the Directly Observed Short Course Strategy (DOTS). Materia Socio-Medica 2016;28:249–52.  Back to cited text no. 1
World Health Organization. Global Tuberculosis Report 2017. Available from: https://www.who.int/tb/publications/global_report/gtbr2017_main_text.pdf?ua=1. [Last accessed on 2021 Apr 05].  Back to cited text no. 2
Velavan A, Purty AJ, Shringarpure K, Sagili KD, Mishra AK, Selvaraj KS, et al. Tuberculosis retreatment outcomes and associated factors: A mixed-methods study from Puducherry, India. Public Health Action 2018;8:187–93.  Back to cited text no. 3
Central TB Division, Ministry of Health and Family Welfare. Annual TB Report 2020. Available from: https://tbcindia.gov.in/WriteReadData/l892s/India%20TB%20Report%202020.pdf. [Last accessed on 2021 Mar 29].  Back to cited text no. 4
Alipanah N, Jarlsberg L, Miller C, Linh NN, Falzon D, Jaramillo E, et al. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS Med 2018;15:e1002595. doi: 10.1371/journal.pmed. 1002595.  Back to cited text no. 5


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