Adherence to tuberculosis treatment under directly observed treatment, short-course (DOTS) in Nepal: Quantitative and qualitative studies.

Thesis Report.

SUMMARY: Non-adherence to anti-tuberculosis treatment is a major barrier to the global control of TB. Non-adherence may result in persistent infectiousness on the part of the patient and higher rates of treatment failure, relapse, and drug resistance. TB is one of the most significant health problems in Nepal. The anti-TB programme Directly Observed Treatment Short-course (DOTS) was started in 1996 and reported to be successfully implemented throughout the country by April 2001. Despite this success, the most recent report estimates that from 5000 to 7000 people in the country died from TB in 2002/2003. In 2001, the non-adherence rate for new smear positive patients under DOTS was estimated to be 5% and the failure rate 1%. Several studies reporting on unsupervised treatment indicate that treatment non-adherence is associated with poor socioeconomic position; patient-related factors like patients ' beliefs, knowledge, perception and attitudes about and experiences with disease and treatment; treatment-related factors like medication side effects; disease-/condition-related factors like severity of disease, pervious TB treatment and being smear positive; co-morbidity such as psychiatric illness; and factors related to the health care system like quality of relation and communication between health workers and patients. However, very few studies have dealt with treatment adherence under DOTS.

Eng.