Qualitative Assessment of Adherence to Anti-Tuberculosis Medication Among Active Tuberculosis Patients


  • Pavithra GB Saveetha Medical College, Saveetha Institute of Technical Sciences, Thandalam, Tamil Nadu, India
  • R. Prassanna Adithiyan Saveetha Medical College, Saveetha Institute of Technical Sciences, Thandalam, Tamil Nadu, India
  • Charumathi B Saveetha Medical College, Saveetha Institute of Technical Sciences, Thandalam, Tamil Nadu, India
  • Timsi Jain Saveetha Medical College, Saveetha Institute of Technical Sciences, Thandalam, Tamil Nadu, India




Tuberculosis, DOTS, Barriers to treatment adherence, In-depth interview


Background: Non- adherence is one of the major risk factors for the emergence of MDR and XDR TB. It is also one of the key factors responsible for treatment failure, disease relapse, prolonged infection and death. This study was conducted to explore the various factors contributing to non-adherence to the Anti-TB medication.

Methods: A qualitative study was done on Adult Pulmonary and extra pulmonary TB patients who were in course of the treatment. A total of 20 patients were enrolled. Socio –demographic details and specific questions regarding TB were collected using a semi-structured questionnaire. In depth telephonic interviews were conducted among all participants.

Results: The study participants comprised between 15 to 68 years of age with a mean age of 36 ±14.9years. Factors influencing non-adherence to medication were grouped under Patient, medication, Socio-economic and Health care related factors, Motive. Almost all patients reported more than one factor.

Conclusion: Increasing the awareness of various TB services in the community may increase knowledge and improve attitude among the patients. Providing more information about the effects of medication may reduce the risk of being non adherent. TB anonymous groups can be organized for patients to discuss their challenges while on treatment.


India, M., 2021. Home: Central TB Division. [online] Tbcindia.gov.in. Available at: https://tbcindia.gov.in/ [Accessed 25 December 2021].

Tavares AM, Fronteira I, Couto I, Machado D, Viveiros M, Abecasis AB, Dias S. HIV and tuberculosis co-infection among migrants in Europe: A systematic review on the prevalence, incidence and mortality. PloS one. 2017 Sep 28;12(9):e0185526 doi: https://doi.org/10.1371/journal.pone.0185526 PMid:28957400 PMCid:PMC5619775 DOI: https://doi.org/10.1371/journal.pone.0185526

Bagchi S, Ambe G, Sathiakumar N. Determinants of poor adherence to anti-tuberculosis treatment in Mumbai, India. International journal of preventive medicine. 2010;1(4):223.

World Health Organization. WHO operational handbook on tuberculosis: module 4: treatment: drug-resistant tuberculosis treatment. https://apps.who.int/iris/bitstream/handle/10665/332398/9789240006997-eng.pdf

Lange C, Abubakar I, Alffenaar JW, Bothamley G, Caminero JA, Carvalho AC, Chang KC, Codecasa L, Correia A, Crudu V, Davies P. Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement.

Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Frontiers in pharmacology. 2013 Jul 25;4:91. doi: https://doi.org/10.3389/fphar.2013.00091 PMid:23898295 PMCid:PMC3722478 DOI: https://doi.org/10.3389/fphar.2013.00091

Demissie M, Lindtjor B, Berhane Y. Patient and health service delay in the diagnosis of pulmonary tuberculosis. Ethiopia: BMC Public Health. 2002;2:23. doi: https://doi.org/10.1186/1471-2458-2-23 PMid:12296975 PMCid:PMC130033 DOI: https://doi.org/10.1186/1471-2458-2-23

Khan J, Irfan M, Zaki A, Beg M, Hussain SF, Rizvi N. Knowledge, attitude and misconceptions regarding tuberculosis in Pakistani patients. J Pak Med Assoc. 2006;56(5):211.

Dick J, Lombard C. Shared vision a health education project designed to enhance adherence to anti tuberculosis treatment. Int J Tuberc Lung Dis. 1997;1:181-6.

Castelnuovo B. A review of compliance to anti tuberculosis treatment and risk factors for defaulting treatment in sub Saharan Africa.Afr Health Sci. 2010;10:320-4

Van der Werf T, Dade G, Van der Mark T. Patient compliance with tuberculosis treatment and factors influencing adherence to therapy in a rural service programme. Ghana: Tubercle. 1990;71(4):247-52. doi: https://doi.org/10.1016/0041-3879(90)90036-8 DOI: https://doi.org/10.1016/0041-3879(90)90036-8

Widjanarko B, Gompelman M, Dijkers M, van der Werf MJ. Factors that influence treatment adherence of tuberculosis patients living in Java, Indonesia. Patient Prefer Adherence. 2009;3:231-8 doi: https://doi.org/10.2147/PPA.S6020 PMid:19936166 PMCid:PMC2778426 DOI: https://doi.org/10.2147/PPA.S6020

Demissie M, Getahun H, Lindtjørn B. Community tuberculosis care through TB clubs in rural North Ethiopia. SocSci Med. 2003;56(10):2009-18. doi: https://doi.org/10.1016/S0277-9536(02)00182-X DOI: https://doi.org/10.1016/S0277-9536(02)00182-X

Mehari M, Kiros N, Yemane A, Asghedom N, Debesay S, Tekeste T. Factors affecting treatment adherence among HIV-positive patients in Eritrea. IBBJ. 2017;3(3):150-6.

Gebrezgi M, Trepka M, Kidane A. Barriers to and facilitators of hypertension management in Asmara, Eritrea: patients' perspectives. J Health PopulNutr. 2017;36:11 doi: https://doi.org/10.1186/s41043-017-0090-4 PMid:28407794 PMCid:PMC5390439 DOI: https://doi.org/10.1186/s41043-017-0090-4

Sagbakken M, Frich JC, Bjune G. Barriers and enablers in the management of tuberculosis treatment in Addis Ababa, Ethiopia: a qualitative study. BMC Public Health. 2008;8:11. doi: https://doi.org/10.1186/1471-2458-8-11 PMid:18186946 PMCid:PMC2257959 DOI: https://doi.org/10.1186/1471-2458-8-11

Dueñes M, Cardona D. Factors related to treatment adherence in patients with tuberculosis in Pereira, Colombia, 2012-2013. Biomedica. 2016;36(3):423-31. doi: https://doi.org/10.7705/biomedica.v36i3.2904 PMid:27869390 DOI: https://doi.org/10.7705/biomedica.v36i3.2904

Liu X, Blaschke T, Thomas B, De Geest S, Jiang S, Gao Y, et al. Usability of a Medication Event Reminder Monitor System (MERM) by Providers and Patients to Improve Adherence in the Management of Tuberculosis. Int J Environ Res Public Health. 2017 Oct;14(10):1115. doi: https://doi.org/10.3390/ijerph14101115 PMid:28946683 PMCid:PMC5664616 DOI: https://doi.org/10.3390/ijerph14101115

Pradipta IS, Houtsma D, van Boven JFM, Alffenaar J-WC, Hak E. Interventions to improve medication adherence in tuberculosis patients: a systematic review of randomized controlled studies. npj Prim Care Respir Med. 2020 Dec;30(1):21. doi: https://doi.org/10.1038/s41533-020-0179-x PMid:32393736 PMCid:PMC7214451 DOI: https://doi.org/10.1038/s41533-020-0179-x

Available from URL https://tbcindia.gov.in/WriteReadData/TBAarogyaSathiEnglishV1.png (Accessed on Dec 28.12.2021)

Nguyen TA, Pham MT, Nguyen TL, Nguyen VN, Pham DC, Nguyen BH, Fox GJ. Video directly observed therapy to support adherence with treatment for tuberculosis in Vietnam: a prospective cohort study. International Journal of Infectious Diseases. 2017 Dec 1;65:85-9. doi: https://doi.org/10.1016/j.ijid.2017.09.029 PMid:29030137 DOI: https://doi.org/10.1016/j.ijid.2017.09.029

Liu X, Lewis JJ, Zhang H, Lu W, Zhang S, Zheng G, et al. (2015) Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomized Trial. PLoS Med 12(9): e1001876. doi: https://doi.org/10.1371/journal.pmed.1001876 PMid:26372470 PMCid:PMC4570796 DOI: https://doi.org/10.1371/journal.pmed.1001876




How to Cite

Pavithra GB, Adithiyan RP, Charumathi B, Jain T. Qualitative Assessment of Adherence to Anti-Tuberculosis Medication Among Active Tuberculosis Patients. Natl J Community Med [Internet]. 2022 May 31 [cited 2022 Jul. 5];13(05):308-12. Available from: https://njcmindia.com/index.php/file/article/view/14



Original Research Articles