Background: Defaulter (loss to follow-up) tuberculosis (TB) patients present a challenge to TB program by increasing drug resistance and transmission. Knowing factors contributing to non-adherence to TB treatment might help the program implementers to develop appropriate strategies to tackle the problem.
Objectives: The objectives of this study were to explore factors contributing to non-adherence among defaulter TB patients and to delve into the perceived barriers to adherence according to directly observed treatment, short-course (DOTS) providers and staffs of TB unit (TU) at Burdwan Municipality.
Materials and Methods: A total of 14 in-depth interviews of defaulter TB patients, 4 focus group discussions with 30 DOTS provider, and 4 key informant interviews with staffs of TU were conducted from May to November 2017 at Burdwan Municipality, West Bengal. The analysis of free list and pile sort data obtained was undertaken using Anthropac 4.98.1/X Software.
Results: Key reasons contributing to default appeared to be addiction, improvement and non-improvement of symptoms, side effect and pill burden with long regime of the drugs, loss of daily wages, lack of awareness, stigma, poverty, non-referral by private practitioner, familial problem, negative counseling by friends, and perceptions of government medicines are bad.
Conclusion: Triangulation of the response from patients, DOTS providers, TB health visitors, and senior treatment supervisor divulged certain contributing factors for non-adherence to TB treatment in the municipality such as addiction and side effect of the drug. Policymakers may consider inclusion of causality analysis and psychological counseling in the program for assessing true burden of drug-related adverse effects and for fighting the effect of addiction, respectively.
Key words: Pile Sorting; Smiths S Value; Addiction; Defaulters; Qualitative Study
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