a) Sociological considerations
AU : Leff A, Lester TW & Addington WW
TI : Tuberculosis: A chemotherapeutic triumph but a persistence socio-economic problem.
SO : ARCH INTERN MED 1979, 139, 1375-1377.
DT : Per
AB :

There is evidence that man has suffered from TB for more than 5,000 years, and through crowded living conditions, debilitation, and malnutrition, TB became epidemic in western civilization and was a major cause of mortality. Identification of the tubercle bacillus as the causative agent in 1882 firmly established the infectious nature of the disease and the development of sanatoria soon followed. Before the advent of effective chemotherapeutic agents treatment involved rest, diet, and various surgical procedures, which were of little or no benefit to the patient. The discovery of dihydrostreptomycin, aminosalicylic acid, and isoniazid in the late 1940`s and early 1950`s meant that TB was now entirely curable in virtually all patients. Despite these effective chemotherapeutic and preventive agents, TB has receded to socio-economically disadvantaged urban and rural areas, where the incidence parallels that of developing countries. Conquest of the disease will require improved health care delivery to the indigent and dispossessed.


a) Treatment Failure & The Problem of Non Adherence
AU : Addington WW
TI : Patient compliance: The most serious remaining problem in the control of tuberculosis in the United States.
SO : CHEST 1979, 76, 741-743.
DT : Per
AB :

In the United States, failure to comply with appropriate anti-TB chemotherapy is the most serious remaining barrier to the control of TB. Studies on patient compliance can be separated into a number of categories, yet, very little exists that is useful in overcoming the problem of non-compliance. A health belief model (Becker 1974) has been developed that contains the patient’s perception of susceptibility to and severity of his/her illness and, the costs and benefits of the recommended treatment. It was found that patients often report that they stop taking their medicine as soon as they feel better, a crucial phenomenon in the patient’s non-compliance. The author’s perception was that non-compliance represented self-destructive forces in the patient that were poorly understood by both the patient and the health care provider. Examples of such destruction were evident even within the health belief model. Data from reports on TB patients who completed their chemotherapy, received within 24 months by the Center for Disease Control, USA, revealed that approximately 23-31% of newly-diagnosed TB patients did not complete their chemotherapy within 24 months and, this result extrapolated for all patients in the US, led to an estimated 7,130 - 11,512 non-completers for the years 1970-1975.

Experience at Cook County Hospital in Chicago for 5 years is discussed in detail. The study, here, concluded that directly supervised chemotherapy was the only possible solution to poor compliance in inner city TB programmes. Organising the supervision of therapy was more crucial than the type of regimen chosen. It was suggested that the cost of such initial therapy would be less as multiple hospitalizations and treatment failures could be prevented.