The behavioural aspects of TB control are a leading causal factor in the growing epidemic. Major obstacles to the control of TB worldwide include poor patient adherence to treatment, deficiencies in medical management and lack of governmental support. For an improved TB control programme, efforts must be made to improve physicians' knowledge, attitudes and practices in TB control management. Effective techniques for improving adherence include the use of DOT, incentives and enablers, fixed-dose combination pills or capsules of demonstrated bioequivalence, patient education, appointment reminders and comprehensive services.

Drug resistance, poverty, natural disasters, HIV and lack of government commitment have contributed to the resurgence of TB worldwide. However, even acknowledging these forces, there is little chance of controlling TB unless the behavioural barriers that allow the epidemic to progress are considered. Biomedical advances are essential but, alone, are insufficient for the control of TB - the human element remains critical. With adequate funding and programme changes, control of TB can be achieved, even under adverse conditions.

The problems of compliance among TB patients are similar in developed and developing nations and the solutions are a little different. The reasons for non-compliance, the kind of patients in whom non-compliance is high, the problems in detecting compliance, patients’ attitudes which affect compliance and suggestions to overcome these attitude problems are presented. Ways to reduce non-compliance include such means as providing SCC, directly administered therapy, providing all treatment medications only once daily, providing a fixed-dose combination of treatment drugs and, treating the patients on an out-patient basis.

Measures known to improve adherence such as short course chemoprophylaxis and directly observed therapy can be enhanced to a significant extent by the use of incentives. Adherence to TB therapy is influenced by several factors, including the health care system, complexity of therapeutic regimens and patient’s characteristics. Individual factors that negatively influence patient’s adherence are the most difficult to counter. Preventive TB therapy is doubly challenging because the benefit of treatment is not felt, while toxicity from the medication, when it occurs, is experienced immediately. Ingenious incentives therefore have to make it worth the patient’s while. During a study on preventive regimens, a request for an incentive, Sustacal, was observed to help completion of preventive regimens. Components of individual TB programs may help in patient adherence; it is important for health care staff to identify these aspects and, if they are successful, utilize these as an incentive to complete treatment.