Drug default is the major hurdle in the management of TB and also the cause for relapse and treatment failure due to drug resistance. Non-compliant patient remains infectious for a longer period and is more likely to develop drug resistance. Non-compliance is usually associated with complex treatment regimens involving multiple drugs, prolonged duration of administration, confusing dosage schedule and unacceptable route of administration. Knowledge about disease and treatment can influence patient decision and is essential for treatment compliance. This study evaluates the role of better patient communication and motivation by the provider in improving the compliance to chemotherapy in pulmonary TB.

A randomized control trial was conducted with newly diagnosed pulmonary TB cases in the age group 15 to 70 years attending the chest clinic of Medical College and STC, Thiruvananthapuram, Kerala. The study population of 530 patients was randomly allotted to intervention (267) and control groups (263). The intervention group was provided with daily chemotherapy, innovative communication and motivation strategy, whereas the control group received daily chemotherapy with usual motivation by Social Worker/Treatment Organizer. Information provided to the patient was understandable, unbiased, and indicated both risks & benefits. Baseline characteristics like mean age, disease severity, and pre diagnostic cost were similar in both the groups. Most of the default occurred in the initial months of chemotherapy; 76% in the control and 50% in the intervention groups occurring during the second and third months of chemotherapy. Treatment completion rate was significantly lower in the control group (63%) compared to intervention group (85%). Mortality rate was 7% and 2% for control and intervention groups respectively (p = 0.0004).

In the multivariate analysis of the study population, age, co-morbidity, income and severity of disease did not emerge as significant predictors of compliance. Significantly higher treatment completion rate among the intervention group compared to the control group indicates that to get better results, curing should be combined with caring mode in the management of TB. The study highlights the need for improved communication with patients to help them successfully complete treatment without default.