The study was conducted to determine if homevisiting made any difference in the regularity of drug-taking, in the domiciliary treatment area of the NDTC. All cases of pulmonary TB in this area were included in the study. Every patient’s home was visited once, within one week of starting treatment, to give routine advice, motivate and confirm that the patient was a bonafide resident of the area. Thereafter, the patients were randomly allocated to three groups based on certain criteria. The regularity in drug collection was defined as:

             Drugs collected any period
-------------------------------------------------------       X   100
Drugs which should have been collected

The interim analysis of the data shows that home visiting definitely helps to reduce default and increase the regularity of drug collection. Whether the policy of “Preventive” visiting pays better dividends than retrieving defaulters still remains to be seen.

The annual incidence of TB cases among Singapore residents fell steadily from 306 per 100,000 population in 1960 to 56/100,000 in 1987 but has since remained at between 50 and 55/100,000. One of the possible reasons for this non-decline may be persistence of transmission of TB in the community due to delayed diagnosis, treatment and ineffective case holding.

Compared to non-defaulting patients as controls, defaulters were mostly non-Chinese, and those live on their own or with friends. There was no significant association of defaulting with age, sex, marital or employment status, disease characteristics, or treatment-related factors. Seventy per cent defaulted during the continuation phase of treatment.

The study was a retrospective patient record based case control study conducted in the TB Control Unit (TBCU), Singapore. This being the main treatment centre, which treats about 50% of the cases was the venue of the study. The objectives were to: (i) identify any demographic, social, disease or treatment-related characteristics which may be predictive of patients defaulting from treatment; (ii) assess the effectiveness of home visits as a means of defaulter recall; and (iii) ascertain outcome in these patients. TB treatment defaulters were defined as the patients who missed their scheduled appointments and required a home visit to recall for treatment. Equal number of controls were randomly selected from non-defaulting patients who started treatment on the same dates as the defaulters. Majority of the patients were supplied drugs for self-administration at home and there were about 10% of the patients who were on DOTS during the study period.

Of the 44 treatment defaulters, 6 (13.6%) were contacted directly, 20 (45.5%) through a person at home during the visit and for 18 (40.9%) a recall letter was slipped through the door due to no contact with patient or any other person at home. Following home visits, 20 (45.5%) returned within 7 days. The treatment outcome was not very encouraging as only 19 (43.2%) completed treatment, 21 (47.7%) were not traceable, 1 was dead and 3 were hospitalized. However, of the 21 patients who were lost to follow-up, all except one had culture negative results. The study identifies the future prediction of default as those who were non-Chinese, living alone, male and had a previous history of treatment.