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Education Materials > Publications > Improving Patients Adherence to TB Treatment > Basic Assumptions

Improving Patient Adherence to Tuberculosis Treatment (1994)

Basic Assumptions

The approach and suggestions presented in this booklet reflect several important assumptions.

  1. Persons with active TB can be successfully treated with currently recommended primary drug regimens provided the patients are fully adherent to the prescribed regimen.
  2. Although the tools are available, the successful treatment of TB cannot be achieved by clinical medicine alone. Treatment success is influenced by the health care system and by the behaviors both of patients and health care providers. Treatment outcomes may be influenced by many factors:
    • personal and social characteristics of patients and health care providers
    • culturally determined knowledge and beliefs of patients and providers
    • health care infrastructure that supports TB treatment
    • quantity and quality of information about TB that is available to patients and the public
    • extent of patient's knowledge of TB
    • quality of training that health care providers have received

    Other factors economic, legislative, and political can also have an effect, although indirectly, on treatment outcomes. Together and individually, all of these factors influence the behavior of patients and health care providers.

  3. Patients and health care providers share responsibility for treatment outcomes. Even though patients must decide daily whether to take medications, their success in adhering to treatment is strongly influenced by the acceptability and accessibility of the care they receive. For this reason, providers have a much greater responsibility than making appropriate drugs available. Treatment success will depend on the development of a partnership an alliance between the patient and the provider.
  4. All patients are different, and treatment should be individualized to meet their specific concerns and constraints. Individualizing the treatment will require some understanding of each patient's social and cultural values.
  5. TB is a complex disease that carries biological, social, and cultural ramifications for the patient. Health care providers should be mindful of the strong impact that this disease can have on all aspects of the patient's life and try to help the patient cope with the resulting difficulties.

The basic premise of this booklet, then, is that providers have an important responsibility for reaching out to patients, who will make many important decisions about how well they follow treatment recommendations. For this reason, the word compliance, which suggests a more passive role for the patient, is not used. Adherence is the preferred term because it suggests a partnership between the patient and provider, and a sharing of responsibility for treatment outcomes (5).


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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