Improving Patient Adherence to Tuberculosis Treatment
The approach and suggestions presented in this booklet reflect
several important assumptions.
- Persons with active TB can be successfully treated with currently
recommended primary drug regimens provided the patients are fully
adherent to the prescribed regimen.
- 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
- culturally determined knowledge and beliefs of patients and
- 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.
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.
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.
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 - http://www.cdc.gov/tb
Please send comments/suggestions/requests
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333