Self-Study Modules on Tuberculosis
Module 9: Patient Adherence to Tuberculosis Treatment
Answers To Case Studies
9.1. Mr. Howard is unemployed and homeless. The homeless shelter
Mr. Howard frequents recently sent him to the hospital because he
had TB symptoms. He was diagnosed with TB and admitted to the hospital
for TB treatment. The hospital's infection control nurse immediately
telephoned a TB case report to the health department TB clinic.
Mr. Howard remained in the hospital for 5 days. On the
day he was discharged, a nurse instructed Mr. Howard to go to the
TB clinic the following morning for an evaluation and a supply of
medicine. He failed to keep the appointment.
A health care worker had been assigned to find Mr. Howard
when his case was reported. When Mr. Howard missed his appointment,
she set out to locate him and persuade him to come to the clinic.
She eventually found him in a crowded bar, where she scolded him
for his careless behavior and ordered him to return with her to
- What should the health care worker have done differently?
The health care worker should have visited Mr. Howard to begin
the assessment as soon as possible (before Mr. Howard left the
hospital). If he had left the hospital before she got there,
she should have located him and spoken to him privately. By
approaching Mr. Howard in a public place, she has failed to
maintain confidentiality. After approaching him in this way,
the health care worker will have a difficult time establishing
a trusting relationship with Mr. Howard. It is important he
feel comfortable sharing his thoughts.
- How can the health care worker get to know Mr. Howard
better in order to assess potential adherence problems?
The health care worker will need to learn as much as possible
about Mr. Howard in order to assess potential adherence problems.
The health care worker will need to learn the following about
- Medical history and current health problems
- Knowledge, beliefs, and attitudes about TB
- Ability to take responsibility for following the TB treatment
- Resources (family, other social support, finances)
- Barriers to treatment
- History of adherence to previous TB regimens or other medication
Also, assessing TB patients' knowledge, beliefs, and attitudes
regarding TB and adherence to TB medicine may help the health
care worker better understand the patient's views and suggest
areas in which the patient needs education. They may also give
the health care worker some idea of the patient's ability to
adhere to a treatment regimen. For example, asking a patient
what problems the illness has caused him or her can help the
health care worker assess the strength of family and social
support; potential job-related problems; and, to some extent,
the problem-solving skills of the patient.
Throughout treatment, the health care worker should ask the
patient about his or her concerns about TB and success with
adherence to the regimen. Whenever possible, the health care
worker should adapt such questions according to the patient's
age, family situation, education level, and cultural background.
Remember that the more the health care worker is aware of the
patient's ideas and concerns about TB and its treatment, the
better prepared the health care worker will be to anticipate
and resolve problems that can arise.
9.2. Michael, 45 years old, is a cook at a local fast food restaurant.
He went to see his physician because he was feeling fatigued, was
unable to sleep, had lost his appetite, and had been coughing for
several weeks. His physician suspected tuberculosis and admitted
Michael to the hospital for further tests.
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