Determinants of Poor Adherence to Anti-Tuberculosis Treatment in Mumbai, India

Objectives: In this study, we investigated the determinants of poor adherence with anti-tuberculosis therapy among pulmonary tuberculosis (TB) patients in Mumbai, India, receiving Directly Observed Treatment Short Course (DOTS) therapy. Methods: A cross-sectional study on 538 patients receiving DOTS I and II regimen was conducted. Patients were interviewed and clinical and laboratory data were collected. Eighty seven patients were considered non-adherent. Multivariable logistic regression was used to determine risk factors associated with non-adherence. Results: Factors associated with non-adherence were found to be different among the newly-diagnosed patients and all the other residual groups. Smoking during treatment and travel-related cost factors were significantly associated with non-adherence in the newly-diagnosed patients, while alcohol consumption and short-age of drugs were significant in the residual groups. Conclusions: An approach, targeting easier access to drugs, an ensured drug supply, effective solutions for travel-related concerns and modification of smoking and alcohol related behaviors are essential for treatment adherence

Choice‐Based Reminder Cues: Findings From an mHealth Study to Improve Tuberculosis (TB) Treatment Adherence Among the Urban Poor in India

Poor treatment outcomes due to nonadherence and consequent high levels of drug resistance continue to challenge efforts to combat tuberculosis (TB) in India. Mobile health‐ or mHealth‐based reminder cues have been considered in multiple health behavior modification interventions, including TB treatment nonadherence. We conducted a quasi‐experimental study in Ahmedabad, India, to examine the effectiveness of mHealth‐based reminder cues customized to meet diverse patient needs. Results from this experiment indicate that the potential of customized mHealth reminder cues may remain unrealized unless addressed in conjunction with the multifaceted drivers of TB treatment nonadherence. The perspective we present here has broad relevance for future mHealth studies, especially in interpreting challenges that arise within resource‐scarce settings of the urban poor and prevent them from adhering to recommended TB treatment regimens