Stop TB Partnership

Not to blame the victim. Non-adherence to tuberculosis treatment: A multidimensional problem. What can we do?


09 April 2015 - Poor adherence, besides causing medical and psychosocial complications, undermines the quality of life of patients, impacting more strongly in families with fewer resources. The interdependent relationship between economic poverty and disease is given by the synergistic relationship between health and socioeconomic status.

Despite evidence that shows the contrary, there continue to be a tendency to focus on patient-related factors as the causes of problems with adherence. However is not a matter of heroes or guilty. Adherence to any treatment regimen is not just limited to taking medication, but reflects a range of therapeutic behaviors. Thus, adherence has become a multidimensional phenomenon and the ability of patients to follow treatment plans in an optimal manner is frequently compromised by more than one barrier, usually related to different aspects of the problem.

We need to consider that the possibility of adherence does not occur randomly or by the mere will of the patient. The unequal distribution of resources for example in terms of class, gender, religion, age and educational level- affect unequally the abilities to act on one's health and to complete the treatments. In consequence, there is no automatic linear correlation between these factors.

Non-adherence to tuberculosis treatment is considered one of the main obstacles for disease control due to the consequences that arise from the interruption of treatment -disease progression, contagion, and the development of resistant strains- and, in general, non-adherence is related to the social vulnerability of the patients. Indeed, the evidence indicates that those patients living in worse conditions and with a lower socioeconomic level is most likely to have difficulty adhering to the treatment.

In the month of the World TB Day we must consider what can we do to improve quality of life of patients with tuberculosis as well as contribute to better adherence levels. Further studies to identify factors that contribute to improve adherence to tuberculosis treatment and joint actions are needed in order to help people affected to improve their health and quality of life. Adherence to tuberculosis treatment is a dynamic process that needs to be followed up. In consequence, a multidisciplinary approach towards adherence is needed. What can we do?

I want to take this opportunity to share a transversal case-control study that we carried out in the Metropolitan Area of Buenos Aires, to identify the socio-demographic characteristics of patients and the treatment characteristics that influence non-adherence to anti-tuberculosis treatment: http://www.unla.edu.ar/saludcolectiva/publication23_bis/en_v8s1a12.pdf

Text by María Belén Herrero

*Department of International Relations, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Argentina, bherrero@flacso.org.ar Researcher at Poverty Reduction and Regional Integration (PRARI) project, coordinated by Open University.