Treatment adherence status of the TB patients notified from private sector and its associated factors: Findings of a secondary data analysis from West Bengal, India.

INTRODUCTION: In India, each year, estimated one million TB cases are missing from notification, most of them being diagnosed treated in private sector. The large number of patients in private sector has raised concerns about suboptimal quality of care; lack of systems for treatment adherence thus raising the risk of drug resistance. The current analysis was conducted to find out the status of TB treatment adherence in private sector & to identify the factors associated with poor TB treatment adherence.

METHODS: Analysis of secondary data obtained through adherence monitoring house visit by THALI (an USAID funded project) field workers during July 2018-June 2019, was done.

RESULTS: Default rate among the private patients was 5%. Among the private TB patients 81.6% & among the defaulter 87.3% were in the age bracket of 15-59 years. Reasons stated for being a defaulter were 'Medicine is not working' (30%), 'Travel' (28.6%), 'Cost involved in the treatment' (21.8%), 'Side effects of ATD' (11.6%), 'Anxiety or Depression' (7.2%) & 'Feeling of completely cured' (0.8%). Despite best of efforts only 36.9% defaulter could be retrieved. Factors associated with increased risk of lost to follow-up were 15-59 years age, male sex, earning member of the family,tobacco user, alcohol user, DR-TB, continuation phase of treatment, previous history of TB, presence of symptoms & inability to walk.

CONCLUSION: Privately treated TB patients are vulnerable for non-adherence. Once defaulted, it is difficult to retrieve them. Economically productive age group is at higher risk of being defaulter. Commonest reason for lost to follow up is wrong impression about TB medicine. Program should think of extensive engagement & sensitization drive for the private providers; Strict adherence monitoring of private TB patients, extensive advocacy communication & social mobilization program in the community & workplaces/institutions.