High rate of non-compliance with anti-tuberculosis treatment despite a retrieval system: a call for implementation of directly observed therapy in Saudi Arabia.
METHODS
Taif Chest Hospital, Taif, Saudi Arabia.


OBJECTIVE
Non-compliance with anti-tuberculosis drug therapy is recognised as a major cause of treatment failure, drug resistance and relapse. In Saudi Arabia, the problem of non-compliance is frequent and has serious implications which need urgent attention from the health-care authority. The objectives of this study were to define factors that affect compliance rate and to determine the appropriate methods to modify these factors.


METHODS
We designed and tested a retrieval system to improve patient return for follow-up and drug collection after an initial hospital admission period in a large chest hospital in the western region of the country.


RESULTS
Of 628 patients, 358 (57%) did not attend the first out-patient clinic visit. The retrieval system was successful in bringing back only 83 patients, reducing the default rate by only 13.2%. Various factors that may affect compliance were analysed in the remaining 275 (43.8%) non-compliant patients.


CONCLUSIONS
Because many of these factors are difficult to change, we strongly support implementation of the WHO-recommended directly observed treatment (DOT) strategy in Saudi Arabia and other countries facing similar problems with tuberculosis control.
Al-Hajjaj
M S
MS
King Saud University Medical College, Riyadh, Saudi Arabia. mshajjaj@ksu.edu.sa
Al-Khatim
I M
IM
D000328:Adult; D000359:Aftercare / Q000379:methods / Q000523:psychology; D000553:Ambulatory Care / Q000379:methods*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D019370:Observation / Q000379:methods*; D017010:Reminder Systems; D012307:Risk Factors; D012529:Saudi Arabia; D012646:Self Administration / Q000379:methods* / Q000523:psychology; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000188:drug therapy* / Q000523:psychology; D014944:World Health Organization
D000995:Antitubercular Agents