Why do tuberculosis patients default in Tashkent City, Uzbekistan? A qualitative study.
BACKGROUND
Tuberculosis (TB) control in Tashkent City, Uzbekistan, is organised in accordance with the DOTS strategy. Intensive phase treatment is provided in hospital, while the continuation phase is given on an ambulatory basis. In 2005, the defaulter rate was 21%. An earlier quantitative study explored when patients default and identified some of the risk factors associated with default, but did not answer the question: 'Why do patients default?'


OBJECTIVE
To investigate reasons for defaulting and to identify possible solutions.


METHODS
We conducted a qualitative follow-up study consisting of 32 in-depth interviews with defaulters, patients who had completed treatment and health care providers.


RESULTS
Communication between patients and health care staff is poor. Patients lack proper information on TB and its treatment. There is a widespread belief that TB is not curable. Hospitalisation is problematic due to poor general conditions in TB hospitals, costs incurred by patients during hospitalisation and because TB patients need to earn a living or take care of their families.


CONCLUSIONS
Poor communication between health care staff and TB patients is a key issue underlying several of the causes of default identified, and needs to be addressed. Reducing the period of hospitalisation may also improve adherence to TB treatment.
Hasker
E
E
Department of Public Health, Epidemiology and Disease Control Unit, Institute of Tropical Medicine, Antwerp, Belgium. ehasker@itg.be
Khodjikhanov
M
M
Sayfiddinova
S
S
Rasulova
G
G
Yuldashova
U
U
Uzakova
G
G
Butabekov
I
I
Veen
J
J
van der Werf
M J
MJ
Lefèvre
P
P
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003142:Communication; D003625:Data Collection; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics; D014610:Uzbekistan; D055815:Young Adult
D000995:Antitubercular Agents