title: Patient and Provider Reported Reasons for Lost to Follow Up in MDRTB Treatment: A Qualitative Study from a Drug Resistant TB Centre in India.
abstract: BACKGROUND
  Multidrug-resistant Tuberculosis (MDR TB) is emerging public health concern globally. Lost to follow-up (LTFU) is one of the key challenge in MDRTB treatment. In 2013, 18% of MDR TB patients were reported LTFU in India. A qualitative study was conducted to obtain better understanding of both patient and provider related factors for LTFU among MDR TB treatment.
  
  
  METHODS
  Qualitative semi-structured personal interviews were conducted with 20 MDRTB patients reported as LTFU and 10 treatment providers in seven districts linked to Nagpur Drug resistant TB Centre (DRTBC) during August 2012-February 2013. Interviews were transcribed and inductive content analysis was performed to derive emergent themes.
  
  
  RESULTS
  We found multiple factors influencing MDR TB treatment adherence. Barriers to treatment adherence included drug side effects, a perceived lack of provider support, patient financial constraints, conflicts with the timing of treatment services, alcoholism and social stigma.
  
  
  CONCLUSIONS
  Patient adherence to treatment is multi-factorial and involves individual patient factors, provider factors, and community factors. Addressing issue of LTFU during MDRTB treatment requires enhanced efforts towards resolving medical problems like adverse drug effects, developing short duration treatment regimens, reducing pill burden, motivational counselling, flexible timings for DOT services, social, family support for patients & improving awareness about disease.
authors: World Health Organisation, Country Office for India, New Delhi, India.
authors: Rajesh D
authors: RD
authors: Deshmukh
authors: Department of Pulmonary Medicine, Drug Resistant TB centre, Lata Mangeshkar Hospital, Nagpur, Maharashtra, India.
authors: D J
authors: DJ
authors: Dhande
authors: Central TB Division, Ministry of Health and Family Welfare, New Delhi, India.
authors: Kuldeep Singh
authors: KS
authors: Sachdeva
authors: World Health Organisation, Country Office for India, New Delhi, India.
authors: Achuthan
authors: A
authors: Sreenivas
authors: International Union against Tuberculosis and Lung Disease, South East Asia Office, New Delhi, India.
authors: A M V
authors: AM
authors: Kumar
authors: Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
authors: Srinath
authors: S
authors: Satyanarayana
authors: World Health Organisation, Country Office for India, New Delhi, India.
authors: Malik
authors: M
authors: Parmar
authors: Division of TB Elimination, International Research Programs Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georiga, United States of America.
authors: Patrick K
authors: PK
authors: Moonan
authors: Division of TB Elimination, International Research Programs Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georiga, United States of America.
authors: Terrence Q
authors: TQ
authors: Lo
mesh_terms: D000328:Adult; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007194:India; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011634:Public Health; D036301:Qualitative Research; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology