title: Are tuberculosis patients adherent to prescribed treatments in China? Results of a prospective cohort study.
abstract: BACKGROUND
  Tuberculosis (TB) patients face numerous difficulties adhering to the long-term, rigorous TB treatment regimen. Findings on TB patients' treatment adherence vary across existing literature and official reports. The present study attempted to determine the actual treatment adherence of new TB patients and to identify factors leading to non-adherence.
  
  
  METHODS
  A prospective cohort of 481 newly confirmed TB patients from three counties in western China were enrolled during June to December 2012 and was followed until June 2013. Patients who missed at least one dose of drugs or one follow-up re-examination during the treatment course were deemed as non-adherent. Influencing factors were identified using a logistic regression model.
  
  
  RESULTS
  A total of 173 (36.0 %) patients experienced non-adherence and the loss to follow-up cases reached 136 (28.2 %). Only 13.9 % of patients took drugs under direct observation, and 60.5 % of patients were supervised by phone calls. Factor analyses suggested that patients who were observed by family members (OR:5.54, 95 % CI:2.87-10.69) and paying monthly service expenses above 450 RMB (OR:2.08, 95 % CI:1.35-3.19) were more likely to be non-adherent, while supervision by home visit (OR:0.06, 95 % CI:0.01-0.28) and phone calls (OR:0.27, 95 % CI:0.17-0.44) were protective factors.
  
  
  CONCLUSIONS
  Despite recent efforts, a large proportion of newly confirmed TB patients could not adhere to standard TB treatment, and patients' lost to follow-up was still a serious problem. Poor treatment supervision and heavy financial burden might be the main causes for non-adherence. More needs to be done to enhance treatment supervision policies and financial supports to both health providers and TB patients.
authors.affiliation: China Effective Health Care Network, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Lei
authors.affiliation: Public Health Clinical Center of Chengdu, Chengdu, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Huang
authors.affiliation: China Effective Health Care Network, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China. liuqin81622@163.com.
authors.forename: Qin
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Changhang Hospital of Chongqing, Chongqing, China.
authors.forename: Yong-Feng
authors.initials: YF
authors.lastname: Jie
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Sheng-Lan
authors.initials: SL
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002681:China; D005260:Female; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D014376:Tuberculosis / Q000188:drug therapy* / Q000523:psychology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Adherence; China; Prospective cohort study; Tuberculosis