Background: Treatment adherence is an important operational measure of tuberculosis-control programmes that can affect infectivity, treatment failure, relapse and acquired drug resistance. The factors that influence adherence in rural areas are not just the availability of the drug, but also the cost of transportation, the loss of income, stigma, literacy, distance from centres, and the quality of patient-provider communication. This study was conducted to fill the local evidence gap. Methods: Cross-sectional observational study was done among 286 registered drug-sensitive tuberculosis patients in six rural DOTS centres. Patients were consecutively sampled and included if they met the inclusion/exclusion criteria. A structured proforma was used to collect the data, which were analysed descriptively, using chi-square test, t-test/ANOVA as appropriate and multivariable logistic regression. Results: The overall adherence was 78.3%, and there were significant differences in missed-dose episodes among patients with low literacy, daily-wage work, distance to travel > 5 km, and moderate-to-high perceived stigma. Low literacy, travel distance more than 5 km, and inadequate family support were independent predictors of non-adherence in multivariable analysis (adjusted OR 2.41, 95% CI 1.31-4.43; adjusted OR 2.18, 95% CI 1.18-4.03; and adjusted OR 2.76, 95% CI 1.49-5.11, respectively). Conclusions: The results suggest that simple programme-linked and laboratory-linked indicators can be used to identify patients who need more intense follow-up and can help to improve early clinical decision-making in resource-limited settings.

Tuberculosis; treatment adherence; DOTS; rural health; sociodemographic factors; India