Background

Tuberculosis (TB) remains the leading infectious cause of adult mortality, despite 60 years of effective chemotherapy. One reason for this is the problem caused by the interruption and failure of treatment, which usually are related to non-adherence. The reasons for non-adherence to TB treatment are multifaceted, ranging from the personalities of the patients to the social and economic environment. In South Africa, the most common problems have been shown to be the erratic way in which the treatment is taken, and not patients absconding from the treatment program. There is a strong suspicion that the disability grants issued to TB patients are acting as a disincentive to finish anti-tuberculosis medication. TB is a stigmatised disease and the lack of support from health workers, family and friends, as well as the length of the treatment period, all contribute to the temptation to discontinue TB therapy. This research was undertaken in Van Wyksvlei, a sub-economic area of Wellington. Wellington is part of the Drakenstein Municipality in the Western Cape, South Africa and is mainly an agricultural area. The aim of the study was to explore and describe the reasons why patients in the Wellington area do not complete their TB treatment, and then to make recommendations to improve adherence.

Methods

The method used in this study was a descriptive qualitative one. Free attitude interviews were conducted with six non-adherent patients from Van Wyksvlei, a sub-economic area. The exploratory question was: “Which circumstances resulted in your interruption of your treatment?” The patients' responses were recorded and transcribed, and analysed to identify common themes.

Results

The major themes that were identified were priorities, motivation and support. Priorities imply definite choices the TB patient has to make from the day the diagnosis is made. The patients are poorly equipped with decision-making and coping skills. A lack of motivation resulted from an improvement in the symptoms while on medication, group pressure, poor self-esteem, distance from clinic and lack of continuity of care. The support theme centred on lack of support from both the family and the community.

Conclusion

Patients should not carry primary responsibility for their adherence, but be part of a team. If TB treatment is to be optimised, patient cooperation and information need to be addressed, as these are essential for success. Existing services need to be made more accessible and acceptable. Additional effort needs to be made to educate the community.