Reasons for interruption of anti-tubercular treatment among the retreatment patients in category II of RNTCP in Chandigarh, north India.

Introduction: More re-treatment TB patients are notified in India than any other country in the world, and default among this group is a serious public health problem. Adherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment taking behaviour. The main aim of the study was to study the basic clinical and demographic profile of the defaulters and the reasons for discontinuation of treatment among these retreatment patients in category II of RNTCP.
Methods: A longitudinal study was designed and the patients registered under RNTCP category II from June 2010 to December 2011 at various centres in Chandigarh formed the study cohort. Out of total 607 patients registered during this period under category II of RNTCP in Chandigarh, 545 consented to participate in the study. These were followed up to September 2012 till the completion of treatment. 32 patients among the registered 545 defaulted from the treatment during the period. These patients were traced in the community and information regarding reasons for interruption and barriers to treatment was obtained from them using a pre-structured pre-tested questionnaire. Data were analysed using SPSS 18 statistical software package.
Results: 32(5.9%) patients defaulted from the treatment under RNTCP category II. 29(90.6%) were pulmonary patients while 3(9.4%) were extra-pulmonary patients. 46.9% of the defaulters were in the age group of 20-35 years, followed by 31.3% in the age group of 36-50 years. 21.9% went to traditional healers for cure while 12.5% tried herbal medicine during the treatment. 25% (eight) patients did not have faith on the DOTS treatment. Most common side effects of treatment complained by the patients were GI upset (62.5%), fatigue (59.4%), drowsiness (34.4%) and itching (31.3%). 46.8% believed that ATT induced side-effects were the main reason for treatment interruption. Maximum treatment interruption was seen at the end of the third month (31.3%).
Conclusions: Maximum interruptions were found to occur by end of third month of ATI. AT" induced side-effects were the main reason for treatment interruption. Efforts need to be made to improve the pre-treatment counselling, increase proportion of patients treated by community-based DOTS providers, repeated health education to the patients emphasizing the need to continue treatment.