RESUMEN
SETTING: The urban area of Kathmandu has a population of one million, with an annual risk of tuberculosis (TB) infection of 4%. It is estimated that up to 200 people default from treatment in Kathmandu annually, giving a defaulter rate of 10%. OBJECTIVES: To identify the socio-demographic factors, availability and accessibility of DOTS services and behavioural factors affecting patient adherence to DOTS. METHODS: Structured questionnaire of a random sample of 234 new smear-positive TB patients enrolled on treatment. Analysis of socio-demographic, psychosocial factors and availability and accessibility of DOTS services. Sub-analysis of non-adherent (missed >7 consecutive treatment days) vs. adherent patients. RESULTS: Reasons given by non-adherent patients included 61% who claimed insufficient knowledge about the need to take daily treatment, especially after they felt better. Directly observed treatment, younger age, knowledge of TB and availability of daily health education were associated with increased adherence. Daily health education and knowledge of TB and its treatment were independently associated with adherence on multivariate analysis (OR 6.27, 95%CI 2.88-13.64, P < 0.001). CONCLUSION: Daily health education delivered at DOTS centres is strongly associated with improved adherence. Adherence throughout treatment needs emphasis.