Compliance with medication and directly observed therapy in the treatment of TB in Lesotho

One measure to control the spread of tuberculosis (TB), HIV-associated TB, drug resistant TB (DRTB), and multi-drug resistant TB (MDRTB) is the establishment of a program known as directly observed therapy, short course (DOTS). DOTS is a public health strategy designed to reduce the risk that patients may develop DRTB or MDRTB by having a treatment supervisor ensure that patients take their medications as prescribed. In order to understand this public health risk, this dissertation specifically studies patients\u27 and DOTS supervisors\u27 knowledge and attitudes about TB and DOTS. It also studies strategies used by DOTS supervisors to gain patient cooperation. Data were obtained through taped interviews and completion of questionnaires in seven health service areas (HSAs) in the Kingdom of Lesotho. There were 186 patients interviewed, representing 2.2% of the total registered TB population in 1999. In addition, 71 DOTS supervisors were interviewed. Since the total number of active DOTS supervisors in 1999 was unknown, the percentage of DOTS supervisors interviewed out of the universe of potential respondents was not calculated. However, if every patient had his or her own DOTS supervisor then 0.8% of all possible DOTS supervisors were interviewed. In addition, taped interviews were conducted with 50 patients, 25 DOTS supervisors, six social workers, 16 TB coordinators, 4 traditional healers, and 9 biomedical doctors. This research found that patients are confused about the difference between sejeso (a disease traditionally believed to be the result of witchcraft) and TB. Some patients attributed TB deaths to sejeso rather than to HIV/AIDS. In addition, it was found that most patients and DOTS workers had a similar level of education. Nurses and nursing assistants who served as DOTS workers were the exception. Some patients and DOTS supervisors discussed how hunger and transportation costs limited their participation in DOTS. Recommendations, including nutritional and financial incentives, educational campaigns, and the inclusion of traditional healers in DOTS programs, are discussed