Under- and over-consumption intermittent TB treatment among rural TB patients in south-west China

OBJECTIVE: To assess adherence to intermittent directly observed treatment (DOT) during the 2-month intensive phase of tuberculosis (TB) treatment in south-west rural China.DESIGN: A cross-sectional study was conducted in Simao Prefecture, Yunnan Province, China. One hundred and thirty new TB patients registered under DOTS and treated during the 2-month intensive phase and their observers were separately interviewed at their homes using structured questionnaires. Numbers of packs of TB drugs were checked on the spot.RESULTS: Of 130 visits, the same percentage (3.1%) of patients and their observers reported missing ≥2 consecutive weeks of treatment (prevalence-adjusted κ = 0.94). The percentages who missed ≥20% of the packs, as reported by patients and observers, were 3.8 and 2.3, respectively (prevalence-adjusted κ = 0.969). According to the pill count, nine patients (7%) had missed ≥20% of the packs, 10 had over-consumed TB drugs and two had lost respectively five and six packs. Eight of the 10 who had over-consumed had done so due to confusion in the days of the month, and two because they wanted a quicker recovery.CONCLUSIONS: Intermittent regimens in China need to be more carefully monitored to avoid over-consumption of anti-tuberculosis drugs in addition to non-adherence due to under-consumption.