A randomised trial of the impact of counselling on treatment adherence of tuberculosis patients in Sialkot, Pakistan

SETTING: Tuberculosis Department, Bethania Hospital, Sialkot, Pakistan.OBJECTIVE: To determine whether intensive counselling can improve treatment adherence.DESIGN: In a randomised controlled intervention trial of 1019 adult tuberculosis patients, 49% were assigned to the intervention group and 51% to the control group. Baseline data were obtained through semi-structured interviews. Patients were followed until the end of treatment (cure, default, referral or death). The intervention included counselling at the start of treatment and at each subsequent visit for ambulatory patients, or weekly for hospitalised patients. Counselling combined health education with strategies to strengthen patients' self-efficacy. Control group patients received the usual care. The outcome measure was treatment default.RESULTS: The default rate was 54% in the control group and 47% in the intervention group: the default risk ratio was 0.87, implying a reduction in defaulting of 13%. The impact was stronger in women, ambulatory patients, re-treatment patients, women who worked in the home, and patients who were not the main provider, those with a poor knowledge of the disease or those with a short treatment delay.CONCLUSIONS: Intensive counselling has a significant, although limited, impact on treatment adherence.