Factors influencing non-adherence to treatment and loss to follow up in tuberculosis patients

Introduction: India contributes over one-fourth of the global TB burden, with 27 lakh new cases annually and over 40% of the population infected with Mycobacterium tuberculosis. Loss to follow-up continues to hinder TB control and program efficiency under NTEP.Aims and Objectives: This study aimed to examine the factors influencing non-adherence to treatment and loss to follow-up (LTFU) among tuberculosis (TB) patients under the Directly Observed Treatment, Short-course (DOTS) strategy of the National Tuberculosis Elimination Program (NTEP). The objective was to identify sociodemographic, patient-related, provider-related, and treatment-related factors contributing to non-adherence and suggest measures to improve adherence and cure rates.Materials and Methods: A cross-sectional study was conducted among pulmonary and extrapulmonary TB patients declared LTFU under the NTEP. Data were collected using structured interviews and analyzed for correlations with sociodemographic and treatment-related factors.Results: Among 208 subjects, most LTFU patients were males aged 31–40 years, employed, literate, married, from rural, low-income backgrounds. Major patient-related reasons were symptom improvement (44.23%), lack of disease awareness (29.33%), non-compliance (15.87%), and private sector treatment (12.98%). Provider-related reasons included long-distance travel (9.13%), travel costs (7.69%), physician advice to stop treatment (5.77%), unsuitable DOTS timings (1.92%), and medicine shortage (1.44%). Treatment-related factors included vomiting (46.15%), nausea (45.19%), hepatitis (6.73%), and hypersensitivity reactions (2.88%). Most defaults occurred after two months in the continuation phase among new cases.Conclusion: Loss to follow-up remains a major barrier to TB elimination. Addressing symptom-based defaulting, improving awareness, reducing logistical barriers, and managing side effects can enhance adherence and treatment success under the NTEP.