FACTORS AFFECTING COMPLIANCE WITH PREVENTIVE TREATMENT FOR TUBERCULOSIS AT MISTASSINI LAKE, QUEBEC, CANADA

Non-compliance is the most important cause of failure of anti-tubercul ous therapy throughout the world. In 1990 and 1991, an outbreak of tub erculosis occurred on the Mistassini Cree territory in Northern Quebec , Canada, and a number of cases of active tuberculosis occurred among known tuberculin-positive contacts who were non-compliant with prevent ive therapy. To better understand the factors affecting compliance wit h preventive treatment, a review of patients prescribed preventive tre atment over the past 10 y was conducted. A freely-translated, intervie wer-administered questionnaire was used to measure personal/lifestyle factors and knowledge/attitudes about tuberculosis. Clinic dossiers we re reviewed to assess compliance. One hundred and two (102) subjects p rescribed preventive treatment between 1981 and 1991 were interviewed, of whom 33.7% were judged to have been compliant. The most significan t factor associated with compliance with preventive therapy was year o f therapy. Between 1981 and 1985, 78% completed treatment, compared to less than 20% since 1986 (p <.0001). The major factor identified as a ssociated with this sudden change was a shift in responsibility for tu berculosis treatment follow-up from native community health workers to non-native nurses in 1985/86. We conclude that tuberculosis control p rograms must be tailored to take into account the importance of cultur al factors in promoting compliance with therapy.