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 tubercu losis patients, 49% were assigned to the intervention group and 51% to the control group. Baseline data were obtained through semi-structured intervie ws. Patients were followed until the end of treatment (cure, default, refer ral or death). The intervention included counselling at the start of treatm ent and at each subsequent visit for ambulatory patients, or weekly for hos pitalised patients. Counselling combined health education with strategies t o strengthen patients' self-efficacy. Control group patients received the u sual care. The outcome measure was treatment default. RESULTS: The default rate was 54% in the control group and 47% in the inter vention group: the default risk ratio was 0.87, implying a reduction in def aulting of 13%. The impact was stronger in women, ambulatory patients, re-t reatment 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, imp act on treatment adherence.