Determinants of Adherence to DOTS Therapy in drug-Sensitive Tuberculosis: A Cross-Sectional Study from NITRD, New Delhi

Abstract

Background: Tuberculosis (TB) remains a major global health concern, with India bearing the highest burden. Despite the proven efficacy of the Directly Observed Treatment Short-Course (DOTS) strategy, non-compliance continues to hinder treatment success and threatens TB elimination targets. Aim: To assess the compliance of drug-sensitive TB (DS-TB) patients with DOTS therapy at NITRD, New Delhi, and to identify socio-demographic, behavioural, and health system factors influencing adherence. Methods: A descriptive survey design was used, involving 350 DS-TB patients in the continuation phase of DOTS therapy at selected NITRD-affiliated DOTS and microscopy centres. Data were collected through record review, structured interviews, a knowledge questionnaire, and an attitude scale. Descriptive statistics summarised participant characteristics and compliance rates, while Chi-square and Pearson’s correlation tests examined associations and relationships. Results: Full compliance was observed in 91.71% of patients, partial compliance in 6.57%, and non-compliance in 1.72%. Compliance was significantly associated with age, education, occupation, and monthly family income (p<0.05), but not with marital status or co-morbidities. Higher knowledge scores were correlated with more positive attitudes towards DOTS therapy (r = 0.58, p<0.05). Common facilitators of adherence included self-motivation, family support, and proximity to DOTS centres, while barriers included medication side effects, economic hardship, and long travel distances. Conclusion: High compliance rates indicate effective programme delivery; however, targeted interventions addressing socio-economic and logistical barriers, alongside continuous patient education, are essential to sustain adherence and meet TB elimination goals.