Why do tuberculosis patients default in Tashkent City, Uzbekistan? A qualitative study

BACKGROUND: Tuberculosis (TB) control in Tashkent City, Uzbekistan, is organised in accordance with the DOTS strategy. Intensive phase treatment is provided in hospital, while the continuation phase is given on an ambulatory basis. In 2005, the defaulter rate was 21%. An earlier quantitative study explored when patients default and identified some of the risk factors associated with default, but did not answer the question: 'Why do patients default?' OBJECTIVE: To investigate reasons for defaulting and to identify possible solutions. METHODS: We conducted a qualitative follow-up study consisting of 32 in-depth interviews with defaulters, patients who had completed treatment and health care providers. RESULTS: Communication between patients and health care staff is poor. Patients lack proper information on TB and its treatment. There is a widespread belief that TB is not curable. Hospitalisation is problematic due to poor general conditions in TB hospitals, costs incurred by patients during hospitalisation and because TB patients need to earn a living or take care of their families. CONCLUSION: Poor communication between health care staff and TB patients is a key issue underlying several of the causes of default identified, and needs to be addressed. Reducing the period of hospitalisation may also improve adherence to TB treatment