Assessment of Treatment Adherence and Its Determinants Among Tuberculosis Patients Enrolled Under NTEP in Urban and Rural Areas: A Community-Based Comparative Study

Abstract

Background: Despite extensive measures under the National Tuberculosis
Elimination Programme (NTEP), non-adherence to anti-tuberculosis treatment
remains a significant barrier to disease control. Urban-rural disparities, sociodemographic characteristics, and systemic barriers often influence treatment
adherence. Evaluating these factors is essential for tailoring interventions to
strengthen programmatic outcomes.
Objectives: To assess the level of treatment adherence among tuberculosis patients
enrolled under NTEP in urban and rural areas and to identify key determinants
influencing adherence.
Methods: This cross-sectional, community-based comparative study was conducted
from August 2024 to March 2025 at GMERS Medical College Dharpur-Patan. A
total of 100 TB patients (50 each from urban and rural areas) receiving treatment for
more than one month were enrolled using stratified random sampling. Data were
collected through structured interviews using a pre-tested questionnaire and Morisky
Medication Adherence Scale (MMAS-8), and analyzed using SPSS version 25. Chisquare tests and logistic regression were used to identify determinants of adherence.
Results: The study population had a mean age of 36.9 ± 10.9 years, with 62.5%
males. High adherence was observed in 65% of patients, with better adherence in
urban (70%) than rural (60%) areas. Literacy (OR=2.5; p=0.01), monthly income
above ₹5000 (OR=1.8; p=0.04), proximity to treatment facility (OR=2.2; p=0.02),
and family support (OR=3.0; p=0.001) were found to be significant predictors of
adherence.
Conclusion: Adherence to TB treatment is influenced by multiple factors including
education, economic status, accessibility, and social support. Addressing these
determinants through localized strategies under NTEP can help reduce the TB burden
and prevent the emergence of drug-resistant strains.