Adeel Ahmed Khan, Unaib Rabbani, Sohail Bawani, Mubashir Zafar, Adeel Ahsan, Zafar Fatmi.
Social determinants of health and adherence to tuberculosis therapy for patients living in Karachi: a qualitative study.
Pak J Public Health Jan ;3(3):9-15.

Background: Tuberculosis (TB) is the second leading cause of deaths due to infectious diseases after HIV globally . The treatment of TB is a long term therapy and therefore adherence to the treatment is crucial for good outcomes, however, in low and middle income countries there obstacles to compliance. Pakistan has a high burden of tuberculosis (TB) and treatment compliance is known to be low with high default rates. The latter has resulted in the emergence of multi-drug resistant TB. This study aimed to identify the social determinants of adherence to Anti Tuberculosis Therapy (A TT) among TB patients in selected towns of Karachi. Methods: The research objective of this research was to identify the determinants of compliance to Anti Tuberculosis Therapy (A TT) among TB patients in towns of Karachi, Pakistan. A qualitative study was carried out in Karachi from January 2012 to March 2012 to identify the key social determinants of adherence(or compliance) A TT . In this respect, 10 TB patients and 5 physicians were interviewed using a semi-structured instrument based on a theoretical framework for health related behavior. The notion of judgment in qualitative sampling was used to select potential study participants. Results: Both facilitating and impeding determinants that inuence participants' adherence towards TB treatment were identied. Determinants that positively affect an individual's adherence include good behavior of the doctor, family support and correct knowledge about the disease. Barriers to treatment adherence include poor knowledge about the disease, lack of adequate counseling by health personnel, low nancial status and distant health facilities. Were there any differences between men and women? Was there any difference between ages? Conclusion: V arious factors related to the social determinants of health from an individual level (e.g. education, access, economic status), to the health care system level where the behaviour of health professionals played a role in treatment adherence. Human Resource Managers and Policy makers need to focus on improved communication skills of health care providers, fostering awareness among the patients about adverse outcomes of non-adherence and establishment of diagnostic and treatment facilities in the distant areas could improve adherence to ATT.

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