15.2  Refilling of medication and adherence to treatment

It is important for you to monitor all individuals with TB during treatment, both adults and children — checking that they are taking their medication properly during the intensive phase of treatment, and that they are periodically collecting their drugs during the continuation phase — this is called refilling their drugs.

Monitoring with sputum examination is readily available only for patients with sputum smear-positive pulmonary tuberculosis and these are usually adults and older children. Routine monitoring of treatment response by chest X-ray (recall from Study Session 14) is unnecessary and wasteful of resources because it is not readily available and also costly to the patient. But if patients with smear-negative TB and extra-pulmonary TB do not show clinical improvement (their symptoms do not improve and there is no weight gain), or if patients get worse during or after anti-TB drug treatment, you must refer such patients to a hospital for further evaluation. For such patients, it is essential that you monitor clinical symptoms and keep monitoring their weight over time.

How can you ensure that patients are adhering to their treatment regimen? In all your interactions with patients, you need to be strong-minded and clear in your instruction, but also polite, considerate and respectful. Always treat the patient with dignity and give the patient every opportunity to voice concerns and to regularly ask questions.

Behaving in this way will help create a relationship of trust and confidence between you as the DOTS provider and the TB patient, which will help bring about the patient’s adherence to treatment. Also, adherence is all the more likely if the patient and his or her family members learn from you the basic information about TB, including what is necessary for effective treatment and cure.