Adherence counseling: Why it’s always on our mind

Those who follow CAP-TB’s work know that patient adherence counseling is a central pillar of our strategy against TB and MDR-TB. Why is it so critical? To understand this, we must remember that the cornerstone of the WHO’s “STOP TB Strategy,” developed in the 1970’s, included a very important and practical recommendation-- to “directly observe” every dose of TB medication throughout a patient’s treatment.  In resource limited settings, this directly observed therapy (DOT) is prioritized during the intensive phase for drug-susceptible TB, which normally lasts two months. 

In some countries, however, DOT is not implemented in a consistent fashion, mostly due to the shortage of human resources.  There is also increased complexity for implementing DOT for MDR-TB in resource-limited settings, since MDR-TB drugs are given twice daily for at least a recommended 20 months in duration.  It would be wonderful if DOT could reach every TB and MDR-TB patient in the Greater Mekong.  But if that is not possible, we must find other ways to directly reach TB patients so that they themselves understand the critical importance of taking every dose and of completing their TB treatment. In this context, it also becomes clear that engaging health care providers to train them on effective adherence counseling is crucial -- reinforcing “doctor-patient” communication to improve adherence, even if the doctors themselves cannot observe every single dose.

We believe that adherence counseling, which is essentially an intensive “behavior change communication” targeted to TB patients, is one of the best methods to address the challenge of TB/MDR-TB treatment completion and success. For this reason, CAP-TB’s team in China has prioritized the development of rigorous and innovative counseling programs, with a particular focus on TB peer counselors.  The goal is to make crystal clear why patients must adhere to their treatment, how to prevent infection of others, and how to win the fight against the disease.

CAP-TB’s prioritization of adherence counseling also underlies our commitment to leveraging the emerging social media platforms and mobile communication tools that create new ways of forming connections with TB patients. The stronger our patient counseling strategy, the more effective our fight to eliminate TB and MDR-TB.
Pictured: CAP-TB supported a TB counseling training for 13 community health workers from Fu Hai Residential  District, Kunming, China. These counselors will facilitate referrals and linkages within the TB network as well as community-based care for TB patients who have returned to their homes.

Posted by: CAP-TB