Qualitative research: Is this a missing link to control tuberculosis in Saudi Arabia?

TLDR: The World Health Organization recommends the directly observed treatment, short course (DOTS), strategy which enables the patient to be monitored during the treatment on a daily basis by a health careworker, however, defiance to such strategies still remains high among patients, particularly in developing countries.

Abstract: Tuberculosis (TB) is a major public health problem worldwide, with 9 million newly reported cases and 1.4 million deaths annually [1]. TB can be cured with a 6-month standard anti-TB drug therapy. However, many patients fail to complete the treatment for various reasons – which include drugs have unpleasant side-effects, treatment is complicated, patients are not aware of the consequences of the discontinuation of medication, and patients feel better after several weeks of treatment. Poor adherence to treatment is common despite various interventions aimed to improve treatment completion and outcome. Poor compliance leads the patient to remain infectious for longer and most likely suffer a relapse and die in the future. To minimize all the above said issues, The World Health Organization (WHO) recommends the directly observed treatment, short course (DOTS), strategy which enables the patient to be monitored during the treatment on a daily basis by a health careworker [2]. However, defiance to such strategies still remains high among patients, particularly in developing countries [3]. The reasons for such defiance are not really understood in many settings, including Saudi Arabia. In Saudi Arabia the annual TB infection rate is moderate (24 cases/100,000 population) [1]. Indeed, the treatment outcome has never reached the 85% target set by WHO, despite the introduction of DOTS in the early 1990s [4]. It is presumed that there may be certain valid reasons causing such failures in the country. These reasons include and are not limited to: