In 2004, Doctors of the World (DOW), a non-governmental organization, conducted a Knowledge, Attitudes and Practices (KAP) survey in Romania as part of a USAID-funded tuberculosis (TB) project. The KAP study was implemented to identify barriers for TB control in three communities in Romania (Bucharest, Ilfov and in Neamt County). The study was conducted from February through March 2004 using quantitative and qualitative data collection methods with patients, community members, and healthcare providers (nurses and general practicioners). This article presents a subset of the larger study involving 150 TB patients,100 family doctors, and 107 nurses respondents and focuses on adherence behavior determinants factors. The KAP study raised several important issues related to patient understanding about TB, systemic barriers to completion care, and the role of providers in improving or reducing adherence. The study found a lack of TB training and material resources for patient education. While TB patients respondents reported that they received ongoing education during their hospitalization period, there was a significant decline in patient education during the continuation phase of treatment, which is also the period when patients are at greatest risk of defaulting. Further, providers in the study reported a need for resource and training to support patient communication. The study also found that providers needed training on TB issues. Additional training and support is needed to improve the quality of care patients receive. These efforts have been recognized as an important for improving treatment adherence.
Keywords: adherence, directly observed therapy (DOT), patient-centered treatment, Rroma, treament default, and tuberculosis