Socio-cultural influences on adherence to tuberculosis treatment in rural India.

India has amongst the highest incidence of tuberculosis (TB) worldwide, with an estimated 2 million new cases each year. The greatest burden of disease is amongst low socio-economic groups, where poor adherence to treatment by directly observed therapy (DOT) is a major constraint to TB control. This study used qualitative in-depth interviews with TB patients and front-line health providers to identify sociocultural and gender influences on DOT adherence. The results highlight the mismatch between cultural norms and directly observed therapy, short-course (DOTS) treatment provision and the divide between providers' and patients' perspectives on treatment default. Improving the efficacy of DOT depends upon acknowledging and addressing underlying cultural influences, which are particularly evident amongst patients from culturally conservative scheduled tribes.