Social support and incentives programme for patients with tuberculosis: experience from the Russian Federation.

Setting: Tuberculosis (TB) services including social support and incentive programmes in four Russian regions (Orel, Vladimir, Belgorod Oblasts and Republic of Mari-El).

Objectives: To determine reasons for TB treatment default among non-adherent patients and to describe patient views of social support programmes and the organisation of treatment.

Methods: Standard anonymous questionnaires were administered to new pulmonary TB patients registered for treatment.

Results: A total of 87 non-adherent patients and 1302 adherent patients were interviewed. The leading reasons for treatment default given by non-adherent patients were the need to earn money (30%), alcohol use (30%) and not perceiving themselves as being sick (25%). Monetary incentives were preferred by the majority of patients (67%), followed by food/hot meals (41%) and transportation reimbursement (32%). Overall, among the proposed social support programmes, those that offered small daily incentives (23%) or a big final bonus (21%) were the most popular. The majority of patients (67%) preferred out-patient treatment.

Conclusion: Collaboration between TB services and social organisations and substance abuse services as well as availability of psychological testing/counselling for patients are social support modalities for improving adherence suggested by study findings. Social support should be combined with a patient-centred approach to TB treatment.