Low Awareness, Poor Adherence Drive Tuberculosis Relapse, Study At KGMU Finds

Even as India intensifies efforts to eliminate tuberculosis (TB), a new study conducted at King George’s Medical University (KGMU), Lucknow, has flagged persistent gaps that could undermine progress, with medication non-adherence emerging as the most significant risk factor for relapse, reported by 76% of participants. The findings were especially worrying as they pointed to a higher burden among younger individuals and men.

Published in the IP Indian Journal of Immunology and Respiratory Medicine, the cross-sectional study found that low patient awareness, poor treatment adherence, and adverse socioeconomic conditions continue to drive relapse TB, highlighting the urgent need for targeted education and stronger post-treatment follow-up within the national TB control programme.

The study assessed knowledge among 80 relapse TB patients attending a DOTS (Directly Observed Treatment Short-course) centre at the university. The findings revealed that limited awareness, poor treatment adherence, and socioeconomic vulnerabilities continue to drive relapse, posing a challenge to TB elimination efforts.

India accounts for nearly a quarter of the global TB burden, with an estimated 2.8 million cases annually. While treatment success rates have improved under national programmes, relapse remains a concern, with nearly 15% of patients experiencing recurrence after completing therapy. Experts noted that relapse not only affects patient outcomes but also contributes to the spread of infection and the rise of drug-resistant TB.

The study found that only 37.5% of participants had basic awareness about TB and relapse TB, while just 16.3% could identify key symptoms. Among those who recognised symptoms, weight loss was the most commonly identified indicator. Poor awareness, researchers noted, may delay diagnosis and increase the risk of continued transmission.

The demographic profile of participants pointed to a higher burden among younger individuals and men. Over half (53.8%) were below 30 years of age, while 65% were male. A majority of participants were from rural areas (75%), with many living in overcrowded or poorly ventilated housing conditions. Nearly 42.5% were illiterate, and 62.5% belonged to lower or upper-lower socioeconomic groups.

Education and socioeconomic status emerged as key determinants of TB-related knowledge. Statistical analysis showed significant associations between awareness levels and factors such as education and income status. Researchers observed that individuals with limited education often lack understanding of disease transmission, symptoms, and the importance of completing treatment.

Medication non-adherence was identified as the most significant risk factor for relapse, reported by 76% of participants. Common reasons included drug side effects—such as nausea and the unpleasant taste of medicines—stigma, and logistical challenges in accessing care. Experts have long cautioned that irregular treatment not only increases the risk of relapse but also contributes to multidrug-resistant TB (MDR-TB), which is more difficult and costly to treat.

Environmental and lifestyle factors also played a role. Overcrowding was identified as a major risk factor, along with exposure to indoor air pollution from traditional chulha cooking, reported by 62.5% of participants. Other contributing factors included smokeless tobacco use and co-existing conditions such as diabetes, both of which can weaken immunity and increase vulnerability to relapse.

The study also highlighted the role of social stigma in TB management. A section of patients reported negative impacts on personal relationships, while some concealed their diagnosis due to fear of discrimination. Such stigma, experts say, can delay treatment-seeking and reduce adherence, particularly in rural and low-income settings.

Researchers emphasised that relapse TB is not merely a medical issue but is closely linked to social, economic, and behavioural factors. “Understanding patient knowledge and perceptions is critical to improving treatment outcomes and reducing relapse rates,” the study noted.

India’s TB control programme, now aligned with the goal of eliminating TB, has expanded diagnostic and treatment services significantly. However, the study points to gaps in post-treatment follow-up, which is not routinely implemented. Experts argued that monitoring patients even after successful treatment is essential to detect relapse early and prevent further transmission.

The findings have called for targeted, patient-centred interventions, particularly for vulnerable groups. These include strengthening counselling at DOTS centres, improving communication about drug side effects, and addressing stigma through community awareness campaigns. Enhancing health education among low-literacy populations is also seen as crucial.

In addition, integrating screening for comorbidities such as diabetes, promoting cleaner cooking fuels to reduce indoor air pollution, and improving living conditions could help reduce relapse risks. The study also suggests that digital adherence tools and community health worker support may improve treatment compliance.

While the study is limited by its small sample size and single-centre design, it provides important insights into the challenges faced by TB patients in high-burden settings.

The study was conducted by researchers including Dr. Priti Bala from Government College of Nursing, BRD Medical College, Gorakhpur, along with Dr. Surya Kant, Dr. Ajay Verma, Dr. Prakriti Mishra, Dr. Kanchan Srivastava, and Dr. Ankit Kumar from the Department of Respiratory Medicine at King George’s Medical University.