02754nas a2200325   4500000000100000008004100001653001500042653001000057653001100067653001100078653001100089653001000100653002300110653001200133653000900145653002500154653001600179653003000195653001800225653001600243100001300259700001100272700001400283245016100297856005100458300000900509490000700518520188900525022001402414       2015                            d10aAdolescent10aAdult10aFamily10aFemale10aHumans10aIndia10aLeprostatic Agents10aleprosy10aMale10aMedication adherence10aMiddle Aged10aResidence Characteristics10aSocial stigma10aYoung Adult1 aRaju M S1 aJohn A1 aKuipers P00aWhat stops people completing multi-drug therapy? Ranked perspectives of people with leprosy, their head of family and neighbours--across four Indian states.  uhttps://leprosyreview.org/article/86/1/00-6020  a6-200 v863 a<p><strong>UNLABELLED: </strong>Summary To maximise successful completion of multi-drug therapy (MDT) and optimise treatment outcomes for people with leprosy, it is vital to understand the relative importance of perceived factors which prevent them from completing the required number of doses in time.</p>

<p><strong>OBJECTIVE: </strong>To explore personal, family, social, community, attitudinal, practical, geographical, cultural and traditional factors which may influence adherence to treatment, a two-phase study was undertaken comprising issue identification via focus groups, and a ranking exercise via individual interview.</p>

<p><strong>STUDY DESIGN: </strong>The perspectives of 895 respondents (320 people affected by leprosy who were not able to complete treatment, 302 of their 'operational heads of family', and 273 of their nearby community members) across four states of India namely i.e. Andhra Pradesh (Salur), Chhattisgarh (Chandkhuri), Maharashtra (Kothara) and Uttar Pradesh (Barabanki) were collected, using a checklist interview method.</p>

<p><strong>RESULTS: </strong>Findings suggest that seeing positive changes in their symptoms as well as not seeing improvement can lead to non-completion of MDT. Problems with scheduling and travel expenses were also key issues. Better management of the expectations of people affected by leprosy and reducing the burden of treatment may be important strategies. The importance of stigma and poverty were noted through a number of issues, none of which were particularly highly ranked.</p>

<p><strong>CONCLUSIONS: </strong>The nature and diversity of perceived issues identified across respondent type and particularly region, suggest that the determinants of adherence are complex and multi-factorial. More community based approaches with greater coordination at the community level are recommended.</p>
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