Nonadherence to Anti-tuberculosis Treatment, Reasons and Associated Factors Among Pulmonary Tuberculosis Patients in the Communities in Indonesia

Dina Bisara Lolong, Ni Ketut Aryastami, Ina Kusrini, Kristina L. Tobing, Ingan Tarigan, Siti Isfandari, Felly Philipus Senewe, Raflizar, Noer Endah, Nikson Sitorus, Lamria Pangaribuan, Oster S. Simarmata, Yusniar Ariati


Tuberculosis (TB) is the world’s major public health problem. We assessed the proportion, reasons, and associated factors for anti-TB treatment nonadherence in the communities in Indonesia.


Tuberculosis remains the leading cause of death from infectious disease among adults worldwide, with more than 10 million people becoming newly sick from tuberculosis yearly, while 1.5 million people die from TB. Indonesia is considered the third country with a high prevalence of TB after India and China [1] Free TB treatment following the directly observed treatment, short-course (DOTS) strategy is, among others, the primary process implemented in Indonesia [2]. Studies showed that DOTS increased the compliance rate, reduced the disease’s recurrence, and prevented the development of multidrug resistance [3].

Materials and method

This study used cross-sectional data from Indonesia’s Tuberculosis Prevalence Survey from 2013 to 2014. The sampling method implemented a stratified multi-stage cluster sampling. The survey is conducted every ten years across the 33 provinces and 156 clusters by collaborating with the National Institute of Health Research and Development (NIHRD) and the Directorate General of Diseases Prevention and Control. A cluster comprises at least two census blocks of the population aged 15 years within approximately 500 people [11].


The total sample involved in the survey was 67,944 subjects. The number of issues included in this analysis was 2,191, with the criteria of those having a TB history. We further identified problems that had taken the TB treatment as 2,045 issues


In this study, the rate of Nonadherence to anti-tuberculosis treatment was 27.2%. This aligns with the study done at Gondar town health centers in Northwest Ethiopia [12] and at TB clinics in Arba Minch Government Health Institutions, Southern Ethiopia [13], which reported 21.2% and 24.7% rates, respectively. However, it is higher than in studies done in the community in PR China [14] and Bandung at the TB lung clinic, Indonesia [15], which were 12.2%and 16%, respectively. This finding is lower than in studies conducted at TB treatment centers in India (50%) [16] and Mekelle, Ethiopia (55.8%) [17]. The variation might be due to the differences in study design and settings.


This study found that the proportion of Nonadherence to anti-TB drugs was high in the communities in Indonesia. The place for first TB treatment at the private practitioner is significantly associated with Nonadherence to treatment. Reasons for Nonadherence to TB treatment depend on subject response and self-confession, respectively.The community is undisciplined in TB treatment. Thus, the role of health workers is essential to focus more on monitoring and implementing standard therapy according to SOP.

Citation: Lolong DB, Aryastami NK, Kusrini I, Tobing KL, Tarigan I, Isfandari S, et al. (2023) Nonadherence to anti-tuberculosis treatment, reasons and associated factors among pulmonary tuberculosis patients in the communities in Indonesia. PLoS ONE 18(8): e0287628.

Editor: Frederick Quinn, The University of Georgia, UNITED STATES

Received: July 22, 2021; Accepted: June 8, 2023; Published: August 8, 2023

Copyright: © 2023 Lolong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This study was funded by Global Fund, KNCV, USAID and WHO. Each Funder had a specific role such as : Global Fund for data collection and management; KNCV and USAID for laboratory instruments including its apparatus; WHO for technical research assistant including training for the team, research preparation, data collection and supervision.

Competing interests: The authors have declared that no competing interests exist.


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