Optimising Medication Adherence in Drugresistant Tuberculosis through PharmacistLed Counselling: A Prospective Interventional Study

Introduction: Medication adherence describes how well patients follow their prescribed treatment in terms of dose, timing and frequency. The present study evaluated adherence patterns to identify areas where focused interventions such as patient education, counselling and improved support systems may be needed. Aim: To assess medication adherence among patients with DrugResistant Tuberculosis (DR-TB) using a validated adherence assessment tool and to evaluate the impact of patient counselling through Patient Information Leaflets (PIL) on adherence-related outcomes. Materials and Methods: A prospective interventional multicentre study was carried out among 133 patients diagnosed with DR-TB from April 2025 to March 2026 at the District Tuberculosis Centre, Belagavi, Karnataka, India. along with four associated centres in North Karnataka under the National Tuberculosis Elimination Programme (NTEP). Medication adherence was evaluated using a validated and structured adherence assessment tool. In addition, patient counselling was provided through specially designed PIL and adherence-related parameters were assessed and compared throughout the study period. The data were analysed using descriptive statistics, paired t-test, Wilcoxon’s signed-rank test, correlation analysis and multiple linear regression. Results: Among 136 patients screened, 133 eligible patients with DR-TB were enrolled and completed the study. Following individualised medication-adherence counselling, significant improvements were observed across all medication adherence domains (p<0.001). The greatest improvement was observed in the medical condition-related domain (mean difference=3.02; Cohen’s dz=2.40), followed by the therapy-related domain (mean difference=1.92; Cohen’s dz=1.37). Wilcoxon’s signedrank analysis demonstrated significant positive changes in 20 of 21 questionnaire items, with effect sizes ranging from 0.295 to 0.833. No significant change was observed for the item assessing delays in medication refilling due to financial constraints (p=1.000). Overall, the intervention resulted in a substantial improvement in medication adherence among DRTB patients. Conclusion: The intervention significantly improved adherencerelated outcomes across multiple domains, independent of demographic factors. Pharmacist-led, patient-centred strategies may enhance DR-TB management and support effective Tuberculosis (TB) control.