Initial defaulting in the National Tuberculosis Programme in Ho Chi Minh City, Vietnam: a survey of extent, reasons and alternative actions taken following default.

Setting: Ho Chi Minh City, Vietnam.
Aim: To determine the extent of initial default in the NTP, the reasons for initial default, health seeking after initial default and treatment received at other health facilities.
Method: Questionnaire-based interviews of patients who were diagnosed with sputum-positive TB in the NTP during 2000 and who did not register for treatment in the NTP.
Results: The initial default rate was 8.3%; 79% gave reasons related to the NTP working procedures or treatment strategy, while 17.5% gave reasons related to insufficient knowledge among patients about TB and/or the need for treatment. Sixty-five per cent had been treated with anti-tuberculosis drugs at other health facilities after default, of which 74% had been treated at fully private facilities.
Conclusion: Initial default is mainly caused by some patients' negative perceptions of working procedures and/or treatment strategy in the NTP. The majority of these patients are treated in private clinics after default from the NTP. The NTP needs to improve patients' perceptions of the treatment strategy and develop more user-friendly services that enable more patients to access treatment and reduce the risk of patients receiving substandard treatment in the private sector.