Factors Associated With Tuberculosis Treatment Interruption in New York City

Driver, Cynthia R.; Matus, Sandra P.; Bayuga, Sharon; Winters, Ann; Munsiff, Sonal S.

doi:10.1097/00124784-200507000-00017

Cited by 22 publications

(26 citation statements)

References 6 publications

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“…Some studies have reported communication barriers or poor communication between patients and providers as being linked to poor adherence [15,17,18]. Perceived communication quality or lack thereof may reflect the status of the patient provider relationship and influence patient behavior [18,19]. Other studies have reported associations between TB treatment default and a poor level of knowledge of TB or low patient satisfaction regarding information provided concerning their illness [17-20].…”

Section: Discussionmentioning

confidence: 99%

Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

et al. 2012

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BackgroundPersons who default from tuberculosis treatment are at risk for clinical deterioration and complications including worsening drug resistance and death. Our objective was to identify risk factors associated with tuberculosis (TB) treatment default in South Africa.MethodsWe conducted a national retrospective case control study to identify factors associated with treatment default using program data from 2002 and a standardized patient questionnaire. We defined default as interrupting TB treatment for two or more consecutive months during treatment. Cases were a sample of registered TB patients receiving treatment under DOTS that defaulted from treatment. Controls were those who began therapy and were cured, completed or failed treatment. Two respective multivariable models were constructed, stratified by history of TB treatment (new and re-treatment patients), to identify independent risk factors associated with default.ResultsThe sample included 3165 TB patients from 8 provinces; 1164 were traceable and interviewed (232 cases and 932 controls). Significant risk factors associated with default among both groups included poor health care worker attitude (new: AOR 2.1, 95% CI 1.1-4.4; re-treatment: AOR 12, 95% CI 2.2-66.0) and changing residence during TB treatment (new: AOR 2.0, 95% CI 1.1-3.7; re-treatment: AOR 3.4, 95% CI 1.1-9.9). Among new patients, cases were more likely than controls to report having no formal education (AOR 2.3, 95% CI 1.2-4.2), feeling ashamed to have TB (AOR 2.0, 95% CI 1.3-3.0), not receiving adequate counseling about their treatment (AOR 1.9, 95% CI 1.2-2.8), drinking any alcohol during TB treatment (AOR 1.9, 95% CI 1.2-3.0), and seeing a traditional healer during TB treatment (AOR 1.9, 95% CI 1.1-3.4). Among re-treatment patients, risk factors included stopping TB treatment because they felt better (AOR 21, 95% CI 5.2-84), having a previous history of TB treatment default (AOR 6.4, 95% CI 2.9-14), and feeling that food provisions might have helped them finish treatment (AOR 5.0, 95% CI 1.3-19).ConclusionsRisk factors for default differ between new and re-treatment TB patients in South Africa. Addressing default in both populations with targeted interventions is critical to overall program success.

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Section: Discussionmentioning

confidence: 99%

Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

et al. 2012

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“…It has been observed before that adverse events during treatment increase the risk of non-adherence to therapy [13,20-25]. Driver [26] studied determinants for treatment interruption and found that the lack of TB disease and treatment related knowledge were important reasons for patients discontinuing treatment. Indeed, health education has shown to improve treatment adherence [24].…”

Section: Discussionmentioning

confidence: 99%

Treatment adherence among sputum smear-positive pulmonary tuberculosis patients in mountainous areas in China

Yao¹,

Huang

Hof

et al. 2011

BMC Health Serv Res

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BackgroundWe carried out an investigation in five provinces in China to assess treatment adherence and identify factors associated with insufficient treatment adherence in tuberculosis (TB) patients in mountainous, rural areas of China.MethodsIn each of the five provinces, all counties with > 80% mountainous area were stratified into three groups according to their gross domestic product. In each stratum, one county was randomly sampled. Study subjects were sampled from all smear positive TB cases registered in 2007 in the target counties. TB patients, village doctors, county doctors and directors of the TB prevention and control institutes were interviewed. Insufficient medication adherence was defined as taking less than 90% of anti-TB drug doses prescribed. Insufficient re-examination adherence was defined as having less than the recommended three sputum smear examinations during the treatment course.ResultsA minority of patients took drugs under direct observation: on average 29% during the intensive phase of treatment. In total, 524 TB patients were included, of whom 49 (9.4%) took less than 90% of all doses prescribed and 92 (17.6%) did not have all sputum smear examinations, with substantial variations between the provinces. In multivariable analysis, no direct observation of treatment during the intensive phase and the presence of adverse events were associated both with insufficient medication adherence and insufficient re-examination adherence. Overall, 79% of patients were adherent both to treatment and re-examinations.ConclusionsIn these remote and poor areas of China, the TB control program is not fully functioning according to the guidelines. The majority of patients are not treated under direct observation, while direct observation by health care staff was associated with better adherence, both to drug therapy and re-examinations. Insufficient adherence increases the risk of unsuccessful treatment outcomes and development of drug resistance. Measures should be taken urgently in these areas to strengthen implementation of the international Stop TB strategy.

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“…Different patient groups may also be associated with higher probability of interrupting treatment [6]–[8]. Further, the methods used to define treatment interruption have not been standard across studies with some defining interruption as any single missed treatment dose [4], [5], [7], utilizing the number of times treatment was interrupted [4], the median or total duration of missed doses [5], [6], maximum number of consecutive doses missed [4], [7], or cut-offs for proportion of total treatment that was missed [6], [8]. It is possible that some crude definitions lack sensitivity to identify patients at greatest risk for poor outcomes; other categorizations may have differing relevance to outcomes within a program context.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Treatment Interruption among Patients with Multidrug-Resistant TB (MDR TB) and Association with Interim and Final Treatment Outcomes

et al. 2013

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BackgroundThe reasons that patients with multidrug-resistant tuberculosis (MDR TB) miss treatment are multi-factorial and complex. Identifying patterns of treatment interruption that predict poor outcomes can be used to target program activities aiming to improve treatment adherence.ObjectiveTo characterize patterns of treatment interruption among MDR TB patients and determine the association between patterns and treatment outcomes.MethodsRetrospective analysis of MDR TB patients. A treatment interruption was defined as any time that a patient missed a prescribed dose of treatment for at least 1 day but for a period of less than 2 consecutive months. Patients were characterized by the number, length and variability of interruptions, variability of time between interruptions, and percent of missed doses. Final treatment outcome was dichotomized as a successful (cured or completed) or poor outcome (defaulted, failed, or died). Risk ratios were calculated to determine the association between characteristics of treatment interruption and treatment outcomes. All analyses were conducted in 6 month treatment intervals.ResultsOnly 7.0% of 583 patients completed treatment without interruption. Of the remaining 542 patients, the median time to the first interruption was 2 ½ months (70 days). In multivariate analysis, patients who had longer interruptions with sporadic variability during the 6–12 month or the 12–18 month treatment period had a significantly increased risk for poor outcomes compared to patients who had short, regular interruptions (RRadj 4.37, 95% CI 1.2–15.8; = 0.03 and RRadj 3.38, 95% CI 1.6–7.1; p = 0.001, respectively). In addition, missing 10% or more of the prescribed doses during any 6 month period in the initial 18 months of therapy significantly increased the risk for poor outcomes (RRadj range 1.55–2.35; p-value range 0.01–0.005).ConclusionPatients that miss more consecutive days of treatment with sporadic interruption patterns or a greater proportion of treatment are at an increased risk for poor treatment outcomes.

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Factors Associated With Tuberculosis Treatment Interruption in New York City

Abstract: Efforts to improve patients' understanding of TB disease and related treatment issues may be an important TB control program strategy and should be emphasized at the initiation of therapy and at intervals throughout the treatment course to minimize treatment interruption.

Cited by 22 publications

References 6 publications

Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

Treatment adherence among sputum smear-positive pulmonary tuberculosis patients in mountainous areas in China

Patterns of Treatment Interruption among Patients with Multidrug-Resistant TB (MDR TB) and Association with Interim and Final Treatment Outcomes

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