Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru

Abstract

BackgroundAlthough tuberculosis (TB) is usually curable with antibiotics, poor adherence to medication can lead to increased transmission, drug resistance, and death. Prior research has shown several factors to be associated with poor adherence, but this problem remains a substantial barrier to global TB control. We studied patients in a high-incidence district of Lima, Peru to identify factors associated with premature termination of treatment (treatment default).MethodsWe conducted a prospective cohort study of adult smear-positive TB patients enrolled between January 2010 and December 2011 with no history of TB disease. Descriptive statistics and multivariable logistic regression analyses were performed to determine risk factors associated with treatment default.ResultsOf the 1233 patients studied, 127 (10%) defaulted from treatment. Patients who defaulted were more likely to have used illegal drugs (OR = 4.78, 95% CI: 3.05-7.49), have multidrug-resistant TB (OR = 3.04, 95% CI: 1.58-5.85), not have been tested for HIV (OR = 2.30, 95% CI: 1.50-3.54), drink alcohol at least weekly (OR = 2.22, 95% CI: 1.40-3.52), be underweight (OR = 2.08, 95% CI: 1.21-3.56), or not have completed secondary education (OR = 1.55, 95% CI: 1.03-2.33).ConclusionsOur study identified several factors associated with defaulting from treatment, suggesting a complex set of causes that might lead to default. Addressing these factors individually would be difficult, but they might help to identify certain high-risk patients for supplemental intervention prior to treatment interruption. Treatment adherence remains a barrier to successful TB care and reducing the frequency of default is important for both the patients’ health and the health of the community.

Evaluation of tuberculosis defaulters in Yemen from the perspective of health care service

“…Moreover, the available studies did not identify constraints in TB treatment as well as the timing of default. A low success rate and a high defaulting rate of 79.7% and 12.6% respectively, were reported, which is consistent with the high defaulting rates reported in similar studies, namely 7.2% in South Africa, 10% in Sudan, 17% in Busia, 10% in Lima, Peru and 9.4% in Nigeria . The importance of this study is highlighted by the fact that WHO recommends that TB defaulting rates should not exceed 10%…”

“…The persistence of respiratory symptoms related to smoking might force the patient to stop TB treatment. Several studies have reported smoking as a risk factor of TB defaulters . However, some studies were unable to establish an association between smoking and TB treatment defaulters …”

Studi Karakteristik Pasien Tuberkulosis Di Puskesmas Seberang Ulu 1 Palembang

“…Penderita TB akan mengalami penurunan nafsu makan sehingga mengalami kehilangan berat badan. Menurut penelitian Lackey (2015) responden yang kurang gizi memiliki risiko TB sebesar 2.08 kali. Hal ini disebabkan karena perubahan metabolik pada pasien TB seperti perubahan leptin darah dan penekanan eritropoesis menyebab pasien TB mengalami anemia dan malnutrisi (Lackey dkk, 2015;Nasution, 2015) Kadar Gula darah sewaktu pasien TB pada penelitian ini rata-rata 137.10 g/dl dengan kadar tertinggi adalah 178.27 g/dl, serta didapatkan 13.2% pasien TB dengan DM.…”

Factors that contribute to treatment defaulting amongst tuberculosis patients in Windhoek District, Namibia

“…[35] It was found that TB patients who have a problem with alcoholism do not collect their treatment regularly and were found to default treatment more than the non-alcoholic patients. [7] One health service related factor that can cause stigma is the integration of the TB and HIV departments as well as having this combined department separate from the main health centre. This situation was perceived by the TB patients in the current study as causing stigma because once they were seen entering the department, they feared they would be labelled as HIV positive.…”

“…[5] Another study reported a defaulter rate of 14% in Vietnam in 2004 [6] and 10% in 2014 in Lima, Peru. [7] WHO [8] reports that TB incidence has worsened in Africa especially sub-Saharan Africa where the epidemic is worsened by the HIV/AIDS pandemic. A low treatment success rate of 70% has been reported in Africa which has been blamed on treatment defaulting.…”