Risk Factors for Treatment Default among Re-Treatment Tuberculosis Patients in India, 2006

Abstract

SettingUnder India's Revised National Tuberculosis Control Programme (RNTCP), >15% of previously-treated patients in the reported 2006 patient cohort defaulted from anti-tuberculosis treatment.ObjectiveTo assess the timing, characteristics, and risk factors for default amongst re-treatment TB patients.MethodologyFor this case-control study, in 90 randomly-selected programme units treatment records were abstracted from all 2006 defaulters from the RNTCP re-treatment regimen (cases), with one consecutively-selected non-defaulter per case. Patients who interrupted anti-tuberculosis treatment for >2 months were classified as defaulters.Results1,141 defaulters and 1,189 non-defaulters were included. The median duration of treatment prior to default was 81 days (25%–75% interquartile range 44–117 days) and documented retrieval efforts after treatment interruption were inadequate. Defaulters were more likely to have been male (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.2–1.7), have previously defaulted anti-tuberculosis treatment (aOR 1.3 95%CI 1.1–1.6], have previous treatment from non-RNTCP providers (AOR 1.3, 95%CI 1.0–1.6], or have public health facility-based treatment observation (aOR 1.3, 95%CI 1.1–1.6).ConclusionsAmongst the large number of re-treatment patients in India, default occurs early and often. Improved pre-treatment counseling and community-based treatment provision may reduce default rates. Efforts to retrieve treatment interrupters prior to default require strengthening.

Smear Conversion, Treatment Outcomes and the Time of Default in Registered Tuberculosis Patients on RNTCP DOTS in Puducherry, Southern India

“…The overall default rate for all registered TB patients was 7.4% and in those retreatment cases registered as treatment after default (N=44) the default rate was 9%. These findings are consistent with the findings of a study done by Jha et al, [5] Paradesi et al, [4] and Singh A et al, [2] These findings suggest that more efforts are needed to promote adherence to treatment in the retreatment cases. Interruption of treatment among these retreatment patients should warrant retrieval of the patient on a priority basis.…”

“…Gender, alcoholism, treatment after default, poor knowledge of tuberculosis, irregular treatment and socioeconomic status are some of the factors which have been found to be associated with higher default rates [5,6]. Other factors related to the service providers like difficulty in accessing health facility, non-governmental DOT center and previous treatment from non-RNTCP providers have also been identified as reasons for non-completion of treatment [5,7]. Very few studies have been done in the recent past focusing on understanding the time of default.…”

Reasons for defaulting from drug-resistant tuberculosis treatment in Armenia: a quantitative and qualitative study

“…The relationship between sex and default, shown previously for drug-susceptible TB, 15,[25][26][27][28] was close to signifi cance. This association may be explained by the fact that in Armenia males are more likely to work outside the home; presumably, once their health improves they seek employment, sometimes outside the country.…”

Treatment Outcome Among the Retreatment Tuberculosis (TB) Patients Under RNTCP in Chandigarh, India

“…In the present study cohort of category II patients 48.4% were relapse patients, 30.6% belonged to others category, 13.8% were on treatment after default, 7.2% were failure cases while in a study done by Jha et al, 33.0% were relapse patients, 37.6% were treatment after default, 20.5% were other patients, and 8.9% were failure cases [7].…”

“…In the present study on the retreatment patients maximum patients belonged to the age group of 25-34 years(25.3% [7].…”