Tuberculosis treatment adherence and fatality in Spain

Abstract

BackgroundThe adherence to long tuberculosis (TB) treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment.MethodsProspective study of a large cohort of TB cases diagnosed during 2006-2007 by 61 members of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Predictive factors of completion outcome (cured plus completed treatment vs. defaulters plus lost to follow-up) and fatality (died vs. the rest of patients) were based on logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI).ResultsOf the 1490 patients included, 29.7% were foreign-born. The treatment outcomes were: cured 792 (53.2%), completed treatment 540 (36.2%), failure 2 (0.1%), transfer-out 33 (2.2%), default 27 (1.8%), death 27 (1.8%), lost to follow-up 65 (4.4%), other 4 (0.3%). Completion outcome reached 93.5% and poor adherence was associated with: being an immigrant (OR = 2.03; CI:1.06-3.88), living alone (OR = 2.35; CI:1.05-5.26), residents of confined institutions (OR = 4.79; CI:1.74-13.14), previous treatment (OR = 2.93; CI:1.44-5.98), being an injecting drug user (IDU) (OR = 9.51; CI:2.70-33.47) and treatment comprehension difficulties (OR = 2.93; CI:1.44-5.98). Case fatality was 1.8% and it was associated with the following variables: age 50 or over (OR = 10.88; CI:1.12-105.01), retired (OR = 12.26;CI:1.74-86.04), HIV-infected (OR = 9.93; CI:1.48-66.34), comprehension difficulties (OR = 4.07; CI:1.24-13.29), IDU (OR = 23.59; CI:2.46-225.99) and Directly Observed Therapy (DOT) (OR = 3.54; CI:1.07-11.77).ConclusionImmigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required for patients who are retired, HIV-infected, IDU, and those with treatment comprehension difficulties.

A Retrospective Case-Control Study, Factors Affecting Treatment Outcomes for Pulmonary Tuberculosis in İstanbul, Turkey

“…As in past studies, which showed that foreign-born patients were at higher risk for default (18,19), in our study, being born outside Turkey was associated with a more than fivefold increase in odds for adverse treatment outcome.…”

Risk factors for non-cure among new sputum smear positive tuberculosis patients treated in tuberculosis dispensaries in Yunnan, China

“…Poor adherence to anti-tuberculosis treatment is considered the most important factor leading to non-curein patients infected with strains susceptible to the drugs [9-11]. Therefore, observation of treatment is considered one of the key elements of the DOTS strategy.…”

Opinião dos profissionais de saúde sobre os serviços de controle da tuberculose

“…For this reason, it is necessary to recognize and consider social, economic and family aspects, in order to establish autonomy and co-responsibility of health care. (7) Professionals who participated in this study agreed with the need to consider such aspects, mainly because focus on family had a satisfactory score. Although integration is lacking among users, family and the health team, tuberculosis control actions and patient follow-up are, in general, developed together with the family.…”

“…A study conducted in Spain reported that life without family members is one of the main reasons for non-adherence to the treatment. (7) Concerning disease transmission, data showed a contradiction among responses: Professionals reported investigating the disease in communities, but the variable "giving a01 sputum test container" had only a fair score. This means that this action is not conducted with the necessary frequency.…”