SettingPublic tuberculosis (TB) clinics in urban Morocco.ObjectiveExplore risk factors for TB treatment default and develop a prediction tool. Assess consequences of default, specifically risk for transmission or development of drug resistance.DesignCase-control study comparing patients who defaulted from TB treatment and patients who completed it using quantitative methods and open-ended questions. Results were interpreted in light of health professionals’ perspectives from a parallel study. A predictive model and simple tool to identify patients at high risk of default were developed. Sputum from cases with pulmonary TB was collected for smear and drug susceptibility testing.Results91 cases and 186 controls enrolled. Independent risk factors for default included current smoking, retreatment, work interference with adherence, daily directly observed therapy, side effects, quick symptom resolution, and not knowing one’s treatment duration. Age >50 years, never smoking, and having friends who knew one’s diagnosis were protective. A simple scoring tool incorporating these factors was 82.4% sensitive and 87.6% specific for predicting default in this population. Clinicians and patients described additional contributors to default and suggested locally-relevant intervention targets. Among 89 cases with pulmonary TB, 71% had sputum that was smear positive for TB. Drug resistance was rare.ConclusionThe causes of default from TB treatment were explored through synthesis of qualitative and quantitative data from patients and health professionals. A scoring tool with high sensitivity and specificity to predict default was developed. Prospective evaluation of this tool coupled with targeted interventions based on our findings is warranted. Of note, the risk of TB transmission from patients who default treatment to others is likely to be high. The commonly-feared risk of drug resistance, though, may be low; a larger study is required to confirm these findings.

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Background To explore demographic characteristics, substance use patters, and estimate the prevalence of sexually transmitted infections (STI) and high-risk behaviors among male sex workers (MSW) in Moscow and to assess the feasibility of prospective cohort recruitment and retention among this population. Methods Longitudinal study of 50 men with 6 month follow up period. Participants were recruited through venue based and snowball sampling. Results HIV prevalence at baseline was 16% and 1 male seroconverted during the follow up period. 24 % were diagnosed with at least one STI: 12% had syphilis; 8% had HPV;, and 4% had HSV-2. Three (6%) of the study participants had evidence of previous HCV exposure at baseline. Conclusions This was the first study to evaluate baseline demographics, substance use patterns, and prevalence of infectious disease among MSW in Moscow. Identification, and recruitment of this population appears to be feasible, but retention rates were poor with higher retention significantly associated with older men. While the sample size in the current study was small, the results also suggested that this is a population at considerable high risk for HIV. Male sex workers in Moscow may be an important at risk population in the Russian HIV epidemic and further research is urgently required to address their needs and explore prevention strategies.

Interventions to enhance TB treatment completion should take into account the local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.