Factors affecting defaulting from DOTS therapy under the national programme of tuberculosis control in Alexandria, Egypt

Abstract

This unmatched case-control study aimed to identify factors affecting default from therapy under the national programme of TB control in Alexandria, Egypt. Record reviews and structured interviews were made with 57defaulters and 187 randomly selected controls. Univariate analysis showed 13 out of 54 factors investigated were significantly associated with defaulting and, after stepwise logistic regression, 5 factors remained in the model: younger age (adjusted OR= 0.16), rural area of residence (OR = 12.9), long waiting times (OR = 5.81), poor physician-patient communication (OR = 3.06) and fear of information leakage (OR = 3.62). Reasons cited by defaulters included long distance to the clinic, unsuitable clinic times and long waiting times. The main factors associated with defaulting from the national programme of TB control in Alexandria, Egypt were service-related factors, which are amenable to improvement. RÉSUMÉ La présente étude cas-témoins non appariés visait à identifier les facteurs influant sur l'abandon du traitement dans le cadre du programme national de lutte antituberculeuse à Alexandrie (Égypte). Les dossiers médicaux de 57 patients ayant abandonné le traitement et de 187 témoins sélectionnés aléatoirement ont été examinés puis des entretiens structurés ont été menés. Une analyse univariée a démontré que 13 facteurs étudiés sur 54 étaient significativement associés à un abandon et, après une analyse de régression logistique par étapes, cinq facteurs ont été dégagés à partir du modèle : un âge plus jeune (OR ajusté = 0,16), un lieu de résidence en milieu rural (OR = 12,9), un long temps d'attente (OR = 5,81), une mauvaise communication entre le médecin et le patient (OR = 3,06) et la crainte de la divulgation d'informations (OR = 3,62). Une longue distance pour atteindre l'établissement de soins, des horaires d'ouverture peu pratiques et de longs temps d'attente comptaient parmi les raisons citées par les patients ayant abandonné le traitement. Les principaux facteurs associés à un abandon du traitement dans le cadre du programme national de lutte antituberculeuse à Alexandrie (Égypte) relevaient du domaine des services se prêtant aux améliorations.

High non-compliance rate with anti-tuberculosis treatment: a need to shift facility-based directly observed therapy short course (DOTS) to community mobile outreach team supervision in Saudi Arabia

“…Even if the patient pays regular visits to clinics for DOTS as part of the National anti-TB program, health professionals and sometimes even the treatment observer are never entirely sure whether the patient is actually taking the medicine or not [4, 23–25]. Studies have shown that patients tend to misinform and lie to even the treatment observer [23, 24]. To avoid this ambiguity, and to comply with the prescribed treatment, this year the NTCPP introduced the new concept of Community Mobile Outreach Teams.…”

Time Trend Analysis of Tuberculosis Treatment While Using Digital Adherence Technologies—An Individual Patient Data Meta-Analysis of Eleven Projects across Ten High Tuberculosis-Burden Countries

“…Previous research found that TB patients may be more comfortable with using a digital treatment monitoring app over time, meaning that they know how to use the technology better [ 33 ]. Perhaps this led to better adherence at first, whereafter the “usual” observed adherence pattern occurred: a decrease in adherence from the intensive phase to the continuation phase, as demonstrated by other studies [ 34 , 35 , 36 ]. The sensitivity analysis, however, did not confirm this pattern and showed a continues decrease in adherence without the increase between month 1 and 2.…”

“…These trends need further exploration when more data become available. Decreasing adherence over time might be caused by the fact that some patients may still suffer from side effects, which may result in treatment discontinuation, or patients may experience fewer symptoms during the continuation phase and misinterpret this as being cured [ 34 , 35 ]. Consequently, patients may be less eager to take medication.…”

Characteristics of Poor Tuberculosis Treatment Outcomes among Patients with Pulmonary Tuberculosis in Community Hospitals of Thailand

“…In a study conducted in India, patients treated without DOTS had higher risks of adverse outcomes than patients treated with DOTS. 44 The rural area was indicated to be one of the factors contributing to low adherence to DOTS in studies conducted in Egypt, 45 China, 46 and Nepal. 47 There were various reasons that made the rural area being the contributing factor to low DOTS adherence such as travel costs, illiteracy, poor knowledge of TB, and frequent visits to the clinic.…”