Movement of Tuberculosis Patients and the Failure to Complete Antituberculosis Treatment

Abstract

The outcomes of tuberculosis (TB) patients who move before completing antituberculosis treatment have not been described. We studied a population-based cohort of 2,576 adult patients reported as having TB in California during 1993, including 147 patients who moved from one local health jurisdiction to another within California. We determined treatment outcomes (completed, defaulted, died, other) for 131 (89%) of these 147 patients. Patients who moved defaulted more often (relative risk [RR] = 5.5, 95% confidence interval [CI] = 4.1 to 7.4) than patients who did not move. Including these patients' treatment outcomes increased the known number of defaulters by 30%, from 141 to 183 persons. Additionally, diagnosis of TB in a state prison emerged as the strongest risk factor for defaulting from treatment. Patients who moved or defaulted were more likely to abuse drugs or alcohol, to be homeless or to be associated with congregate settings such as jails and prisons. On average, patients who defaulted after moving received less than three-quarters of their recommended treatment regimens. These patients may remain infectious or become infectious again. Our findings highlight the importance of ensuring complete treatment for TB patients who move; failure to do so will adversely affect patient health and TB control, especially in many high-risk populations and settings.

Defaulting from tuberculosis treatment in the Netherlands: rates, risk factors and trend in the period 1993–1997

“…Although not all of the patients reported as having moved away may have defaulted, the risk of defaulting is likely to be high in this group [20]. Although the level of defaulting may have been somewhat overestimated by this approach, the inclusion or exclusion of this group made little difference in the analysis of most risk factors.…”

HIV and Housing Assistance in Four U.S. Cities: Variations in Local Experience

“…In turn, other studies of HIV patients in the United States have shown that providing housing assistance to individuals enhances their entry and access to care (Conover & Whetten-Goldstein, 2002, Conviser & Pounds, 2002, Messeri, Abramson, Aidala, Lee, & Lee, 2002. Beyond the realm of HIV, housing instability and homelessness has been linked to default on treatment for tuberculosis (Cummings, Mohle-Boetani, Royce, & Chin, 1998), dropping out of drug treatment (Marrero et al, 2005), and nonadherence to mental health treatment referrals (Dobscha, Delucchi, & Young, 1999).…”

Tuberculosis trends in California correctional facilities, 1993–2013

“…These results are consistent with findings showing that patients who move are less likely to complete treatment. 22 Our analysis reveals potential limitations in assessing treatment outcomes using surveillance data, and highlights the need for better coordination of care between correctional facilities, state and local health jurisdictions, and international TB partners, especially upon parole.…”