Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

Abstract

BackgroundPersons who default from tuberculosis treatment are at risk for clinical deterioration and complications including worsening drug resistance and death. Our objective was to identify risk factors associated with tuberculosis (TB) treatment default in South Africa.MethodsWe conducted a national retrospective case control study to identify factors associated with treatment default using program data from 2002 and a standardized patient questionnaire. We defined default as interrupting TB treatment for two or more consecutive months during treatment. Cases were a sample of registered TB patients receiving treatment under DOTS that defaulted from treatment. Controls were those who began therapy and were cured, completed or failed treatment. Two respective multivariable models were constructed, stratified by history of TB treatment (new and re-treatment patients), to identify independent risk factors associated with default.ResultsThe sample included 3165 TB patients from 8 provinces; 1164 were traceable and interviewed (232 cases and 932 controls). Significant risk factors associated with default among both groups included poor health care worker attitude (new: AOR 2.1, 95% CI 1.1-4.4; re-treatment: AOR 12, 95% CI 2.2-66.0) and changing residence during TB treatment (new: AOR 2.0, 95% CI 1.1-3.7; re-treatment: AOR 3.4, 95% CI 1.1-9.9). Among new patients, cases were more likely than controls to report having no formal education (AOR 2.3, 95% CI 1.2-4.2), feeling ashamed to have TB (AOR 2.0, 95% CI 1.3-3.0), not receiving adequate counseling about their treatment (AOR 1.9, 95% CI 1.2-2.8), drinking any alcohol during TB treatment (AOR 1.9, 95% CI 1.2-3.0), and seeing a traditional healer during TB treatment (AOR 1.9, 95% CI 1.1-3.4). Among re-treatment patients, risk factors included stopping TB treatment because they felt better (AOR 21, 95% CI 5.2-84), having a previous history of TB treatment default (AOR 6.4, 95% CI 2.9-14), and feeling that food provisions might have helped them finish treatment (AOR 5.0, 95% CI 1.3-19).ConclusionsRisk factors for default differ between new and re-treatment TB patients in South Africa. Addressing default in both populations with targeted interventions is critical to overall program success.

Factors associated with non-adherence during tuberculosis treatment among patients treated with DOTS strategy in Jayapura, Papua Province, Indonesia

“…Similar to our study, two African studies found that younger age is associated with non-adherence [20,21]. This association was also observed in the Indian and Moroccan studies [7,19].…”

“…This finding is supported by a large case-control study conducted by Finlay et al [21] in South Africa. Other studies in Africa also show that difficulties of physical access and transfer of cases to other healthcare units related to moving of residence affected adherence to TB treatment negatively [20,24].…”

Nationwide and regional incidence of microbiologically confirmed pulmonary tuberculosis in South Africa, 2004–12: a time series analysis

“…16 Temporal-spatial variations in the gap between incidence estimates for microbiologically confi rmed pulmonary tuberculosis and new cases registered for treatment were noted, which could be caused by both patient and provider factors. 17,18 In 2012, this gap was more than 25% in fi ve of the nine provinces, which is concerning because patients not linked to care could be the major source of persisting M tuberculosis transmission in the community. Several limitations were also noted for data for new cases registered for treatment, including some provinces lacking or only having limited data for some years.…”

Faktor Penghalang dan Penggalak Kepatuhan daripada Perspektif Pesakit Tuberkulosis Cicir Rawatan di Kuala Lumpur

“…Castelnuovo (2010) dalam kajian kualitatif yang beliau jalankan bagi melihat kepada faktor risiko cicir rawatan mendapati antara faktor yang menyebabkan cicir rawatan dalam kalangan pesakit tuberkulosis di Sub-Sahara Afrika adalah kurang pengetahuan mengenai rawatan tuberkulosis (Castelnuovo 2010). Selain itu, menggunakan reka bentuk kajian yang berbeza faktor ini turut sama dilaporkan mempunyai perkaitan beerti dengan ketidakpatuhan dalam kajian kes kawalan dalam kalangan pesakit tuberkulosis cicir rawatan di Afrika Selatan (Finlay et al 2012). Ada di antara responden dalam kajian semasa ini menyatakan yang mereka berhenti daripada mengambil ubat kerana merasakan diri sudah sihat.…”

“…Ada di antara responden dalam kajian semasa ini menyatakan yang mereka berhenti daripada mengambil ubat kerana merasakan diri sudah sihat. Hal yang sama turut dinyatakan di dalam kajian sebelum ini (Finlay et al 2012;Slama et al 2013).…”