Risk factors for dots treatment default among new HIV-TB coinfected patients in Nalgonda (Dist.) Telangana (State): A case control study

Abstract

Background:The therapeutic regimens as recommended by the Revised National TB Control Programme (RNTCP) have been shown to be highly effective for both preventing and treating tuberculosis, but poor adherence to medication is a major barrier to its global control.Aim and Objectives:The study was conducted to assess the influence of patient related factors for DOTS Treatment Default among HIV-TB Co-infected cases.Setting and Design:This was a case control study conducted in Nalgond, Telangana.Materials and Methods:All new HIV-TB coinfected and DOTS-defaulted patients registered under RNTCP for the period from January 2010 to December 2012 were selected. Of the 154 patients, 23 had died and 11 could not be traced, and these were excluded. Thus the total number of available cases were 120 for those age- and sex-matched controls (HIV-TB coinfected patients and those who had completed the DOTS regimen successfully) were selected.Results:The mean age was 36.5 ± 9 years; the majority (23.3%) of patients defaulted during the second month of treatment. Significant risk factors associated with defaulting included unskilled occupation [adjusted odds ratio (AOR: 3.56; 95% confidence interval (CI): 1.1-11.56], lower middle class socioeconomic status (AOR: 17.16; 95% CI: 3.93-74.82), small family size (AOR: 21.3; 95% CI: 6.4-70.91), marital disharmony (AOR: 6.78; 95% CI: 1.93-23.76), not being satisfied with the conduct of health personnel (AOR: 7.38; 95% CI: 2.32-23.39), smoking (AOR: 8.5; 95% CI: 2.31-31.21), and side effects of drugs (AOR: 4.18; 95% CI: 1.35-12.9).Conclusion:Unskilled occupation, marital disharmony, small family size, lower middle class socioeconomic status, not being satisfied with the conduct of health personnel, smoking, and drug side effects were significantly associated with defaulting. Information on the pattern of tuberculosis (TB), the outcome of anti-tuberculosis treatment (ATT), and the factors associated with it will help in planning interventions to improve adherence to DOTS treatment.

A comparative analysis of the profile and treatment outcomes of tuberculosis patients managed at the community and primary health care facilities in Botswana

“…Patients who ran their businesses were also significantly more likely to enrol in CBDOT compared to FBDOT. This finding was supported by studies in Ethiopia [14] and India [15] . A possible explanation could be that these patients are always engaged with their daily work thus, CBDOT is convenient for them.…”

“…Across all spectrums of employment, patients were likely to be cured compared to the unemployed. This finding was supported by studies in Ethiopia [14] and India [15] indicating a lower likelihood of having successful TB outcomes among the unemployed and unskilled occupations than among the employed. This could be explained that the employed has a reliable socioeconomic status, which may influence treatment outcomes through its impact on improved nutrition, and thereby is associated with the increased strength of the immune system and improved clinical outcomes [28] , [29] .…”

Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort

“…A recent study conducted in the same scenario showed that the need for hospitalization for TB treatment is more frequent in non-white patients living in poverty [34]. In our study, schooling was used as a proxy for the economic situation, and, although schooling was not associated with DOT, the lower the schooling, the greater the percentage of DOT, a trend already observed in other studies [33,35].…”

“…Notwithstanding, the district has a health center that is historically considered one of the pioneers in tuberculosis treatment [18]. Sex and age were not associated with the outcome, as in other studies that point out that these are not decisive factors for the performance of DOT [31–33]. In terms of sociodemographic variables, data on race and schooling show the vulnerability associated with DOT.…”

Prevalence and predictive factors of tuberculosis treatment interruption in the Asia region: a systematic review and meta-analysis

“…Thirty-nine studies were accounted for pooled prevalence analysis, which included 32 020 treatment interrupters out of 654 872 populations in the study cohorts. All case–control studies and one cross-sectional study were excluded due to a fixed ratio sampling between treatment interrupters and non-interrupters,17–26 while another cross-sectional study included all interrupters in the study population 27. The overall pooled estimated prevalence for the Asia region was 17% (95% CI 16% to 18%).…”