Study of various reasons for interruption of anti-tubercular treatment in patients of tuberculosis reporting to tertiary care center of west Rajasthan

Abstract

Background: Tuberculosis is a major cause of death in India. Premature cessation of treatment in tuberculosis patient is a leading cause for developing MDR (multidrug resistant tuberculosis) as well as a major threat to control programs. Despite the easy approach and free of cost, availability to antitubercular medicines the interruptions of the treatment are still on a high. So, we analyzed such various reasons leading to interrupt the antitubercular treatment.Methods: Total 150 patients who interrupted the antitubercular treatment, were interviewed with a predesigned questionnaire and the result was analyzed.Results: Out of total 150 patients 115 (76.7%) male and 35 (23.3%) female were interviewed, who were having history of antitubercular treatment interruption. Out of 150 patients, 79 (52.7%) patients stopped their treatment because of improvement. Total 25 (16.7%) patients had stopped their treatment because of high cost, 16 (10.7%) due to personal/family reason, 17 (11.4%) patients had stopped their treatment due to nausea/vomiting/anorexia, 5 (3.3%) due to alcoholism/drug or other addiction, 2 (1.3%) patients had stopped their treatment because they were advised to stop it by health personnel and long distance travelled to take drugs.Conclusions: Improvement of symptoms was the most common reason in patients who received DOTS treatment and high cost of treatment in patients who received non DOTS treatment. Poor education and socioeconomic status of society are the other reasons for possible treatment interruptions because as soon as the patient improves, they move out to earn their wages to run the family with the unavoidable default from the treatment.

Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

“…Patient mobility, represented by migration [139,140,142] or change of address [140], was a commonly reported barrier. Clinical factors included medication side effects in 6 studies [138][139][140][141][142][143], lack of symptom improvement [141], and early symptom improvement in 5 studies [139][140][141][142][143]. Nearly half of patients were lost to follow-up due to early symptom improvement in 2 studies [140,143].…”

“…Other patient-related reasons included psychological barriers such as forgetfulness in dosetaking [138] or non-compliant attitude to treatment [140]; substance use disorders such as alcoholism [139,140] and smoking [138]; knowledge gaps such as lack of awareness of the treatment duration [140,141] or misbelief that TB therapy is hazardous [143]; family or personal problems [139,140,143]; and social stigma [139].…”

“…Health-system related reasons included lack of faith in treatment [140]; healthcare accessibility challenges such as long distance to the health center [138,140,142,143] and high treatment costs [140,143]; healthcare provider barriers such as healthcare workers advising patients to stop treatment [140,143] or refusing to give treatment [140]; and shortage or non-availability of medications at the health center [140,142]. in 1 adjusted analysis [145], not being on antiretroviral therapy in 2 adjusted [144] and 1…”

“…Lower symptom severity b (N=4) 2 [39,59] 1 [44] 1 [105] Previous TB history (N=19) 1 [39] h 2 [41,51] j 2 [42,64] 13 [46,73,82,84,104,121,127,129,131,133,134,143,144] 1 [156] Drug-resistant TB (N=3) 2 [86,107] 1 [158] Medication non-adherence (N=6) 5 [81,84,97,98,121] 1 [158] Other clinical factors Undernutrition (N=11) 8 [84,86,111,116,118,121,122,134] 3 [85,96,154] HIV (N=5) 1 [42] 4 [86,107,130,132]…”

“…Disappearance of symptoms was a common reason for chest X-ray non-completion [55]. In Gap 4, patients report that mild symptoms at treatment initiation or early symptom resolution with treatment are common reasons for loss to follow-up [80,99,105,108,127,[139][140][141][142][143]. These results align with findings suggesting patients diagnosed by active case-finding-which identifies people with TB at a less symptomatic disease stagewere more likely to experience pretreatment and on-treatment loss to follow-up (Gaps 3 and 4) [74,75].…”