Impact of patient and program factors on default during treatment of multidrug-resistant tuberculosis
OBJECTIVE: To determine patient and socio-demographic characteristics associated with default, and the impact of patient support measures on default.
DESIGN: Retrospective cohort analysis of 583 MDR-TB patients treated from 1999 to 2006.
RESULTS: A total of 88 (15%) patients defaulted from treatment. The median follow-up time for patients who defaulted was 289 days (range 1–846). In multivariate analysis adjusted for age, sex and previous TB treatment, receiving a greater number of treatment drugs (≥5 vs. 2–3 drugs, HR 7.2, 95%CI 3.3–16.0, P < 0.001) was significantly associated with an increased risk of default, while decentralization reduced the risk of default (HR 0.3, 95%CI 0.2–0.7, P < 0.001).
CONCLUSION: Improving access to treatment for MDR-TB through decentralization of care to centers near the patient's residence reduced the risk of default. Further research is needed to evaluate the feasibility, impact and cost-effectiveness of decentralized care models for MDR-TB treatment.
Keywords: drug-resistant tuberculosis; patient incentives; program interventions; risk factors; treatment adherence
Document Type: Research Article
Affiliations: 1: Tropical Disease Foundation, Manila, The Philippines 2: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Publication date: 01 July 2012
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