Defaults among tuberculosis patients treated under DOTS in Bangalore City: a search for solution
Vijay, S.; Balasangameswara, V.H.; Jagannatha, P.S.; Saroja, V.N.; Kumar, P.
Indian Journal of Tuberculosis 50(4): 185-195
2003
ISSN/ISBN: 0019-5707 Document Number: 253936
A retrospective case-control study was conducted to identify the sociodemographic and treatment related risk factors predictive of treatment default among tuberculosis patients treated under DOTS (directly observed therapy short course), and to examine treatment regularity and bacteriological profile of defaulted tuberculosis patients in an urban setting. 264 new (CAT I) and 219 retreatment (CAT II) smear-positive patients who were treated under DOTS from March 1999 to September 2000 in all treatment centres of Bangalore Mahanagara Palike, Karnataka, India, were interviewed using pre-tested semi-structured questionnaires. Defaults were 25 and 45% in CAT I and CAT II, respectively. The predictive factors associated with default identified through multivariate logistic regression analysis were being male (adjusted odds ratios (AORs): 2.49 in CAT I and 2.78 in CAT II) and alcoholism (AORs: 6.38 in CAT I and 3.93 in CAT II). In addition, patients with poor knowledge about tuberculosis (AOR, 3.06) and those returning for treatment after default (AOR, 2.55) were predictors of default among CAT II. Majority of the patients (CAT I, 65.7%; CAT II, 71%) defaulted treatment during the intensive phase, particularly after the 12th dose. More than half of the patients who defaulted treatment remained bacteriologically positive at the end of treatment period. It is suggested that recommendations be formulated concerning management of tuberculosis patients with respect to the risk of treatment default.