Authors: Hill, P.C.¹; Stevens, W.¹; Hill, S.¹; Bah, J.¹; Donkor, S.A.¹; Jallow, A.²; Lienhardt, C.³

Source: The International Journal of Tuberculosis and Lung Disease, Volume 9, Number 12, December 2005 , pp. 1349-1354(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: An urban tuberculosis (TB) clinic, The Gambia.

OBJECTIVE: To identify patient characteristics associated with increased rates of defaulting from treatment, specifically knowledge and cost factors amenable to intervention.

DESIGN: Prospective cohort study of TB cases at least 15 years of age commencing treatment, interviewed by semi-structured questionnaire and followed for attendance at thrice-weekly directly observed treatment (DOT).

RESULTS: Of 301 patients, 76 (25.2%) defaulted from treatment and 25 did not return for treatment. The defaulting rate was higher among those who said they were uncertain that their treatment would work (HR 3.64; 95%CI 1.42–9.31, P = 0.007) and among those who incurred significant time or money costs travelling to receive treatment (HR 2.67; 95%CI 1.05–6.81; P = 0.04). These factors had differing effects with respect to time: uncertainty over treatment success was important in the first 90 days of treatment, while increased cost of travelling to the clinic was important after 90 days.

CONCLUSION: In The Gambia, risk groups for defaulting can be recognised at the start of treatment and are at highest risk at different times. Home-based self-administration of medications after 3 months of DOT should be considered as confidence in treatment success rises, and the costs of travelling to receive treatment start to take their toll.

Keywords: The Gambia; tuberculosis; defaulting; cost; knowledge

Document Type: Regular paper

Affiliations: 1: Department of Tuberculosis, Medical Research Council Laboratories, Banjul, The Gambia 2: Department of Disease Control, Gambia Government, Banjul, The Gambia 3: Tuberculosis Unit, Institut de Recherche pour le Développement, Dakar, Senegal

Publication date: 2005-12-01

More about this publication?

• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

  Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

• Editorial Board
• Information for Authors
• Subscribe to this Title
• ingentaconnect is not responsible for the content or availability of external websites

Related content

• In this: publication
• By this: publisher
• In this Subject: Internal Medicine
• By this author: Hill, P.C. ;  Stevens, W. ;  Hill, S. ;  Bah, J. ;  Donkor, S.A. ;  Jallow, A. ;  Lienhardt, C.

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers