Authors: Kapella, B.K.¹; Anuwatnonthakate, A.²; Komsakorn, S.³; Moolphate, S.⁴; Charusuntonsri, P.⁵; Limsomboon, P.⁶; Wattanaamornkiat, W.⁷; Nateniyom, S.⁸; Varma, J.K.⁹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 13, Number 2, February 2009 , pp. 232-237(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Thailand's Tuberculosis (TB) Active Surveillance Network in four provinces in Thailand.

OBJECTIVE: As treatment default is common in mobile and foreign populations, we evaluated risk factors for default among non-Thai TB patients in Thailand.

DESIGN: Observational cohort study using TB program data. Analysis was restricted to patients with an outcome categorized as cured, completed, failure or default. We used multivariate analysis to identify factors associated with default, including propensity score analysis, to adjust for factors associated with receiving directly observed treatment (DOT).

RESULTS: During October 2004-September 2006, we recorded data for 14359 TB patients, of whom 995 (7%) were non-Thais. Of the 791 patients analyzed, 313 (40%) defaulted. In multivariate analysis, age ≥45 years (RR 1.47, 95%CI 1.25-1.74), mobility (RR 2.36, 95%CI 1.77-3.14) and lack of DOT (RR 2.29, 95%CI 1.45-3.61) were found to be significantly associated with default among non-Thais. When controlling for propensity to be assigned DOT, the risk of default remained increased in those not assigned DOT (RR 1.99, 95%CI 1.03-3.85).

CONCLUSION: In non-Thai TB patients, DOT was the only modifiable factor associated with default. Using DOT may help improve TB treatment outcomes in non-Thai TB patients.

Keywords: tuberculosis; migrants; default; Thailand

Document Type: Regular paper

Affiliations: 1: United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Bangkok, Thailand 3: Chiang Rai Provincial Public Health Office, Chiang Rai, Thailand 4: Research Institute of Tuberculosis, Tokyo, Japan 5: Bangkok Metropolitan Health Administration, Bangkok, Thailand 6: Phuket Provincial Public Health Office, Phuket, Thailand 7: Office of Disease Prevention and Control 7, Ubon-Ratchathani, Thailand 8: Thailand Ministry of Public Health, Bangkok, Thailand 9: United States Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA; and Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand

Publication date: 2009-02-01

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• 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.

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