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Free Content Non-adherence and drug-related interruptions are risk factors for delays in completion of treatment for tuberculosis

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Abstract:

SETTING: A key program performance objective established by the Centers for Disease Control and Prevention (CDC) is that ≥93% of tuberculosis (TB) cases complete treatment within 12 months.

OBJECTIVE: To determine the rate of and risk factors for delay in anti-tuberculosis treatment completion.

DESIGN: Nested case-control study among TB cases reported to the Tennessee Department of Health between 1 January 2000 and 31 December 2010. Time to complete treatment was calculated using treatment start and stop dates documented in the Tuberculosis Information Management System (TIMS).

RESULTS: Of 2627 cases, 261 (9.9%) required >12 months to complete treatment. In adjusted conditional logistic regression analyses, cavitary disease and positive cultures after 2 months of therapy (OR 5.85, 95%CI 1.98–17.32, P = 0.001), non-adherence (OR 4.13, 95%CI 1.76–9.72, P < 0.001), and interruptions in treatment due to drug-related issues (OR 6.91, 95%CI 3.76–12.70, P < 0.001) were independently associated with delay in completion of TB treatment.

CONCLUSION: From 2000 to 2010, the proportion of TB cases completing treatment within 12 months increased from 84.6% to 94.9%, and remained above the CDC target during 2009–2010. Efforts to improve patient adherence and reduce interruptions in treatment due to anti-tuberculosis drug-related issues could improve the proportion of TB cases completing treatment within 12 months.

Keywords: Mycobacterium tuberculosis; program evaluation; program objective; treatment completion delay; treatment recommendations

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.12.0133

Affiliations: 1: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA 2: Tennessee Department of Health, Nashville, Tennessee, USA 3: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA 4: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; and Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

Publication date: April 1, 2013

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

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