Non-adherence and drug-related interruptions are risk factors for delays in completion of treatment for tuberculosis
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.
Document Type: Research Article
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
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