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Free Content Reasons for defaulting from drug-resistant tuberculosis treatment in Armenia: a quantitative and qualitative study

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Abstract:

SETTING: Armenia, a country with a high prevalence of drug-resistant tuberculosis (DR-TB).

OBJECTIVE: To identify factors related to default from DR-TB treatment in Yerevan.

DESIGN: Using a retrospective cohort design, we compared defaulters with patients who were cured, completed or failed treatment. Patients who initiated DR-TB treatment from 2005 to 2011 were included in the study. A qualitative survey was conducted including semi-structured interviews with defaulters and focus group discussions with care providers.

RESULTS: Of 381 patients, 193 had achieved treatment success, 24 had died, 51 had failed treatment and 97 had defaulted. The number of drugs to which the patient was resistant at admission (aRR 1.16, 95%CI 1.05–1.27), the rate of treatment interruption based on patient's decision (aRR 1.03, 95%CI 1.02–1.05), the rate of side effects (aRR 1.18, 95%CI 1.09–1.27), and absence of culture conversion during the intensive phase (aRR 0.47, 95%CI 0.31–0.71) were independently associated with default from treatment. In the qualitative study, poor treatment tolerance, a perception that treatment was inefficient, lack of information, incorrect perception of being cured, working factors and behavioural problems were factors related to treatment default.

CONCLUSION: In addition to economic reasons, poor tolerance of and poor response to treatment were the main factors associated with treatment default.

Keywords: default; resistance; tuberculosis

Document Type: Research Article

DOI: http://dx.doi.org/10.5588/ijtld.13.0369

Affiliations: 1: Epicentre, Paris, France 2: Médecins Sans Frontières, Paris, France 3: National Tuberculosis Programme Office, Yerevan, Armenia

Publication date: February 1, 2014

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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.

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

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