Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India
DESIGN: Sputum samples collected from a cohort of TB patients registered between April 2000 and December 2001 were examined by fluorescence microscopy for acid-fast bacilli and by culture for Mycobacterium tuberculosis at 6, 12 and 18 months after treatment completion.
RESULTS: Of the 534 cured patients, 503 (94%) were followed up for 18 months after treatment completion. Of these, 62 (12%) relapsed during the 18-month period; 48 (77%) of the 62 relapses occurred during the first 6 months of follow-up. Patients who took treatment irregularly were twice more likely to have a relapse than adherent patients (20% vs. 9%; adjusted odds ratio [aOR] 2.5; 95%CI 1.4–4.6). Other independent predictors of relapse were initial drug resistance to isoniazid and/or rifampicin (aOR 4.8; 95%CI 2.0–11.6) and smoking (aOR 3.1; 95%CI 1.6–6.0). The relapse rate among non-smoking, treatment adherent patients with drug-sensitive organisms was 4.8%.
CONCLUSIONS: The relapse rate under the DOTS programme may be reduced by ensuring that patients take their treatment regularly and are counselled effectively about quitting smoking.
Keywords: DOTS; India; relapse; tuberculosis
Document Type: Regular Paper
Affiliations: Tuberculosis Research Centre (ICMR), Chennai, India
Publication date: May 1, 2005
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