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Free Content Risk factors associated with default from multidrug-resistant tuberculosis treatment, South Africa, 1999–2001

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SETTING: Multidrug-resistant tuberculosis (MDR-TB) treatment centers in five provinces, South Africa.

OBJECTIVES: To estimate the mortality and evaluate risk factors associated with default from MDR-TB treatment.

DESIGN: Using registries and a standardized questionnaire, we conducted a case-control study among patients diagnosed and treated for MDR-TB. Cases were defined as patients who began MDR-TB treatment between 1 October 1999 and 30 September 2001 and defaulted from treatment for more than 2 months; controls were defined as patients who began MDR-TB treatment during the same time and were cured, completed or failed.

RESULTS: After initial identification and reclassification, 269 cases and 401 controls were confirmed eligible for interview. Further investigation revealed that 74 (27%) cases and 44 (10%) controls had died. Among 96 cases located who consented and were interviewed, 70% had defaulted after receiving at least 6 months of treatment. In a multivariate model, the strongest individual risk factors for default included reporting smoking marijuana or mandrax during treatment, and having an unsatisfactory opinion about the attitude of health care workers.

CONCLUSION: Mortality among MDR-TB defaulters was high. Interventions to reduce default from MDR-TB treatment should center on substance abuse treatment, patient education and support and improving provider-patient relationships.
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Keywords: South Africa; multidrug-resistant tuberculosis; treatment default; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Medical Research Council, Pretoria, South Africa 3: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and New York City Department of Health and Mental Hygiene, New York, New York, USA

Publication date: June 1, 2006

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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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