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Free Content Risk factors for defaulting from tuberculosis treatment: a prospective cohort study of 301 cases in The Gambia

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SETTING: An urban tuberculosis (TB) clinic, The Gambia.

OBJECTIVE: To identify patient characteristics associated with increased rates of defaulting from treatment, specifically knowledge and cost factors amenable to intervention.

DESIGN: Prospective cohort study of TB cases at least 15 years of age commencing treatment, interviewed by semi-structured questionnaire and followed for attendance at thrice-weekly directly observed treatment (DOT).

RESULTS: Of 301 patients, 76 (25.2%) defaulted from treatment and 25 did not return for treatment. The defaulting rate was higher among those who said they were uncertain that their treatment would work (HR 3.64; 95%CI 1.42–9.31, P = 0.007) and among those who incurred significant time or money costs travelling to receive treatment (HR 2.67; 95%CI 1.05–6.81; P = 0.04). These factors had differing effects with respect to time: uncertainty over treatment success was important in the first 90 days of treatment, while increased cost of travelling to the clinic was important after 90 days.

CONCLUSION: In The Gambia, risk groups for defaulting can be recognised at the start of treatment and are at highest risk at different times. Home-based self-administration of medications after 3 months of DOT should be considered as confidence in treatment success rises, and the costs of travelling to receive treatment start to take their toll.
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Keywords: The Gambia; cost; defaulting; knowledge; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Tuberculosis, Medical Research Council Laboratories, Banjul, The Gambia 2: Department of Disease Control, Gambia Government, Banjul, The Gambia 3: Tuberculosis Unit, Institut de Recherche pour le Développement, Dakar, Senegal

Publication date: December 1, 2005

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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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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