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Free Content Risk factors and timing of default from treatment for non-multidrug-resistant tuberculosis in Moldova

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SETTING: The Republic of Moldova, in Eastern Europe, has among the highest reported nationwide proportions of tuberculosis (TB) patients with multidrug-resistant tuberculosis (MDR-TB) worldwide. Default has been associated with increased mortality and amplification of drug resistance, and may contribute to the high MDR-TB rates in Moldova.

OBJECTIVE: To assess risk factors and timing of default from treatment for non-MDR-TB from 2007 to 2010.

DESIGN: A retrospective analysis of routine surveillance data on all non-MDR-TB patients reported.

RESULTS: A total of 14.7% of non-MDR-TB patients defaulted from treatment during the study period. Independent risk factors for default included sociodemographic factors, such as homelessness, living alone, less formal education and spending substantial time outside Moldova in the year prior to diagnosis; and health-related factors such as human immunodeficiency virus co-infection, greater lung pathology and increasing TB drug resistance. Anti-tuberculosis treatment is usually initiated within an institutional setting in Moldova, and the default risk was highest in the month following the phase of hospitalized treatment (among civilians) and after leaving prison (among those diagnosed while incarcerated).

CONCLUSIONS: Targeted interventions to increase treatment adherence for patients at highest risk of default, and improving the continuity of care for patients transitioning from institutional to community care may substantially reduce risk of default.
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Keywords: Eastern Europe; drug resistance; hospitalization; prisons

Document Type: Research Article

Affiliations: 1: Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA 2: National Centre of Health Management, Chisinau, Republic of Moldova 3: Center for Health Policies and Studies, Chisinau, Republic of Moldova 4: Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard School of Public Health, Boston, Massachusetts, USA

Publication date: March 1, 2013

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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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