Risk factors for anti-tuberculosis treatment default

Abstract

Introduction: Republic of Moldova reports the biggest incidence of tuberculosis (114,3/100.000), the lowest success treatment rate (52,3%) and the biggest default rate (13%) among European Region countries. Evaluation of risk factors for anti-tuberculosis treatment default values before starting treatment for initiation of reducing risk measures. Purpose and Objectivies: Assessment of risk factors for anti-tuberculosis treatment default. Material and methods: A selective, descriptive, retrospective study was realized using a total number of 160 new pulmonary tuberculosis cases, divided in a study group (SG) composed by 109 cases wihich defaulted the treatment and a control group (CG) composed of 51 cases cured at the end of DOTS strategy. Default was used for defining the patients who interrupted the treatment for more than 2 months whatever was the reason. Cured was the patient with converted sputum at the end of the treatment. Computerized analysis was performed with Windows XP and Statistica 10,0. For establishing the degree of risk factors was used Cox regression model. The degree of influence for neutral factor was established Odds Ratio (OR) = 1,0 - 1,1; for OR = 1,2 - 1,6 low risk factor, for OR = 1 ,7 - 2,5 medium risk factor and OR > 2,6 high risk factor. Results: Men/women rate 1,8/1, average age 43,8 yrs in SG and men/women rate 2,1/1, average age 48,2 yrs in CG; incomplete educational studies 29 % vs. 30%, OR = 1,1; unemployment 54% vs 74%, OR = 0,9, single status 62% vs 45%, OR = 2,9; active smoking 81% vs 76%, OR = 1 ,3 ; alcohol consumption 50% vs 12%, OR = 7,6; drug injection using 5% vs 0, OR = 1,5; low living conditions 66% vs 35%, OR = 3,3; late detection 75% vs 35%, OR = 5,6; associate diseases 66% vs 62%, OR = 1,2; extensive forms of pulmonary tuberculosis 60% vs 45%, OR = 1,9; adverse drug reactions to antituberculosis treatment 13% vs 2%, OR = 1,8; self interruptions during intensive phase of treatment 68 % 2%, OR = 8,7; High risk factors were evaluated : non adherent behavior, alcohol consumption, low detection, low living conditions, single status; low risk factors were: extensive tuberculosis, low educational status, smoking, drug using, adverse reaction. Conclusion: We assessed that the main determinants of treatment discontinuation are social risk factors: low life state, single status, alcohol consumption, low living conditions, correlated with late detection and non-adherent to treatment behavior. All characteristics outline the target group of patients among which must be performed the reducing risk measures for increasing treatment success rate. Other factors as: unemployment, young age, male sex had no contribution to the poor treatment result. Innovative contribution: We established the targed risk groups for defaulting for performing the increasing treatment success rate measures.