Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
PLoS Negl Trop Dis. 2011 May 3;5(5):e1031. doi: 10.1371/journal.pntd.0001031.
Low adherence to multidrug therapy against leprosy (MDT) is still an important obstacle of disease control, and may lead to remaining sources of infection, incomplete cure, irreversible complications, and multidrug resistance.
METHODOLOGY/PRINCIPAL FINDING: We performed a population-based study in 78 municipalities in Tocantins State, central Brazil, and applied structured questionnaires on leprosy-affected individuals. We used two outcomes for assessment of risk factors: defaulting (not presenting to health care center for supervised treatment for >12 months); and interruption of MDT. In total, 28/936 (3.0%) patients defaulted, and 147/806 (18.2%) interrupted MDT. Defaulting was significantly associated with: low number of rooms per household (OR = 3.43; 0.98-9.69; p = 0.03); moving to another residence after diagnosis (OR = 2.90; 0.95-5.28; p = 0.04); and low family income (OR = 2.42; 1.02-5.63: p = 0.04). Interruption of treatment was associated with: low number of rooms per household (OR = 1.95; 0.98-3.70; p = 0.04); difficulty in swallowing MDT drugs (OR = 1.66; 1.03-2.63; p = 0.02); temporal non-availability of MDT at the health center (OR = 1.67; 1.11-2.46; p = 0.01); and moving to another residence (OR = 1.58; 95% confidence interval: 1.03-2.40; p = 0.03). Logistic regression identified temporal non-availability of MDT as an independent risk factor for treatment interruption (adjusted OR = 1.56; 1.05-2.33; p = 0.03), and residence size as a protective factor (adjusted OR = 0.89 per additional number of rooms; 0.80-0.99; p = 0.03). Residence size was also independently associated with defaulting (adjusted OR = 0.67; 0.52-0.88; p = 0.003).
Defaulting and interruption of MDT are associated with some poverty-related variables such as family income, household size, and migration. Intermittent problems of drug supply need to be resolved, mainly on the municipality level. MDT producers should consider oral drug formulations that may be more easily accepted by patients. Thus, an integrated approach is needed for further improving control, focusing on vulnerable population groups and the local health system.
麻风病多药治疗（MDT）依从性低仍然是疾病控制的一个重要障碍，可能导致传染源持续存在、治疗不彻底、出现不可逆转的并发症和产生耐多药。
方法/主要发现：我们在巴西中南部托坎廷斯州的 78 个城市进行了一项基于人群的研究，并对麻风病患者进行了结构化问卷调查。我们使用了两种结果来评估危险因素：失访（未因监督治疗而在 12 个月以上时间到保健中心就诊）和 MDT 中断。共有 28/936（3.0%）名患者失访，147/806（18.2%）名患者中断 MDT。失访与以下因素显著相关：每户房间数量少（比值比[OR] = 3.43；0.98-9.69；p = 0.03）；诊断后搬至另一住所（OR = 2.90；0.95-5.28；p = 0.04）；家庭收入低（OR = 2.42；1.02-5.63；p = 0.04）。治疗中断与以下因素相关：每户房间数量少（OR = 1.95；0.98-3.70；p = 0.04）；吞咽 MDT 药物有困难（OR = 1.66；1.03-2.63；p = 0.02）；卫生中心暂时无法提供 MDT（OR = 1.67；1.11-2.46；p = 0.01）；搬至另一住所（OR = 1.58；95%置信区间：1.03-2.40；p = 0.03）。逻辑回归确定暂时无法获得 MDT 是治疗中断的独立危险因素（调整比值比[OR] = 1.56；1.05-2.33；p = 0.03），居住面积是保护因素（调整 OR = 每增加一个房间数量则减少 0.89；0.80-0.99；p = 0.03）。居住面积也与失访独立相关（调整 OR = 0.67；0.52-0.88；p = 0.003）。
MDT 失访和中断与一些与贫困相关的变量有关，如家庭收入、家庭规模和移民。需要解决间歇性药物供应问题，主要是在市级层面。MDT 生产商应考虑使用患者可能更容易接受的口服药物制剂。因此，需要采取综合方法进一步改善控制，重点关注弱势群体和当地卫生系统。
