Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
BMC Public Health. 2012 Jan 20;12:56. doi: 10.1186/1471-2458-12-56.
Persons who default from tuberculosis treatment are at risk for clinical deterioration and complications including worsening drug resistance and death. Our objective was to identify risk factors associated with tuberculosis (TB) treatment default in South Africa.
We conducted a national retrospective case control study to identify factors associated with treatment default using program data from 2002 and a standardized patient questionnaire. We defined default as interrupting TB treatment for two or more consecutive months during treatment. Cases were a sample of registered TB patients receiving treatment under DOTS that defaulted from treatment. Controls were those who began therapy and were cured, completed or failed treatment. Two respective multivariable models were constructed, stratified by history of TB treatment (new and re-treatment patients), to identify independent risk factors associated with default.
The sample included 3165 TB patients from 8 provinces; 1164 were traceable and interviewed (232 cases and 932 controls). Significant risk factors associated with default among both groups included poor health care worker attitude (new: AOR 2.1, 95% CI 1.1-4.4; re-treatment: AOR 12, 95% CI 2.2-66.0) and changing residence during TB treatment (new: AOR 2.0, 95% CI 1.1-3.7; re-treatment: AOR 3.4, 95% CI 1.1-9.9). Among new patients, cases were more likely than controls to report having no formal education (AOR 2.3, 95% CI 1.2-4.2), feeling ashamed to have TB (AOR 2.0, 95% CI 1.3-3.0), not receiving adequate counseling about their treatment (AOR 1.9, 95% CI 1.2-2.8), drinking any alcohol during TB treatment (AOR 1.9, 95% CI 1.2-3.0), and seeing a traditional healer during TB treatment (AOR 1.9, 95% CI 1.1-3.4). Among re-treatment patients, risk factors included stopping TB treatment because they felt better (AOR 21, 95% CI 5.2-84), having a previous history of TB treatment default (AOR 6.4, 95% CI 2.9-14), and feeling that food provisions might have helped them finish treatment (AOR 5.0, 95% CI 1.3-19).
Risk factors for default differ between new and re-treatment TB patients in South Africa. Addressing default in both populations with targeted interventions is critical to overall program success.
从结核病治疗中退出的人面临着临床恶化和并发症的风险，包括耐药性恶化和死亡。我们的目的是确定与南非结核病（TB）治疗退出相关的危险因素。
我们进行了一项全国性回顾性病例对照研究，使用 2002 年的项目数据和标准化患者问卷，确定与治疗中断相关的因素。我们将中断治疗定义为连续两个月以上中断结核病治疗。病例是在 DOTS 下接受治疗并从治疗中退出的登记结核病患者的样本。对照者是开始治疗且治愈、完成或失败的患者。根据结核病治疗史（新患者和复治患者）分别构建了两个多变量模型，以确定与退出相关的独立危险因素。
样本包括来自 8 个省份的 3165 名结核病患者；1164 名患者可追踪和访谈（232 例病例和 932 例对照）。两组中与退出相关的显著危险因素包括医护人员态度不佳（新患者：优势比 2.1，95%置信区间 1.1-4.4；复治患者：优势比 12，95%置信区间 2.2-66.0）和治疗期间改变居住地（新患者：优势比 2.0，95%置信区间 1.1-3.7；复治患者：优势比 3.4，95%置信区间 1.1-9.9）。在新患者中，与对照组相比，病例更有可能报告没有接受过正规教育（优势比 2.3，95%置信区间 1.2-4.2）、因患结核病而感到羞耻（优势比 2.0，95%置信区间 1.3-3.0）、没有接受充分的治疗咨询（优势比 1.9，95%置信区间 1.2-2.8）、在结核病治疗期间饮酒（优势比 1.9，95%置信区间 1.2-3.0）和在结核病治疗期间看传统治疗师（优势比 1.9，95%置信区间 1.1-3.4）。在复治患者中，危险因素包括因感觉好转而停止治疗（优势比 21，95%置信区间 5.2-84）、以前有结核病治疗退出史（优势比 6.4，95%置信区间 2.9-14）和感觉提供食物可能有助于他们完成治疗（优势比 5.0，95%置信区间 1.3-19）。
南非新患者和复治患者的退出危险因素不同。针对这两个群体采取有针对性的干预措施，是确保整个项目成功的关键。
