Department of Medicine, Himalayan Institute of Medical Sciences, HIHT University, Swami Ram Nagar, Dehradun 248140, Uttarakhand, India.
Trans R Soc Trop Med Hyg. 2013 Sep;107(9):558-65. doi: 10.1093/trstmh/trt065.
Initial default is a serious issue which can enhance the transmission of TB. We determined the magnitude of and the causative factors for initial default among sputum-positive pulmonary TB (PTB) patients.
In this prospective study, 2310 patients attending a referral hospital in Uttarakhand state, north India, with presumptive TB were investigated and 555 patients with sputum-positive PTB were followed-up for initiation of anti-TB treatment (ATT) during 2010-2012. The patients not confirmed as having started ATT were considered initial defaulters.
Initial default was seen in 120 (21.6%) patients comprising 22 (18.3%) defaulters during diagnosis and 98 (81.6%) defaulters after referral for directly observed treatment, short-course (DOTS). The initial default rate was significantly higher among patients from rural areas than urban areas, illiterate patients than literate patients and smokeless tobacco-users than non-users (p<0.05 for all). The main reasons for initial default among patients referred for DOTS were limited trust in DOTS (n = 44, 44.8%), adverse effects of previous ATT (n = 41, 41.8%), dissatisfaction with health services (n = 38, 38.7%), local deaths while taking DOTS (n = 28, 28.5%), advice by others against DOTS (n = 25, 25.5%), disbelief in the diagnosis (n = 18, 18.3%) and patient death before starting treatment (n = 4, 4.0%).
A high initial default rate was seen among patients with PTB. There is an urgent need to promote public awareness to lower the initial default rate.
初始默认是一个严重的问题，它可以增强结核病的传播。我们确定了痰阳性肺结核（PTB）患者初始默认的程度和原因。
在这项前瞻性研究中，对印度北部北阿坎德邦一家转诊医院的 2310 名疑似结核病患者进行了调查，在 2010-2012 年期间对 555 名痰阳性 PTB 患者进行了随访，以启动抗结核治疗（ATT）。未确诊开始 ATT 的患者被视为初始违约者。
22 名（18.3%）诊断时和 98 名（81.6%）转诊后接受直接观察治疗短程（DOTS）的患者出现初始违约，共有 120 名（21.6%）患者出现初始违约。农村地区的初始违约率明显高于城市地区，文盲患者明显高于识字患者，无烟烟草使用者明显高于非使用者（所有 p<0.05）。转诊接受 DOTS 治疗的患者初始违约的主要原因包括对 DOTS 的信任有限（n=44，44.8%）、以前 ATT 的不良反应（n=41，41.8%）、对卫生服务不满意（n=38，38.7%）、在接受 DOTS 治疗时当地死亡（n=28，28.5%）、他人建议反对 DOTS（n=25，25.5%）、怀疑诊断（n=18，18.3%）和治疗前患者死亡（n=4，4.0%）。
PTB 患者的初始违约率很高。迫切需要提高公众意识，降低初始违约率。
