Document Detail


Risk factors for defaulting from tuberculosis treatment: a prospective cohort study of 301 cases in the Gambia.
MedLine Citation:
PMID:  16466057     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
SETTING: An urban tuberculosis (TB) clinic, The Gambia. OBJECTIVE: To identify patient characteristics associated with increased rates of defaulting from treatment, specifically knowledge and cost factors amenable to intervention. DESIGN: Prospective cohort study of TB cases at least 15 years of age commencing treatment, interviewed by semi-structured questionnaire and followed for attendance at thrice-weekly directly observed treatment (DOT). RESULTS: Of 301 patients, 76 (25.2%) defaulted from treatment and 25 did not return for treatment. The defaulting rate was higher among those who said they were uncertain that their treatment would work (HR 3.64; 95%CI 1.42-9.31, P = 0.007) and among those who incurred significant time or money costs travelling to receive treatment (HR 2.67; 95%CI 1.05-6.81; P = 0.04). These factors had differing effects with respect to time: uncertainty over treatment success was important in the first 90 days of treatment, while increased cost of travelling to the clinic was important after 90 days. CONCLUSION: In The Gambia, risk groups for defaulting can be recognised at the start of treatment and are at highest risk at different times. Home-based self-administration of medications after 3 months of DOT should be considered as confidence in treatment success rises, and the costs of travelling to receive treatment start to take their toll.
Authors:
P C Hill; W Stevens; S Hill; J Bah; S A Donkor; A Jallow; C Lienhardt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease     Volume:  9     ISSN:  1027-3719     ISO Abbreviation:  Int. J. Tuberc. Lung Dis.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2006-02-09     Completed Date:  2006-04-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9706389     Medline TA:  Int J Tuberc Lung Dis     Country:  France    
Other Details:
Languages:  eng     Pagination:  1349-54     Citation Subset:  IM    
Affiliation:
Department of Tuberculosis, Medical Research Council Laboratories, Banjul, The Gambia. phill@mrc.gm
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Antitubercular Agents / administration & dosage*,  economics
Cohort Studies
Female
Gambia
Health Expenditures*
Health Knowledge, Attitudes, Practice*
Humans
Male
Risk Factors
Socioeconomic Factors
Treatment Refusal*
Tuberculosis / drug therapy*,  economics,  psychology
Chemical
Reg. No./Substance:
0/Antitubercular Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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