Top

BMC Public Health

Published in:

Open Access 01-12-2012 | Research article

Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

Authors: Alyssa Finlay, Joey Lancaster, Timothy H Holtz, Karin Weyer, Abe Miranda, Martie van der Walt

Published in: BMC Public Health | Issue 1/2012

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Available only for authorised users

WHO: Global Tuberculosis Control: Surveillance, Planning, Financing. WHO Report 2004. 2004, Geneva, Switzerland, ISBN 92 4 156264 1

Statistics South Africa: Mortality and causes of death in South Africa, 1997-2003; Findings from death notification (Statistical Release P0309.3). 2005, Accessed on 15 May 2011, [http://www.statssa.gov.za]

Pablos-Mendez A, Knirsch CA, Barr RG, Lerner BH, Frieden TR: Nonadherence in tuberculosis treatment: predictors and consequences in New York City. Am J Med. 1997, 102 (2): 164-170. 10.1016/S0002-9343(96)00402-0.CrossRefPubMed

Connolly C, Davies GR, Wilkinson D: Who fails to complete tuberculosis treatment? Temporal trends and risk factors for treatment interruption in a community-based directly observed therapy programme in a rural district of South Africa. Int J Tuberc Lung Dis. 1999, 3 (12): 1081-1087.PubMed

Kharsany AB, Connolly C, Olowolagba A, Abdool Karim SS, Abdool Karim Q: TB treatment outcomes following directly-observed treatment at an urban outpatient specialist TB facility in South Africa. Trop Doct. 2006, 36 (1): 23-25. 10.1258/004947506775598770.CrossRefPubMed

Holtz TH, Lancaster J, Laserson KF, Wells CD, Thorpe L, Weyer K: Risk factors associated with default from multidrug-resistant tuberculosis treatment, South Africa, 1999-2001. Int J Tuberc Lung Dis. 2006, 10 (6): 649-655.PubMed

Castelnuovo B: A review of compliance to anti tuberculosis treatment and risk factors for defaulting treatment in Sub Saharan Africa. Afr Health Sci. 2010, 10 (4): 320-324.PubMedPubMedCentral

Santha T, Garg R, Frieden TR, Chandrasekaran V, Subramani R, Gopi PG, Selvakumar N, Ganapathy S, Charles N, Rajamma J, et al: Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tuberc Lung Dis. 2002, 6 (9): 780-788.PubMed

Jaggarajamma K, Sudha G, Chandrasekaran V, Nirupa C, Thomas A, Santha T, Muniyandi M, Narayanan PR: Reasons for non-compliance among patients treated under Revised National Tuberculosis Control Programme (RNTCP), Tiruvallur district, south India. Indian J Tuberc. 2007, 54 (3): 130-135.PubMed

10.

Chandrasekaran V, Gopi PG, Santha T, Subramani R, Narayanan PR: Status of re-registered patients for tuberculosis treatment under DOTS programme. Indian J Tuberc. 2007, 54 (1): 12-16.PubMed

11.

WHO: Adherence to long-term therapies: evidence for action. 2003, Geneva: World Health Organization

12.

Lauristen JM, Bruus M: A comprehensive tool for validated entry and documentation of data. EpiData Entry. 2006, Odense, Denmark: The EpiData Association, v.3.1

13.

StataCorp: Statistical Softward: Release 9.0. 2008, College Station, TX: Stata Corporation

14.

Hane F, Thiam S, Fall AS, Vidal L, Diop AH, Ndir M, Lienhardt C: Identifying barriers to effective tuberculosis control in Senegal: an anthropological approach. Int J Tuberc Lung Dis. 2007, 11 (5): 539-543.PubMed

15.

Mishra P, Hansen EH, Sabroe S, Kafle KK: Adherence is associated with the quality of professional-patient interaction in Directly Observed Treatment Short-course, DOTS. Patient Educ Couns. 2006, 63 (1-2): 29-37. 10.1016/j.pec.2005.08.006.CrossRefPubMed

16.

Vijay S, Kumar P, Chauhan LS, Vollepore BH, Kizhakkethil UP, Rao SG: Risk factors associated with default among new smear positive TB patients treated under DOTS in India. PLoS ONE. 2010, 5 (4): e10043-10.1371/journal.pone.0010043.CrossRefPubMedPubMedCentral

17.

Comolet TM, Rakotomalala R, Rajaonarioa H: Factors determining compliance with tuberculosis treatment in an urban environment, Tamatave, Madagascar. Int J Tuberc Lung Dis. 1998, 2 (11): 891-897.PubMed

18.

Munro S, Lewin S, Swart T, Volmink J: A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS?. BMC Public Health. 2007, 7: 104-10.1186/1471-2458-7-104.CrossRefPubMedPubMedCentral

19.

Driver CR, Matus SP, Bayuga S, Winters AI, Munsiff SS: Factors associated with tuberculosis treatment interruption in New York City. J Public Health Manag Pract. 2005, 11 (4): 361-368.CrossRefPubMed

20.

Kapella BK, Anuwatnonthakate A, Komsakorn S, Moolphate S, Charusuntonsri P, Limsomboon P, Wattanaamornkiat W, Nateniyom S, Varma JK: Directly observed treatment is associated with reduced default among foreign tuberculosis patients in Thailand. Int J Tuberc Lung Dis. 2009, 13 (2): 232-237.PubMed

21.

Naidoo P, Dick J, Cooper D: Exploring tuberculosis patients' adherence to treatment regimens and prevention programs at a public health site. Qual Health Res. 2009, 19 (1): 55-70.CrossRefPubMed

22.

Suri A, Gan K, Carpenter S: Voices from the field: perspectives from community health workers on health care delivery in rural KwaZulu-Natal, South Africa. J Infect Dis. 2007, 196 (Suppl 3): S505-S511.CrossRefPubMed

23.

Edginton ME, Sekatane CS, Goldstein SJ: Patients' beliefs: do they affect tuberculosis control? A study in a rural district of South Africa. Int J Tuberc Lung Dis. 2002, 6 (12): 1075-1082.PubMed

24.

Rowe KA, Makhubele B, Hargreaves JR, Porter JD, Hausler HP, Pronyk PM: Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings?. Int J Tuberc Lung Dis. 2005, 9 (3): 263-269.PubMed

25.

Garner P, Smith H, Munro S, Volmink J: Promoting adherence to tuberculosis treatment. Bull World Health Organ. 2007, 85 (5): 404-406. 10.2471/BLT.06.035568.CrossRefPubMedPubMedCentral

26.

Getahun H, Maher D: Contribution of 'TB clubs' to tuberculosis control in a rural district in Ethiopia. Int J Tuberc Lung Dis. 2000, 4 (2): 174-178.PubMed

27.

Jakubowiak WM, Bogorodskaya EM, Borisov SE, Danilova ID, Kourbatova EV: Risk factors associated with default among new pulmonary TB patients and social support in six Russian regions. Int J Tuberc Lung Dis. 2007, 11 (1): 46-53.PubMed

28.

Hasker E, Khodjikhanov M, Usarova S, Asamidinov U, Yuldashova U, van der Werf MJ, Uzakova G, Veen J: Default from tuberculosis treatment in Tashkent, Uzbekistan; who are these defaulters and why do they default?. BMC Infect Dis. 2008, 8: 97-10.1186/1471-2334-8-97.CrossRefPubMedPubMedCentral

29.

Gelmanova IY, Keshavjee S, Golubchikova VT, Berezina VI, Strelis AK, Yanova GV, Atwood S, Murray M: Barriers to successful tuberculosis treatment in Tomsk, Russian Federation: non-adherence, default and the acquisition of multidrug resistance. Bull World Health Organ. 2007, 85 (9): 703-711. 10.2471/BLT.06.038331.CrossRefPubMedPubMedCentral

30.

Bhagat VM, Gattani PL: Factors affecting tuberculosis retreatment defaults in Nanded, India. Southeast Asian J Trop Med Public Health. 2010, 41 (5): 1153-1157.PubMed

31.

Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B: Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007, CD004148-2

32.

Whitlock EP, Polen MR, Green CA, Orleans T, Klein J: Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004, 140 (7): 557-568.CrossRefPubMed

33.

Banerjee A, Harries AD, Nyirenda T, Salaniponi FM: Local perceptions of tuberculosis in a rural district in Malawi. Int J Tuberc Lung Dis. 2000, 4 (11): 1047-1051.PubMed

34.

Brouwer JA, Boeree MJ, Kager P, Varkevisser CM, Harries AD: Traditional healers and pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis. 1998, 2 (3): 231-234.PubMed

35.

Barker RD, Millard FJ, Malatsi J, Mkoana L, Ngoatwana T, Agarawal S, de Valliere S: Traditional healers, treatment delay, performance status and death from TB in rural South Africa. Int J Tuberc Lung Dis. 2006, 10 (6): 670-675.PubMed

36.

Harper ME, Hill PC, Bah AH, Manneh K, McAdam KP, Lienhardt C: Traditional healers participate in tuberculosis control in The Gambia. Int J Tuberc Lung Dis. 2004, 8 (10): 1266-1268.PubMed

37.

Colvin M, Gumede L, Grimwade K, Maher D, Wilkinson D: Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa. Int J Tuberc Lung Dis. 2003, 7 (9 Suppl 1): S86-S91.PubMed

38.

Pinidiyapathirage J, Senaratne W, Wickremasinghe R: Prevalence and predictors of default with tuberculosis treatment in Sri Lanka. Southeast Asian J Trop Med Public Health. 2008, 39 (6): 1076-1082.PubMed

39.

Chang KC, Leung CC, Tam CM: Risk factors for defaulting from anti-tuberculosis treatment under directly observed treatment in Hong Kong. Int J Tuberc Lung Dis. 2004, 8 (12): 1492-1498.PubMed

40.

Chan-Yeung M, Noertjojo K, Leung CC, Chan SL, Tam CM: Prevalence and predictors of default from tuberculosis treatment in Hong Kong. Hong Kong Med J. 2003, 9 (4): 263-268.PubMed

41.

Jha UM, Satyanarayana S, Dewan PK, Chadha S, Wares F, Sahu S, Gupta D, Chauhan LS: Risk factors for treatment default among re-treatment tuberculosis patients in India, 2006. PLoS ONE. 2010, 5 (1): e8873-10.1371/journal.pone.0008873.CrossRefPubMedPubMedCentral

42.

Weyer K: Case study: South Africa. Bull World Health Organ. 2007, 85 (5): 391-10.2471/BLT.06.036004.CrossRefPubMedCentral

43.

Ntshanga SP, Rustomjee R, Mabaso ML: Evaluation of directly observed therapy for tuberculosis in KwaZulu-Natal, South Africa. Trans R Soc Trop Med Hyg. 2009, 103 (6): 571-574. 10.1016/j.trstmh.2009.03.021.CrossRefPubMed

44.

Clarke M, Dick J, Zwarenstein M, Lombard CJ, Diwan VK: Lay health worker intervention with choice of DOT superior to standard TB care for farm dwellers in South Africa: a cluster randomised control trial. Int J Tuberc Lung Dis. 2005, 9 (6): 673-679.PubMed

45.

Dick J, Lombard C: Shared vision-a health education project designed to enhance adherence to anti-tuberculosis treatment. Int J Tuberc Lung Dis. 1997, 1 (2): 181-186.PubMed

46.

Thiam S, LeFevre AM, Hane F, Ndiaye A, Ba F, Fielding KL, Ndir M, Lienhardt C: Effectiveness of a strategy to improve adherence to tuberculosis treatment in a resource-poor setting: a cluster randomized controlled trial. JAMA. 2007, 297 (4): 380-386. 10.1001/jama.297.4.380.CrossRefPubMed

47.

Gandhi NR, Moll AP, Lalloo U, Pawinski R, Zeller K, Moodley P, Meyer E, Friedland G: Successful integration of tuberculosis and HIV treatment in rural South Africa: the Sizonq'oba study. J Acquir Immune Defic Syndr. 2009, 50 (1): 37-43. 10.1097/QAI.0b013e31818ce6c4.CrossRefPubMed

48.

Vree M, Huong NT, Duong BD, Sy DN, Van le N, Co NV, Cobelens FG, Borgdorff MW: Mortality and failure among tuberculosis patients who did not complete treatment in Vietnam: a cohort study. BMC Public Health. 2007, 7: 134-10.1186/1471-2458-7-134.CrossRefPubMedPubMedCentral

49.

Botha E, Den Boon S, Verver S, Dunbar R, Lawrence KA, Bosman M, Enarson DA, Toms I, Beyers N: Initial default from tuberculosis treatment: how often does it happen and what are the reasons?. Int J Tuberc Lung Dis. 2008, 12 (7): 820-823.PubMed

50.

Korenromp EL, Bierrenbach AL, Williams BG, Dye C: The measurement and estimation of tuberculosis mortality. Int J Tuberc Lung Dis. 2009, 13 (3): 283-303.PubMed

51.

Hopewell PC, Pai M, Maher D, Uplekar M, Raviglione MC: International standards for tuberculosis care. Lancet Infect Dis. 2006, 6 (11): 710-725. 10.1016/S1473-3099(06)70628-4.CrossRefPubMed

52.

Bateman ED, Feldman C, Mash R, Fairall LR, English RG, Jithoo A: Systems for the management of respiratory disease in primary care - an international series: South Africa. Prim Care Respir J. 2009, 18 (2): 69-75.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/12/56/prepub

Title: Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study
Authors: Alyssa Finlay
Joey Lancaster
Timothy H Holtz
Karin Weyer
Abe Miranda
Martie van der Walt
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/1471-2458-12-56

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Patient- and provider-level risk factors associated with default from tuberculosis treatment, South Africa, 2002: a case-control study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2012

People living with HIV /AIDS (PLWHA) and HIV/AIDS associated oral lesions; a study in Malaysia

Socio-demographic determinants and prevalence of Tuberculosis knowledge in three slum populations of Uganda

Respiratory symptoms and illnesses among brick kiln workers: a cross sectional study from rural districts of Pakistan

Predictors of long-term smoking cessation: results from the global adult tobacco survey in Poland (2009–2010)

Dilemmas in providing resilience-enhancing social services to long-term social assistance clients. A qualitative study of Swedish social workers