Incidence of and factors for non-compliance to antituberculous treatment
Keywords:
Mycobacterium tuberculosis, tuberculosis/therapy, drug therapy, directly observed therapy, treatment refusal, incidence
Abstract
Introduction. Tuberculosis is a public health problem. Non-compliance with treatment regimes increases morbidity-mortality, perpetuates transmission and generates bacterial resistance. It is necessary to know incidence and associated factors to non-compliance for performance interventions.Objective. The incidence of and associated factors associated with non-compliance to antituberculous treatment were investigated.
Materials and methods. A follow-up study was conducted in an adult cohort with tuberculosis, living in an urban area. Non-compliance was defined as treatment default of 30 days or more. Patients were interviewed at the initiation of treatment and and re-interviewed in subsequent intervals. Outcome was defined as the period of time until treatment abandonment. Noncompliance rates were calculated, as well as survival curves; the Cox regression model was used to adjust for associated variables.
Results. Of the 261 patients who were interviewed, 39 (14.9%) had abandoned treatment (rate 0.4 episodes/1,000 days-person, 95%CI 0.2-0.8). Factors associated with compliance were family support (HR=0.4, 95%CI 0.2-0.9), secondary drug effects (HR=0.2, 95%CI 0.1-0.6) and opportunity to receive treatment at the clinic where tuberculosis was diagnosed (HR=0.3, 95%CI 0.1-0.6). Risk factors for non-compliance were as follows: treatment requiring >2 months (HR=14.3, 95%CI 1.8-112.7), low socioeconomic status (HR=3.90, 95%CI 2.1-9.3), age between 21-30 years (HR=20.6, 95%CI 2.4-175.4), history of incarceration (HR=2.2, 95%CI 1.0-5.4), skipping treatments more that twice (HR=6.6, 95%CI 2.8-15.6) and co-infection with HIV/AIDS (HR=2.9, 95%CI 1.6-5.4).
Conclusion. Non-compliance rate is higher than previously reported. The data recommend the following strategies for improving compliance with antituberculosis treatment: (1) early diagnosis, (2) opportune treatment, (3) improved family support and (4) immediate intervention if a treatment is missed -especially in patients with HIV/AIDS, from low socioeconomic strata, or with record of incarceration.
Downloads
Download data is not yet available.
References
1. Organización Mundial de la Salud. Informe sobre tuberculosis en América. [Consultado: noviembre de 2001]. http://www.who.int/inffs/en/fact104.html.
2. Ministerio de Salud. Dirección General de Promoción y Prevención. Guía de atención de la tuberculosis pulmonar y extrapulmonar. Bogotá: Ministerio de Salud; 2001. p.1-47.
3. Pablos-Méndez A, Cnirsch CA, Barr RG, Lerner BH, Frieden TR. Nonadherence in tuberculosis treatment: Predictors and consequences in New York City. Am J Med. 1997;102:164-70.
4. World Health Organization Global. TB Programme. Report of the Ad Hoc Committee on the Tuberculosis Epidemic. WHO/TB/98.245. Geneva: World Health Organization; 1998.
5. Chaparro PE, García I, Guerrero MI, León CI. Situación de la tuberculosis en Colombia, 2002. Biomédica. 2004;24(Suppl.1):102-14.
6. Cáceres FM, Flórez NS, García ME, Ortega N, Téllez LE. Características epidemiológicas de los pacientes con tuberculosis en Bucaramanga, 1990 a 1999.Médicas UIS. 2001;15:89-98.
7. Homedes N, Ugalde A. ¿Qué sabemos del cumplimiento de los tratamientos médicos en el tercer mundo? Bol Of Sanit Panam. 1994;116:491-517.
8. Jaramillo E. Pulmonary tuberculosis and healthseeking behavior: How to get a delayed diagnosis in Cali, Colombia. Trop Med Int Health. 1998; 3:138-44.
9. Pozsik C. Compliance with tuberculosis therapy. Med Clin North Am. 1993;77:1289-301.
10. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100:258-68.
11. Singh M. Adherence to anti-tuberculosis treatment. Indian Pediatr. 1999;36:1285-6
12. Orozco LC, Hernández R, de Usta CY, Cerra M, Camargo D. Factores de riesgo para el abandono (no adherencia) del tratamiento antituberculoso. Médicas UIS. 1998;12:169-72.
13. Dean J, Dean DA, Coloumbier D, Brebdel KA, Smith DC, Burton AH, et al . Epi Info 6.04c. A word processing, database, and statistic program for public health. Atlanta: Center for Disease Control and Prevention, World Health Organization; 1997
14. STATA Corporation Inc. STATA 8.0. College Station. Texas: STATA Corporation Inc; 2003.
15. Matthews DE, Farawell VT. Curvas de sobrevida. En: Estadística médica: aplicación e interpretación. 2 edición. Barcelona: Editorial Salvat; 1990.p.132-48.
16. Green MS, Symons MJ. A comparison of the logistic risk function and the proportional hazards model in prospective epidemiologic studies. J Chronic Dis. 1983;36:715-24
17. Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health. 1989;79:340-9.
18. Christensen E. Multivariate survival analysis using Cox´s regression model. Hepatology. 1987;7:136-58.
19. Grambsch PM, Therneau TM. Proportional hazard test and diagnostics based on weighted residuals. Biometrika. 1994;81:515-26.
20. Cox DR. Regression models and life-tables (with discussion) J R Stat Soc. 1972;34B:187-220.
21. Cleves MA, Gould WW, Gutiérrez RG. An Introduction to survival analysis using stata. Texas: Stata Press; 2002.
22. Cox DR, Snell EJ. A general definition of residuals (with discussion). J R Stat Soc. 1968;30B:248-75.
23. May S, Hosmer DW. A simplified method for calculating a goodness-of-fit test for the proportional hazard model. Lifetime Data Anal. 1998;4:109-20.
24. Vittinghoff E, McCulloch CE. Relaxing the ruler of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710-8.
25. Stare J, O‘Quigley J. Fit and frailties in proportional hazard regression. Biometrical J. 2004;46:157-64.
26. Arbeláez MP, Gaviria MB, Franco A, Restrepo R, Hincapié D, Blas E. Tuberculosis control and managed competition in Colombia. Int J Health Plann Manage. 2004;19(Suppl.1):S25-43.
27. Carvajal R, Cabrera GA, Mateus JC. Efectos de la reforma en salud en las acciones de control de tuberculosis en el Valle del Cauca, Colombia. Biomédica. 2004;24(Suppl.1):138-48.
28. Moro ML, Resi D, Lelli B, Nicoli A, Gaglioti C, Falcone F. Barriers to effective tuberculosis control: a qualitative study. Int J Tuberc Lung Dis. 2005;9:1355-60.
29. Ferrer X, Kirschbaum A, Toro J, Jadue J, Muñoz M, Espinoza A. Caracterización del paciente tuberculoso que abandona el tratamiento, Santiago de Chile. Bol Oficina Sanit Panam. 1991;111:423-31.
30. Kimerling ME, Petri L. Tracing as part of tuberculosis control in a rural Cambodian district during 1992. Tuberc Lung Dis. 1995;76:156-9.
31. North American Nursing Diagnosis Association (NANDA). Nursing diagnoses: definitions and classification 2001-2002. Barcelona: Ediciones Harcourt; 2001.
2. Ministerio de Salud. Dirección General de Promoción y Prevención. Guía de atención de la tuberculosis pulmonar y extrapulmonar. Bogotá: Ministerio de Salud; 2001. p.1-47.
3. Pablos-Méndez A, Cnirsch CA, Barr RG, Lerner BH, Frieden TR. Nonadherence in tuberculosis treatment: Predictors and consequences in New York City. Am J Med. 1997;102:164-70.
4. World Health Organization Global. TB Programme. Report of the Ad Hoc Committee on the Tuberculosis Epidemic. WHO/TB/98.245. Geneva: World Health Organization; 1998.
5. Chaparro PE, García I, Guerrero MI, León CI. Situación de la tuberculosis en Colombia, 2002. Biomédica. 2004;24(Suppl.1):102-14.
6. Cáceres FM, Flórez NS, García ME, Ortega N, Téllez LE. Características epidemiológicas de los pacientes con tuberculosis en Bucaramanga, 1990 a 1999.Médicas UIS. 2001;15:89-98.
7. Homedes N, Ugalde A. ¿Qué sabemos del cumplimiento de los tratamientos médicos en el tercer mundo? Bol Of Sanit Panam. 1994;116:491-517.
8. Jaramillo E. Pulmonary tuberculosis and healthseeking behavior: How to get a delayed diagnosis in Cali, Colombia. Trop Med Int Health. 1998; 3:138-44.
9. Pozsik C. Compliance with tuberculosis therapy. Med Clin North Am. 1993;77:1289-301.
10. Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100:258-68.
11. Singh M. Adherence to anti-tuberculosis treatment. Indian Pediatr. 1999;36:1285-6
12. Orozco LC, Hernández R, de Usta CY, Cerra M, Camargo D. Factores de riesgo para el abandono (no adherencia) del tratamiento antituberculoso. Médicas UIS. 1998;12:169-72.
13. Dean J, Dean DA, Coloumbier D, Brebdel KA, Smith DC, Burton AH, et al . Epi Info 6.04c. A word processing, database, and statistic program for public health. Atlanta: Center for Disease Control and Prevention, World Health Organization; 1997
14. STATA Corporation Inc. STATA 8.0. College Station. Texas: STATA Corporation Inc; 2003.
15. Matthews DE, Farawell VT. Curvas de sobrevida. En: Estadística médica: aplicación e interpretación. 2 edición. Barcelona: Editorial Salvat; 1990.p.132-48.
16. Green MS, Symons MJ. A comparison of the logistic risk function and the proportional hazards model in prospective epidemiologic studies. J Chronic Dis. 1983;36:715-24
17. Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health. 1989;79:340-9.
18. Christensen E. Multivariate survival analysis using Cox´s regression model. Hepatology. 1987;7:136-58.
19. Grambsch PM, Therneau TM. Proportional hazard test and diagnostics based on weighted residuals. Biometrika. 1994;81:515-26.
20. Cox DR. Regression models and life-tables (with discussion) J R Stat Soc. 1972;34B:187-220.
21. Cleves MA, Gould WW, Gutiérrez RG. An Introduction to survival analysis using stata. Texas: Stata Press; 2002.
22. Cox DR, Snell EJ. A general definition of residuals (with discussion). J R Stat Soc. 1968;30B:248-75.
23. May S, Hosmer DW. A simplified method for calculating a goodness-of-fit test for the proportional hazard model. Lifetime Data Anal. 1998;4:109-20.
24. Vittinghoff E, McCulloch CE. Relaxing the ruler of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710-8.
25. Stare J, O‘Quigley J. Fit and frailties in proportional hazard regression. Biometrical J. 2004;46:157-64.
26. Arbeláez MP, Gaviria MB, Franco A, Restrepo R, Hincapié D, Blas E. Tuberculosis control and managed competition in Colombia. Int J Health Plann Manage. 2004;19(Suppl.1):S25-43.
27. Carvajal R, Cabrera GA, Mateus JC. Efectos de la reforma en salud en las acciones de control de tuberculosis en el Valle del Cauca, Colombia. Biomédica. 2004;24(Suppl.1):138-48.
28. Moro ML, Resi D, Lelli B, Nicoli A, Gaglioti C, Falcone F. Barriers to effective tuberculosis control: a qualitative study. Int J Tuberc Lung Dis. 2005;9:1355-60.
29. Ferrer X, Kirschbaum A, Toro J, Jadue J, Muñoz M, Espinoza A. Caracterización del paciente tuberculoso que abandona el tratamiento, Santiago de Chile. Bol Oficina Sanit Panam. 1991;111:423-31.
30. Kimerling ME, Petri L. Tracing as part of tuberculosis control in a rural Cambodian district during 1992. Tuberc Lung Dis. 1995;76:156-9.
31. North American Nursing Diagnosis Association (NANDA). Nursing diagnoses: definitions and classification 2001-2002. Barcelona: Ediciones Harcourt; 2001.
How to Cite
1.
Cáceres F de M, Orozco LC. Incidence of and factors for non-compliance to antituberculous treatment. biomedica [Internet]. 2007 Dec. 1 [cited 2024 May 18];27(4):498-504. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/170
Some similar items:
- Laura Plata-Casas, Óscar Gutiérrez-Lesmes, Óscar Herrán-Falla, Tuberculosis and human immunodeficiency virus coinfection: Epidemiological situation in the department of Meta, 2010- 2015 , Biomedica: Vol. 38 No. Sup. 2 (2018): Suplemento 2, Medicina tropical
- Patricia Escobar, Katherine Paola Luna, Indira Paola Hernández, César Mauricio Rueda, María Magdalena Zorro, Simon L. Croft, In vitro susceptibility of Trypanosoma cruzi strains from Santander, Colombia, to hexadecylphosphocholine (miltefosine), nifurtimox and benznidazole , Biomedica: Vol. 29 No. 3 (2009)
- Gerzaín Rodríguez, Rafael Pinto, Fernando López, Yenny Gómez, Persistent type 2 lepra reaction and clofazimine-induced lethal enteropaty , Biomedica: Vol. 29 No. 1 (2009)
- Juan Gabriel Bueno-Sánchez, Jairo René Martínez-Morales, Elena E. Stashenko, Wellman Ribón, Anti-tubercular activity of eleven aromatic and medicinal plants occurring in Colombia , Biomedica: Vol. 29 No. 1 (2009)
- María Consuelo Garzón, Dailyn Yorledy Angée, Claudia Llerena, Dora Leticia Orjuela, Jorge Ernesto Victoria, Surveillance of Mycobacterium tuberculosis resistance to antituberculosis drugs , Biomedica: Vol. 28 No. 3 (2008)
- Álvaro Ruiz, Right to die with dignity? , Biomedica: Vol. 28 No. 2 (2008)
- María Patricia Arbeláez, Alexánder Arbeláez, Rubén Darío Gómez, Carlos Rojas, Lázaro Vélez, Sonia Luz Arias, Jorge Nagles, Luz Marina Peláez, Gloria Betancourt, Gloria Velásquez, Effectiveness of prophylaxis against tuberculosis in patients infected with HIV , Biomedica: Vol. 27 No. 4 (2007)
- Wellman Ribón, Claudia Castro, Liliana González, Juan Carlos Rozo, Gloria Puerto, Biosafety evaluation of the DNA extraction protocol for Mycobacterium tuberculosis complex species, as implemented at the Instituto Nacional de Salud, Colombia , Biomedica: Vol. 29 No. 4 (2009)
- Leandro Galvis, Ángel Y. Sánchez, Leonardo F. Jurado, Martha I. Murcia, Tuberculosis associated with tumor necrosis factor-α antagonists, case description and analysis of reported cases in Colombia , Biomedica: Vol. 38 No. 1 (2018)
- Diego Chaves, Andrea Sandoval, Luis Rodríguez, Juan C. García, Silvia Restrepo, María Mercedes Zambrano, Comparative analysis of six Mycobacterium tuberculosis complex genomes , Biomedica: Vol. 30 No. 1 (2010)
Published
2007-12-01
Issue
Section
Original articles
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
