Risk factors for treatment default among adult tuberculosis patients in Indonesia

Int J Tuberc Lung Dis. 2013 Oct;17(10):1304-9. doi: 10.5588/ijtld.13.0084.

Abstract

Setting: Defaulting from anti-tuberculosis treatment hinders tuberculosis (TB) control.

Objective: To identify potential defaulters.

Design: We conducted a cohort study in newly diagnosed Indonesian TB patients. We administered a questionnaire, prospectively identified defaulters (discontinued treatment ≥ 2 weeks) and assessed risk factors using Cox's regression.

Results: Of 249 patients, 39 (16%) defaulted, 61% in the first 2 months. Default was associated with liver disease (HR 3.40, 95%CI 1.02-11.78), chest pain (HR 2.25, 95%CI 1.06-4.77), night sweats (HR 1.98, 95%CI 1.03-3.79), characteristics of the head of the household (self-employed, HR 2.47, 95%CI 1.15-5.34; patient's mother, HR 7.72, 95%CI 1.66-35.88), household wealth (HR 4.24, 95%CI 1.12-16.09), walking to clinic (HR 4.53, 95%CI 1.39-14.71), being unaccompanied at diagnosis (HR 30.49, 95%CI 7.55-123.07) or when collecting medication (HR 3.34, 95%CI 1.24-8.98) and low level of satisfaction with the clinic (HR 3.85, 95%CI 1.17-12.62) or doctors (HR 2.45, 95%CI 1.18-5.10). Health insurance (HR 0.24, 95%CI 0.07-0.74) and paying for diagnosis (HR 0.14, 95%CI 0.04-0.48) were protective.

Conclusion: Defaulting is common and occurs early. Interventions that improve clinic services, strengthen patient support and increase insurance coverage may reduce default in Indonesia.

MeSH terms

  • Adult
  • Antitubercular Agents / administration & dosage
  • Antitubercular Agents / therapeutic use*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Indonesia
  • Insurance Coverage / statistics & numerical data
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data
  • Proportional Hazards Models
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Surveys and Questionnaires
  • Time Factors
  • Tuberculosis / drug therapy*

Substances

  • Antitubercular Agents