Risk factors associated with treatment default in pulmonary tuberculosis patients in Tshwane, Gauteng : case control study

Abstract

Background: Tuberculosis is a curable disease. The challenge faced by many TB control programmes around the world is treatment non-compliance. Patients who default their treatment are at risk of clinical deterioration and development of multi-drug resistant tuberculosis. This study therefore aimed at determining the factors associated with tuberculosis treatment default in Tshwane district, Gauteng Province. Methods: The study was conducted on patients who were diagnosed with TB and registered for treatment in Tshwane health facilities in Gauteng Province. This was a case-control study, carried out in two phases. During phase 1 of the study, TB registers in the health facilities were reviewed retrospectively. All the defaulters/cases and randomly selected non-defaulters/controls were identified from the TB registers and reviewed. During the review, the following data was extracted from TB registers including: demographic information, patient’s address, treatment information including dates of TB registration, treatment initiation and completion and treatment outcome. During phase 2 of the study, patients were traced and after giving consent were interviewed using a questionnaire. Data was captured using Microsoft Excell and Epi Info and analyzed using Statistical software (STATA 9.0; StataCorp; College Station, TX). Univariate and multivariate unconditional logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied. Results: Of the 1509 cases in phase 1 of the study, 50.8% (767) and 27.6% (417) defaulted TB treatment within the first and second months of treatment respectively. On multivariate analysis, factors found to be significantly associated with treatment default in phase 1 of the study were age (OR 1.46, CI: 1.23-1.73), male gender (OR 1.56, CI: 1.32-1.85) and co-infection with HIV (OR 1.38, CI: 1.12-1.70). In phase 2 of the study, factors associated with treatment default (bivariate analysis) were inadequate TB knowledge (OR 4.08, CI: 1.68-9.60), changing of residence (OR 5.83, CI: 298-11.5), poor attitudes of health care workers (OR 4.18, CI: 1.75-9.97) and taking treatment without supervision (OR 2.72, CI: 1.42-5.22). None of the risk factors in phase 2 of the study were significant during multivariate analysis. Conclusions: Many patients defaulted their treatment during the first two months of treatment (intensive phase). Health care workers will need therefore to educate their patients and emphasize the importance of staying on treatment during counselling.