title: Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India.
abstract: OBJECTIVE
  To identify risk factors associated with relapse among cured tuberculosis (TB) patients in a DOTS programme in South India.
  
  
  METHODS
  Sputum samples collected from a cohort of TB patients registered between April 2000 and December 2001 were examined by fluorescence microscopy for acid-fast bacilli and by culture for Mycobacterium tuberculosis at 6, 12 and 18 months after treatment completion.
  
  
  RESULTS
  Of the 534 cured patients, 503 (94%) were followed up for 18 months after treatment completion. Of these, 62 (12%) relapsed during the 18-month period; 48 (77%) of the 62 relapses occurred during the first 6 months of follow-up. Patients who took treatment irregularly were twice more likely to have a relapse than adherent patients (20% vs. 9%; adjusted odds ratio [aOR] 2.5; 95% CI 1.4-4.6). Other independent predictors of relapse were initial drug resistance to isoniazid and/or rifampicin (aOR 4.8; 95% CI 2.0-11.6) and smoking (aOR 3.1; 95% CI 1.6-6.0). The relapse rate among non-smoking, treatment adherent patients with drug-sensitive organisms was 4.8%.
  
  
  CONCLUSIONS
  The relapse rate under the DOTS programme may be reduced by ensuring that patients take their treatment regularly and are counselled effectively about quitting smoking.
authors.affiliation: Tuberculosis Research Centre (ICMR), Chetput, Chennai, India.
authors.forename: A
authors.initials: A
authors.lastname: Thomas
authors.forename: P G
authors.initials: PG
authors.lastname: Gopi
authors.forename: T
authors.initials: T
authors.lastname: Santha
authors.forename: V
authors.initials: V
authors.lastname: Chandrasekaran
authors.forename: R
authors.initials: R
authors.lastname: Subramani
authors.forename: N
authors.initials: N
authors.lastname: Selvakumar
authors.forename: S I
authors.initials: SI
authors.lastname: Eusuff
authors.forename: K
authors.initials: K
authors.lastname: Sadacharam
authors.forename: P R
authors.initials: PR
authors.lastname: Narayanan
mesh_terms: D000328:Adult; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology*