title: Risk factors for defaulting from tuberculosis treatment: a prospective cohort study of 301 cases in the Gambia.
abstract: METHODS
  An urban tuberculosis (TB) clinic, The Gambia.
  
  
  OBJECTIVE
  To identify patient characteristics associated with increased rates of defaulting from treatment, specifically knowledge and cost factors amenable to intervention.
  
  
  METHODS
  Prospective cohort study of TB cases at least 15 years of age commencing treatment, interviewed by semi-structured questionnaire and followed for attendance at thrice-weekly directly observed treatment (DOT).
  
  
  RESULTS
  Of 301 patients, 76 (25.2%) defaulted from treatment and 25 did not return for treatment. The defaulting rate was higher among those who said they were uncertain that their treatment would work (HR 3.64; 95%CI 1.42-9.31, P = 0.007) and among those who incurred significant time or money costs travelling to receive treatment (HR 2.67; 95%CI 1.05-6.81; P = 0.04). These factors had differing effects with respect to time: uncertainty over treatment success was important in the first 90 days of treatment, while increased cost of travelling to the clinic was important after 90 days.
  
  
  CONCLUSIONS
  In The Gambia, risk groups for defaulting can be recognised at the start of treatment and are at highest risk at different times. Home-based self-administration of medications after 3 months of DOT should be considered as confidence in treatment success rises, and the costs of travelling to receive treatment start to take their toll.
authors.affiliation: Department of Tuberculosis, Medical Research Council Laboratories, Banjul, The Gambia. phill@mrc.gm
authors.forename: P C
authors.initials: PC
authors.lastname: Hill
authors.forename: W
authors.initials: W
authors.lastname: Stevens
authors.forename: S
authors.initials: S
authors.lastname: Hill
authors.forename: J
authors.initials: J
authors.lastname: Bah
authors.forename: S A
authors.initials: SA
authors.lastname: Donkor
authors.forename: A
authors.initials: A
authors.lastname: Jallow
authors.forename: C
authors.initials: C
authors.lastname: Lienhardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000191:economics; D015331:Cohort Studies; D005260:Female; D005714:Gambia; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors; D016312:Treatment Refusal; D014376:Tuberculosis / Q000188:drug therapy* / Q000191:economics / Q000523:psychology
chemical_list: D000995:Antitubercular Agents