Risk factors associated with default among new pulmonary TB patients and social support in six Russian regions.
METHODS
Tuberculosis (TB) services in six Russian regions in which social support programmes for TB patients were implemented.


OBJECTIVE
To identify risk factors for default and to evaluate possible impact of social support.


METHODS
Retrospective study of new pulmonary smear-positive and smear-negative TB patients registered during the second and third quarters of the 2003. Data were analysed in a case-control study including default patients as cases and successfully treated patients as controls, using multivariate logistic regression modelling.


RESULTS
A total of 1805 cases of pulmonary TB were enrolled. Default rates in the regions were 2.3-6.3%. On multivariate analysis, risk factors independently associated with default outcome included: unemployment (OR 4.44; 95%CI 2.23-8.86), alcohol abuse (OR 1.99; 95%CI 1.04-3.81), and homelessness (OR 3.49; 95%CI 1.25-9.77). Social support reduced the default outcome (OR 0.13; 95%CI 0.06-0.28), controlling for age, sex, region, residence and acid-fast bacilli (AFB) smear of sputum.


CONCLUSIONS
Unemployment, alcohol abuse and homelessness were associated with increased default outcome among new TB patients, while social support for TB patients reduced default. Further prospective randomised studies are necessary to evaluate the impact and to determine the most cost-effective social support for improving treatment outcomes of TB in patients in Russia, especially among populations at risk of default.
Jakubowiak
W M
WM
WHO TB Control Programme in the Russian Federation, Office of the Special Representative of the WHO Director-General in Russia, 28, Ostozhenka St, 119034 Moscow, Russia. w.jakubowiak@who.org.ru
Bogorodskaya
E M
EM
Borisov
S E
SE
Borisov
E S
ES
Danilova
I D
ID
Danilova
D I
DI
Kourbatova
E V
EV
Kourbatova
E K
EK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000995:Antitubercular Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D012944:Social Support; D011795:Surveys and Questionnaires; D016312:Treatment Refusal; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents