title: Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil.
abstract: A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.
authors.affiliation: Departamento de Estudos em Saúde Coletiva, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil. militao@cpqam.fiocruz.br
authors.forename: Maria de Fátima Pessoa Militão
authors.initials: Mde F
authors.lastname: de Albuquerque
authors.forename: Ricardo Arraes de Alencar
authors.initials: RA
authors.lastname: Ximenes
authors.forename: Norma
authors.initials: N
authors.lastname: Lucena-Silva
authors.forename: Wayner Vieira
authors.initials: WV
authors.lastname: de Souza
authors.forename: Andréa Tavares
authors.initials: AT
authors.lastname: Dantas
authors.forename: Odimariles Maria Souza
authors.initials: OM
authors.lastname: Dantas
authors.forename: Laura Cunha
authors.initials: LC
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010352:Patient Dropouts; D012307:Risk Factors; D012959:Socioeconomic Factors; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000401:mortality / Q000628:therapy*