Timing of default from tuberculosis treatment: a systematic review.
OBJECTIVE
To provide a systematic assessment of the timing of default from tuberculosis (TB) treatment which could help to quantify the potential contribution of new shorter duration TB drugs to global TB control.


METHODS
We performed a systematic review following QUOROM guidelines. MEDLINE was searched from 1998 to the present using the terms TB and default or drop-out or compliance or adherence and therapy. A total of 840 articles were returned. A further detailed manual review selected 15 randomized trials and observational studies that reported timing of drop-out and focused on developing countries.


RESULTS
The selected studies comprised randomized controlled trials, retrospective record reviews, and qualitative assessments and spanned 10 countries. Both directly observed treatment (DOT) and non-DOT programs were represented. Thus results were highly heterogeneous and not statistically aggregated. Data suggest, but do not conclude, that the majority of defaulters across the studies completed the 2-month intensive phase of treatment.


CONCLUSIONS
There is insufficient high-quality comparable information on the timing of default from TB treatment to permit any firm conclusions on trends in default. However, a substantial proportion of defaulters appear to leave treatment in the later stages of the current 6-month regimen, suggesting that new TB chemotherapeutic agents which can reduce the length of treatment have the potential to improve global TB treatment success rates.
Kruk
Margaret E
ME
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. mkruk@umich.edu
Schwalbe
Nina R
NR
Aguiar
Christine A
CA
D000995:Antitubercular Agents / Q000008:administration & dosage*; D003906:Developing Countries; D023801:Directly Observed Therapy; D006801:Humans; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016312:Treatment Refusal; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents