[Incidence of and factors for non-compliance to antituberculous treatment].
BACKGROUND
Tuberculosis is a public health problem. Non-compliance with treatment regimes increases morbidity-mortality, perpetuates transmission and generates bacterial resistance. It is necessary to know incidence and associated factors to non-compliance for performance interventions.


OBJECTIVE
The incidence of and associated factors associated with non-compliance to antituberculous treatment were investigated.


METHODS
A follow-up study was conducted in an adult cohort with tuberculosis, living in an urban area. Non-compliance was defined as treatment default of 30 days or more. Patients were interviewed at the initiation of treatment and and re-interviewed in subsequent intervals. Outcome was defined as the period of time until treatment abandonment. Non-compliance rates were calculated, as well as survival curves; the Cox regression model was used to adjust for associated variables.


RESULTS
Of the 261 patients who were interviewed, 39 (14.9%) had abandoned treatment (rate 0.4 episodes/1,000 days-person, 95%CI 0.2-0.8). Factors associated with compliance were family support (HR=0.4, 95%CI 0.2-0.9), secondary drug effects (HR=0.2, 95%CI 0.1-0.6) and opportunity to receive treatment at the clinic where tuberculosis was diagnosed (HR=0.3, 95%CI 0.1-0.6). Risk factors for non-compliance were as follows: treatment requiring >2 months (HR=14.3, 95%CI 1.8-112.7), low socioeconomic status (HR=3.90, 95%CI 2.1-9.3), age between 21-30 years (HR=20.6, 95%CI 2.4-175.4), history of incarceration (HR=2.2, 95%CI 1.0-5.4), skipping treatments more that twice (HR=6.6, 95%CI 2.8-15.6) and co-infection with HIV/AIDS (HR=2.9, 95%CI 1.6-5.4).


CONCLUSIONS
Non-compliance rate is higher than previously reported. The data recommend the following strategies for improving compliance with antituberculosis treatment: (1) early diagnosis, (2) opportune treatment, (3) improved family support and (4) immediate intervention if a treatment is missed -especially in patients with HIV/AIDS, from low socioeconomic strata, or with record of incarceration.
Cáceres
Flor de María
Fde M
Departamento de Salud Pública, Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia. fmcacer@uis.edu.co
Orozco
Luis Carlos
LC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016312:Treatment Refusal; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology
D000995:Antitubercular Agents