Default from tuberculosis treatment in Tashkent, Uzbekistan; who are these defaulters and why do they default?
BACKGROUND
In Tashkent (Uzbekistan), TB treatment is provided in accordance with the DOTS strategy. Of 1087 pulmonary TB patients started on treatment in 2005, 228 (21%) defaulted. This study investigates who the defaulters in Tashkent are, when they default and why they default.


METHODS
We reviewed the records of 126 defaulters (cases) and 132 controls and collected information on time of default, demographic factors, social factors, potential risk factors for default, characteristics of treatment and recorded reasons for default.


RESULTS
Unemployment, being a pensioner, alcoholism and homelessness were associated with default. Patients defaulted mostly during the intensive phase, while they were hospitalized (61%), or just before they were to start the continuation phase (26%). Reasons for default listed in the records were various, 'Refusal of further treatment' (27%) and 'Violation of hospital rules' (18%) were most frequently recorded. One third of the recorded defaulters did not really default but continued treatment under 'non-DOTS' conditions.


CONCLUSIONS
Whereas patient factors such as unemployment, being a pensioner, alcoholism and homelessness play a role, there are also system factors that need to be addressed to reduce default. Such system factors include the obligatory admission in TB hospitals and the inadequately organized transition from hospitalized to ambulatory treatment.
Hasker
Epco
E
Project HOPE Tuberculosis Control Program for the Central Asia Region, Almaty, Kazakhstan. ehasker@itg.be
Khodjikhanov
Maksad
M
Usarova
Shakhnoz
S
Asamidinov
Umid
U
Yuldashova
Umida
U
van der Werf
Marieke J
MJ
Uzakova
Gulnoz
G
Veen
Jaap
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000188:drug therapy*; D014610:Uzbekistan