title: Default from tuberculosis treatment in Tashkent, Uzbekistan; who are these defaulters and why do they default?
abstract: 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.
authors.affiliation: Project HOPE Tuberculosis Control Program for the Central Asia Region, Almaty, Kazakhstan. ehasker@itg.be
authors.forename: Epco
authors.initials: E
authors.lastname: Hasker
authors.forename: Maksad
authors.initials: M
authors.lastname: Khodjikhanov
authors.forename: Shakhnoz
authors.initials: S
authors.lastname: Usarova
authors.forename: Umid
authors.initials: U
authors.lastname: Asamidinov
authors.forename: Umida
authors.initials: U
authors.lastname: Yuldashova
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Gulnoz
authors.initials: G
authors.lastname: Uzakova
authors.forename: Jaap
authors.initials: J
authors.lastname: Veen
mesh_terms: 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