title: Factors associated with low cure rate of tuberculosis in remote poor areas of Shaanxi Province, China: a case control study.
abstract: BACKGROUND
  The directly observed therapy-short course (DOTS) strategy was introduced in Shaanxi province, China to improve tuberculosis (TB) control by means of improved case detection (target: > = 70%) and treatment success rates (target: > = 85%) in new smear positive (SS+) TB patients. At a provincial level the targets were both reached in 2005. However in 30 (28%) out of 107 counties of Shaanxi province the cure rate was below 85%. This study aimed to investigate patient and treatment characteristics associated with non-cure after tuberculosis (TB) treatment in these counties.
  
  
  METHODS
  In this case-control study, new smear positive TB cases in 30 counties with a cure rate <85% were included. Cured patients were compared to non-cured patients using logistic regression analysis to assess determinants for non-cure.
  
  
  RESULTS
  Of the 659 patients included, 153 (23.2%) did not have cure as treatment outcome. Interruption of treatment was most strongly associated with non-cure (OR = 8.7, 95% CI 3.9-18.4). Other independent risk factors were co-morbidity, low education level, lack of appetite as an initial symptom of TB disease, diagnosis of TB outside of the government TB control institutes, missing sputum re-examinations during treatment, and not having a treatment observer. Twenty-six percent of patients did not have a treatment observer. The non-cure rate was better for those with a doctor (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17-0.88) as treatment observer than for those with a family member (OR 0.62, 95%CI 0.37-1.03). The main reason for interrupted treatment mentioned by patients was presence of adverse effects during treatment (46.5%).
  
  
  CONCLUSIONS
  Interruption of treatment was most strongly associated with non-cure. Although treatment observation by medical staff is preferred, in order to diminish the proportion of patients who do not have a treatment observer and thereby reduce the proportion of patients who interrupt treatment, we suggest making it possible for family members, after sufficient training, to be treatment observers in remote areas where it is logistically difficult to have village doctors observe treatment for all patients.
authors.affiliation: The Department of Epidemiology, The Fourth Military Medical University, Xi'an, Shaanxi province, China.
authors.forename: Xianqin
authors.initials: X
authors.lastname: Ai
authors.forename: Ke
authors.initials: K
authors.lastname: Men
authors.forename: Liujia
authors.initials: L
authors.lastname: Guo
authors.forename: Tianhua
authors.initials: T
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Xiaolu
authors.initials: X
authors.lastname: Sun
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhang
authors.forename: Guangxue
authors.initials: G
authors.lastname: He
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Susan
authors.initials: S
authors.lastname: van den Hof
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002681:China; D023801:Directly Observed Therapy; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011204:Poverty Areas; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents