title: Impact of patient and program factors on default during treatment of multidrug-resistant tuberculosis.
abstract: METHODS
  In the Philippines, programmatic treatment of drug-resistant tuberculosis (TB) was initiated by the Tropical Disease Foundation in 1999 and transitioned to the National TB Program in 2006.
  
  
  OBJECTIVE
  To determine patient and socio-demographic characteristics associated with default, and the impact of patient support measures on default.
  
  
  METHODS
  Retrospective cohort analysis of 583 MDR-TB patients treated from 1999 to 2006.
  
  
  RESULTS
  A total of 88 (15%) patients defaulted from treatment. The median follow-up time for patients who defaulted was 289 days (range 1-846). In multivariate analysis adjusted for age, sex and previous TB treatment, receiving a greater number of treatment drugs (≥ 5 vs. 2-3 drugs, HR 7.2, 95%CI 3.3-16.0, P < 0.001) was significantly associated with an increased risk of default, while decentralization reduced the risk of default (HR 0.3, 95%CI 0.2-0.7, P < 0.001).
  
  
  CONCLUSIONS
  Improving access to treatment for MDR-TB through decentralization of care to centers near the patient's residence reduced the risk of default. Further research is needed to evaluate the feasibility, impact and cost-effectiveness of decentralized care models for MDR-TB treatment.
authors.affiliation: Tropical Disease Foundation, Manila, The Philippines.
authors.forename: M T
authors.initials: MT
authors.lastname: Gler
authors.forename: L J
authors.initials: LJ
authors.lastname: Podewils
authors.forename: N
authors.initials: N
authors.lastname: Munez
authors.forename: M
authors.initials: M
authors.lastname: Galipot
authors.forename: M I D
authors.initials: MI
authors.lastname: Quelapio
authors.forename: T E
authors.initials: TE
authors.lastname: Tupasi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D010361:Patients; D010679:Philippines; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D016312:Treatment Refusal; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents