Factors associated with tuberculosis treatment default in an endemic area of the Brazilian Amazon: a case control-study.
METHODS
Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains.


OBJECTIVE
This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions.


METHODS
Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as 'cases' and those completing treatment as 'controls'. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls.


RESULTS
Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default.


CONCLUSIONS
Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs.
Tropical Medicine Post-Graduate Program - Amazonas State University/Dr Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, Brazil. marlucia.garrido@gmail.com
Marlucia da Silva
Mda S
Garrido
Maria Lucia
ML
Penna
Tomàs M
TM
Perez-Porcuna
Alexandra Brito
AB
de Souza
Leni da Silva
Lda S
Marreiro
Bernardino Claudio
BC
Albuquerque
Flor Ernestina
FE
Martínez-Espinosa
Samira
S
Bührer-Sékula
D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil; D016022:Case-Control Studies; D015331:Cohort Studies; D006801:Humans; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents