title: Non-adherence and drug-related interruptions are risk factors for delays in completion of treatment for tuberculosis.
abstract: METHODS
  A key program performance objective established by the Centers for Disease Control and Prevention (CDC) is that ≥93% of tuberculosis (TB) cases complete treatment within 12 months.
  
  
  OBJECTIVE
  To determine the rate of and risk factors for delay in anti-tuberculosis treatment completion.
  
  
  METHODS
  Nested case-control study among TB cases reported to the Tennessee Department of Health between 1 January 2000 and 31 December 2010. Time to complete treatment was calculated using treatment start and stop dates documented in the Tuberculosis Information Management System (TIMS).
  
  
  RESULTS
  Of 2627 cases, 261 (9.9%) required >12 months to complete treatment. In adjusted conditional logistic regression analyses, cavitary disease and positive cultures after 2 months of therapy (OR 5.85, 95%CI 1.98-17.32, P = 0.001), non-adherence (OR 4.13, 95%CI 1.76-9.72, P < 0.001), and interruptions in treatment due to drug-related issues (OR 6.91, 95%CI 3.76-12.70, P < 0.001) were independently associated with delay in completion of TB treatment.
  
  
  CONCLUSIONS
  From 2000 to 2010, the proportion of TB cases completing treatment within 12 months increased from 84.6% to 94.9%, and remained above the CDC target during 2009-2010. Efforts to improve patient adherence and reduce interruptions in treatment due to anti-tuberculosis drug-related issues could improve the proportion of TB cases completing treatment within 12 months.
authors: Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. april.pettit@ vanderbilt.edu
authors: A C
authors: AC
authors: Pettit
authors: J
authors: J
authors: Cummins
authors: L A
authors: LA
authors: Kaltenbach
authors: T R
authors: TR
authors: Sterling
authors: J V
authors: JV
authors: Warkentin
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D015397:Program Evaluation; D012307:Risk Factors; D013714:Tennessee; D013997:Time Factors; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
references: MMWR Recomm Rep. 1997 May 2;46(RR-10):1-55
references: 9148133
references: Am J Respir Crit Care Med. 1995 May;151(5):1486-90
references: 7735604
references: Ann Pharmacother. 1996 Sep;30(9):919-25
references: 8876848
references: MMWR Morb Mortal Wkly Rep. 2010 Mar 19;59(10):295-8
references: 20300056
references: Clin Chest Med. 1997 Mar;18(1):79-87
references: 9098612
references: Stat Med. 1999 Mar 30;18(6):681-94
references: 10204197
references: Ann Intern Med. 2003 Jul 15;139(2):137-47
references: 12859163
references: Thorax. 1996 Feb;51(2):111-3
references: 8711637
references: Am Rev Respir Dis. 1993 May;147(5):1311-20
references: 8484650
references: Int J Tuberc Lung Dis. 2000 Sep;4(9):860-5
references: 10985655
references: Emerg Infect Dis. 2004 Aug;10(8):1426-31
references: 15496244
references: Emerg Infect Dis. 2010 Oct;16(10):1546-53
references: 20875279
references: J Gastroenterol Hepatol. 2008 Feb;23(2):192-202
references: 17995946
references: Ann Epidemiol. 1999 Oct;9(7):419-23
references: 10501409
references: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003343
references: 17943789
references: MMWR Recomm Rep. 2003 Jun 20;52(RR-11):1-77
references: 12836625
references: Drugs. 2002;62(15):2169-83
references: 12381217
references: Int J Tuberc Lung Dis. 2012 Aug;16(8):1075-82
references: 22668774
references: Am J Prev Med. 2001 Feb;20(2):108-12
references: 11165451
references: JAMA. 1998 Mar 25;279(12):943-8
references: 9544769
references: Ann Intern Med. 1997 Aug 15;127(4):289-93
references: 9265429