title: [Medication support and treatment outcome in homeless patients with tuberculosis].
abstract: OBJECTIVE
  We conducted a study on factors related to treatment outcome and medication support in homeless patients with tuberculosis.
  
  
  METHODS
  Participants were 433 homeless patients with tuberculosis newly registered in Osaka City between 2007 and 2009. We investigated factors related to treatment outcome (e.g., length of hospital stay, scheduled duration of outpatient treatment, and type of DOTS). Controls were 3,047 non-homeless patients with pulmonary tuberculosis newly registered in Osaka City during the same period.
  
  
  RESULTS
  Regarding medication support, 219 (70.4%) of the 311 patients with successful treatment received DOTS and completed the treatment during their hospital stay. Thirty-five (72.9%) of the forty-eight patients who did not complete treatment left the hospital at their own discretion, resulting in treatment failure/default. The rate of treatment failure/default in the homeless patients with pulmonary tuberculosis was 11.0%, significantly higher than that of non-homeless patients with pulmonary tuberculosis (6.5%; P < 0.001). Among the 102 patients receiving community DOTS, medication compliance occurred at least 5 days a week in 66 patients (64.7%) and treatments failed or were interrupted in 10 patients (9.8%). The mean hospital stay was 2.0 +/- 1.6 months in patients with failed/defaulted treatment and 4.4 +/- 2.5 months in those with successful treatment. The scheduled duration of outpatient treatment was 7.9 +/- 2.7 months in patients with failed/defaulted treatment and 3.6 +/- 2.1 months in those with successful treatment. Shorter length of hospital stay and longer scheduled duration of outpatient treatment were associated with a higher rate of treatment failure/default (P < 0.01).
  
  
  CONCLUSIONS
  Homeless patients with tuberculosis had a higher rate of treatment failure/default, most likely due to leaving the hospital at their own discretion. Patients with successful treatment generally completed treatment during their hospital stay. In contrast, patients who received community DOTS after discharge from the hospital had a higher rate of treatment failure/default, despite receiving medication at least 5 days a week. This suggests the need for adequate support, particularly in patients with a shorter hospital stay and those with a longer scheduled duration of outpatient treatment.
authors.affiliation: Osaka City Public Health Office, 1-2-7-1000, Asahimachi, Abeno-ku, Osaka-shi, Osaka 545-0051, Japan. ke-matsumoto@city.osaka.lg.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Jun
authors.initials: J
authors.lastname: Komukai
authors.forename: Sachi
authors.initials: S
authors.lastname: Kasai
authors.forename: Asami
authors.initials: A
authors.lastname: Morikochi
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirota
authors.forename: Shinichi
authors.initials: S
authors.lastname: Koda
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Terakawa
authors.forename: Akira
authors.initials: A
authors.lastname: Shimouchi
mesh_terms: D023801:Directly Observed Therapy; D006703:Ill-Housed Persons; D006801:Humans; D007564:Japan; D007902:Length of Stay; D017211:Treatment Failure; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*