title: Reasons for defaulting from drug-resistant tuberculosis treatment in Armenia: a quantitative and qualitative study.
abstract: METHODS
  Armenia, a country with a high prevalence of drug-resistant tuberculosis (DR-TB).
  
  
  OBJECTIVE
  To identify factors related to default from DR-TB treatment in Yerevan.
  
  
  METHODS
  Using a retrospective cohort design, we compared defaulters with patients who were cured, completed or failed treatment. Patients who initiated DR-TB treatment from 2005 to 2011 were included in the study. A qualitative survey was conducted including semi-structured interviews with defaulters and focus group discussions with care providers.
  
  
  RESULTS
  Of 381 patients, 193 had achieved treatment success, 24 had died, 51 had failed treatment and 97 had defaulted. The number of drugs to which the patient was resistant at admission (aRR 1.16, 95%CI 1.05-1.27), the rate of treatment interruption based on patient's decision (aRR 1.03, 95%CI 1.02-1.05), the rate of side effects (aRR 1.18, 95%CI 1.09-1.27), and absence of culture conversion during the intensive phase (aRR 0.47, 95%CI 0.31-0.71) were independently associated with default from treatment. In the qualitative study, poor treatment tolerance, a perception that treatment was inefficient, lack of information, incorrect perception of being cured, working factors and behavioural problems were factors related to treatment default.
  
  
  CONCLUSIONS
  In addition to economic reasons, poor tolerance of and poor response to treatment were the main factors associated with treatment default.
authors.affiliation: Epicentre, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Sanchez-Padilla
authors.affiliation: Epicentre, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Marquer
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Kalon
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Qayyum
authors.affiliation: National Tuberculosis Programme Office, Yerevan, Armenia.
authors.forename: A
authors.initials: A
authors.lastname: Hayrapetyan
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Varaine
authors.affiliation: Epicentre, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bastard
authors.affiliation: Epicentre, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001136:Armenia; D024881:Drug Resistance, Bacterial; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010352:Patient Dropouts; D010465:Perception; D036301:Qualitative Research; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents