title: The role of exogenous risk factors of antituberculosis treatment failure.
abstract: OBJECTIVE
  The Republic of Moldova reports the highest incidence of tuberculosis and the lowest treatment success rate among European region countries. In most of the patients the antituberculosis treatment failure is correlated with social risk factors (low socio-economical state, epidemiological danger characteristics) and biological factors (young age, male sex, physiological conditions, associated diseases). Clinical factors (advanced forms of tuberculosis, chronic evolution, immune disturbances), therapeutic factors (treatment errors and interruptions, individualized regimens) and administrative factors (drug interruption in supply, suboptimal treatment quality) prevail in regions with defficient in health care delivery. The association of risk factors has a higher impact than the severity of one risk factor. The risk factor assessment is very important before initiation of the treatment, for establishing the plan of risk reduction measures for increasing the success rate. The aim of the study was to determine the impact of exogenous risk factors on antituberculosis treatment failure.
  
  
  METHODS
  The study was conducted on 201 patients with pulmonary tuberculosis and treatment failure and 105 patients with pulmonary tuberculosis who successfully finished the antituberculosis treatment. Selected cases were investigated according national standards.
  
  
  RESULTS
  The treatment failure occurred in patients belonging to socially disadvantaged groups, patients with harmful habits (alcohol abuse, drug use, active smoking), patients from infectious clusters. Migration, homelessness and detention releasing imperil the quality of treatment, thus predisposing to the treatment failure. Social, educational support and the substitutive therapy and withdrawal techniques (tobacco, alcohol, psycho-active substances) must be implemented in the high risk groups in order to diminish the risk of treatment failure and to increase the treatment success rate.
  
  
  CONCLUSIONS
  The study of exogenous risk factors in vulnerable groups will contribute to the precocious detection of patients predisposed to failing the tuberculosis treatment and will permit the initiation of measures centered on patient that will favor the increase of treatment quality and success rate.
authors.affiliation: Pneumophthisiology Department, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
authors.forename: Evelina
authors.initials: E
authors.lastname: Lesnic
authors.affiliation: Pneumophthisiology Department, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Ustian
authors.affiliation: Pneumology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Carmen Monica
authors.initials: CM
authors.lastname: Pop
keywords: risk factors; treatment failure; tuberculosis