Non-adherence to tuberculosis therapy can lead to drug
resistance, prolonged infectiousness, and death; therefore, understanding what
causes treatment default is important. Pakistan has one of the highest burdens
of tuberculosis in the world, yet there have been no qualitative studies in
Pakistan that have specifically examined why default occurs. We conducted a
mixed methods study at a tuberculosis clinic in Karachi to understand why
patients with drug-susceptible tuberculosis default from treatment, and to
identify factors associated with default. Patients attending this clinic pick
up medications weekly and undergo family-supported directly observed therapy.
In-depth interviews were administered to 21 patients who had
defaulted. We also compared patients who defaulted with those who were cured,
had completed, or had failed treatment in 2013.
Qualitative analyses showed the most common reasons for
default were the financial burden of treatment, and medication side effects and
beliefs. The influence of finances on other causes of default was also
prominent, as was concern about the effect of treatment on family members. In
quantitative analysis, of 2120 patients, 301 (14.2%) defaulted. Univariate
analysis found that male gender, being 35–59
years of age, or being 60 years of age or older were associated with default. After adjusting for
gender, disease site, and patient category, being 35–59 years of age or 60 years of age or older) were associated with default.
In multivariate analysis age was the only variable
associated with default. This lack of identifiable risk factors and our
qualitative findings imply that default is complex and often due to extrinsic
and medication-related factors. More tolerable medications, improved side
effect management, and innovative cost-reduction measures are needed to reduce
default from tuberculosis treatment.
Full article at: http://goo.gl/KqUFfH
By:
Jay Weiss Institute for Health
Equity at Sylvester Comprehensive Cancer Center, University of Miami Miller
School of Medicine, Miami, Florida, United States of America
Natasha Chida
Department of Internal Medicine,
Division of Infectious Diseases, Johns Hopkins University School of Medicine,
Baltimore, Maryland, United States of America
Zara Ansari, Aamir J. Khan, Shama Mohammed
Interactive Research and
Development, Karachi, Sindh, Pakistan
Hamidah Hussain, Maria Jaswal, Aamir J. Khan
Indus Hospital Research Center,
Indus Hospital, Karachi, Sindh, Pakistan
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