Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa

Abstract

Objective: To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. Methods: A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. Results: A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p 64 years: 3.9%; p 2 months: 4.8%; p 24 years old compared to younger cases (25–34 years: AOR 0.8, 95% CI 0.77–0.87; 35–44 years: AOR 0.6, 95% CI 0.50–0.64; 45–54 years: AOR 0.4, 95% CI 0.32–0.49; 55–64 years: AOR 0.3, 95% CI 0.21–0.43; >64 years: AOR 0.3, 95% CI 0.19–0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46–0.57). Conclusions: Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.

Keywords

• Tuberculosis
• Treatment default
• HIV
• Antiretroviral therapy
• Free State Province
• South Africa