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Multicenter Study
. 2007 Feb;4(2):e37.
doi: 10.1371/journal.pmed.0040037.

Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in Southern Ethiopia

Estifanos Biru Shargie  1 , Bernt Lindtjørn
Affiliations
Multicenter Study

Determinants of treatment adherence among smear-positive pulmonary tuberculosis patients in Southern Ethiopia

Estifanos Biru Shargie et al. PLoS Med. 2007 Feb.

Abstract

Background: Defaulting from treatment remains a challenge for most tuberculosis control programmes. It may increase the risk of drug resistance, relapse, death, and prolonged infectiousness. The aim of this study was to determine factors predicting treatment adherence among smear-positive pulmonary tuberculosis patients.

Methods and findings: A cohort of smear-positive tuberculosis patients diagnosed and registered in Hossana Hospital in southern Ethiopia from 1 September 2002 to 30 April 2004 were prospectively included. Using a structured questionnaire, potential predictor factors for defaulting from treatment were recorded at the beginning of treatment, and patients were followed up until the end of treatment. Default incidence rate was calculated and compared among preregistered risk factors. Of the 404 patients registered for treatment, 81 (20%) defaulted from treatment. A total of 91% (74 of 81) of treatment interruptions occurred during the continuation phase of treatment. On a Cox regression model, distance from home to treatment centre (hazard ratio [HR] = 2.97; p < 0.001), age > 25 y (HR = 1.71; p = 0.02), and necessity to use public transport to get to a treatment centre (HR = 1.59; p = 0.06) were found to be independently associated with defaulting from treatment.

Conclusions: Defaulting due to treatment noncompletion in this study setting is high, and the main determinants appear to be factors related to physical access to a treatment centre. The continuation phase of treatment is the most crucial time for treatment interruption, and future interventions should take this factor into consideration.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Study Profile
Figure 2
Figure 2. Survival Curve of Time on Treatment by Walking Distance from Treatment Centre, Adjusted by Cox Regression Analysis
See this image and copyright information in PMC

Comment in

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