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Alcohol, hospital discharge, and socioeconomic risk factors for default from multidrug resistant tuberculosis treatment in rural South Africa: a retrospective cohort study.
Kendall, Emily A; Theron, Danie; Franke, Molly F; van Helden, Paul; Victor, Thomas C; Murray, Megan B; Warren, Robin M; Jacobson, Karen R.
Affiliation
  • Kendall EA; Division of Infectious Diseases, School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States of America.
  • Theron D; Brewelskloof Hospital, Worcester, South Africa.
  • Franke MF; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
  • van Helden P; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
  • Victor TC; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
  • Murray MB; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America ; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America.
  • Warren RM; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
  • Jacobson KR; Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa ; Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, United States of America.
PLoS One ; 8(12): e83480, 2013.
Article in En | MEDLINE | ID: mdl-24349518
BACKGROUND: Default from multidrug-resistant tuberculosis (MDR-TB) treatment remains a major barrier to cure and epidemic control. We sought to identify patient risk factors for default from MDR-TB treatment and high-risk time periods for default in relation to hospitalization and transition to outpatient care. METHODS: We retrospectively analyzed a cohort of 225 patients who initiated MDR-TB treatment between 2007 through 2010 at a rural TB hospital in the Western Cape Province, South Africa. RESULTS: Fifty percent of patients were cured or completed treatment, 27% defaulted, 14% died, 4% failed treatment, and 5% transferred out. Recent alcohol use was common (63% of patients). In multivariable proportional hazards regression, older age (hazard ratio [HR]= 0.97 [95% confidence interval 0.94-0.99] per year of greater age), formal housing (HR=0.38 [0.19-0.78]), and steady employment (HR=0.41 [0.19-0.90]) were associated with decreased risk of default, while recent alcohol use (HR=2.1 [1.1-4.0]), recent drug use (HR=2.0 [1.0-3.6]), and Coloured (mixed ancestry) ethnicity (HR=2.3 [1.1-5.0]) were associated with increased risk of default (P<0.05). Defaults occurred throughout the first 18 months of the two-year treatment course but were especially frequent among alcohol users after discharge from the initial four-to-five-month in-hospital phase of treatment, with the highest default rates occurring among alcohol users within two months of discharge. Default rates during the first two months after discharge were also elevated for patients who received care from mobile clinics. CONCLUSIONS: Among patients who were not cured or did not complete MDR-TB treatment, the majority defaulted from treatment. Younger, economically-unstable patients and alcohol and drug users were particularly at risk. For alcohol users as well as mobile-clinic patients, the early outpatient treatment phase is a high-risk period for default that could be targeted in efforts to increase treatment completion rates.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Rural Population / Alcohol Drinking / Tuberculosis, Multidrug-Resistant / Ambulatory Care / Hospitalization Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspects: Determinantes_sociais_saude Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2013 Document type: Article Affiliation country: United States Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Rural Population / Alcohol Drinking / Tuberculosis, Multidrug-Resistant / Ambulatory Care / Hospitalization Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Aspects: Determinantes_sociais_saude Limits: Adolescent / Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2013 Document type: Article Affiliation country: United States Country of publication: United States