Abstract
SettingUnder India's Revised National Tuberculosis Control Programme (RNTCP), >15% of previously-treated patients in the reported 2006 patient cohort defaulted from anti-tuberculosis treatment.ObjectiveTo assess the timing, characteristics, and risk factors for default amongst re-treatment TB patients.MethodologyFor this case-control study, in 90 randomly-selected programme units treatment records were abstracted from all 2006 defaulters from the RNTCP re-treatment regimen (cases), with one consecutively-selected non-defaulter per case. Patients who interrupted anti-tuberculosis treatment for >2 months were classified as defaulters.Results1,141 defaulters and 1,189 non-defaulters were included. The median duration of treatment prior to default was 81 days (25%–75% interquartile range 44–117 days) and documented retrieval efforts after treatment interruption were inadequate. Defaulters were more likely to have been male (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.2–1.7), have previously defaulted anti-tuberculosis treatment (aOR 1.3 95%CI 1.1–1.6], have previous treatment from non-RNTCP providers (AOR 1.3, 95%CI 1.0–1.6], or have public health facility-based treatment observation (aOR 1.3, 95%CI 1.1–1.6).ConclusionsAmongst the large number of re-treatment patients in India, default occurs early and often. Improved pre-treatment counseling and community-based treatment provision may reduce default rates. Efforts to retrieve treatment interrupters prior to default require strengthening.
Highlights
India accounts for nearly 20% of the global incidence of TB, with an estimated annual incidence of 1.9 million tuberculosis (TB) cases [1]
The proportion of patients who defaulted from Revised National TB Control Programme (RNTCP) has been relatively low (,8%)
Risk factors for default among new patients have been reported in several studies from India [6,7,8,9]
Summary
India accounts for nearly 20% of the global incidence of TB, with an estimated annual incidence of 1.9 million tuberculosis (TB) cases [1]. Under the Revised National TB Control Programme (RNTCP), treatment outcomes for new patients, have met or exceeded international targets; over 85% of the 553,660 new smear-positive patients notified in 2006 were successfully treated [2]. The public health and clinical consequences of TB treatment default are severe. Relative to those who complete treatment, patients who default may perpetuate TB transmission and have high post-treatment mortality and rates of recurrent disease [4,5]. The proportion of patients who defaulted from RNTCP has been relatively low (,8%). Risk factors for default among new patients have been reported in several studies from India [6,7,8,9]
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