Risk Factors of Drop-Out among Tuberculosis Patients in Semarang: A Case-Control Study

Abstract

Background: A multitude of factors are known to be associated with tuberculosis (TB) patients dropping out of treatment, such as living alone, social vulnerability, and access to health services. Semarang, the capital city of Central Java has never achieved the national TB cure rate target. Semarang city had a cure rate of 63.336% per annum in part due to the increased treatment drop-out from 2.8% in 2015 to 4.5% in 2018. The increase of drop-out TB patients in Semarang causes the decreased of the cure rate each year. The study aimed to identify independent factors associated with drop-out among TB patients and to inform the design of programs that reduce drop-out rates in Semarang, Central Java, and across Indonesia. methods: A case-control study was conducted to identify factors associated with treatment drop-out among TB patients. The pilot study took place in Semarang city with case-control ratio of 1:2. The case consisted of drop-out patients in 2018, whose secondary data was identified from the health district office, totaling 20 patients. Forty unmatched control patients were taken with purposive sampling technique with inclusion criteria: patients’ success treatment recorded in health centers of Semarang city area, lived in the metro area of drop-out patients and aged more than 15 years old. Results:Majority of patients in the case group has insufficient family support during their treatment course (95%) compared to the control group (45%). Inadequate DOT support was also found among the case group (80%), while the control group had less than 50%. More than half of the case group (55%) experienced a high amount of stigma during their treatment course. Anti-TB medications’ side effects appeared in the case group (70%) more than the control group (32.5%). In both groups, majority (case: 95%; control: 97.5%) resided close to the health facility (less than 3 km). Three variables were found to be significantly independent factors for the drop-out of TB patients. These three factors were family support (OR: 26.555 CI: 2.727-268.143), DOT or swallowing drug assistance support (OR: 5.687 CI: 1.261-25.644), and the experience of side effect of anti-TB medication (OR: 5.334 CI: 1.222-23.285). Conclusion: Family support is the key to success to minimize TB patients to drop out. Moreover, the experience of the side effect of anti-TB medication played five to six times higher to TB patients who are likely to drop-out the medication.