Abstract
This study aimed to identify the individual and environmental determinants of nonadherence to tuberculosis (TB) treatment in selected districts in the Buenos Aires Metropolitan Area, in Argentina. We conducted a cross-sectional study using a hierarchical model. Using primary and secondary data, logistic regression was performed to analyze two types of determinants. The likelihood of nonadherence to treatment was greatest among male patients. The following factors led to a greater likelihood of nonadherence to treatment: patients living in a home without running water; head of household without medical insurance; need to use more than one means of transport to reach the health center; place of residence in an area with a high proportion of households connected to the natural gas network; place of residence in an area where a large proportion of families fall below the minimum threshold of subsistence capacity; place of residence in an area where a high proportion of households do not have flushing toilets and basic sanitation. Our results show that social and economic factors - related to both individual and environmental characteristics - influence adherence to TB treatment.
Highlights
Tuberculosis (TB) is a preventable and curable disease, it remains a significant public health problem in Argentina, where over 9,500 new cases are diagnosed and almost 800 people die from the disease every year 1. TB treatment in Argentina is free of charge, one of the main barriers to disease control is patient nonadherence to treatment and its consequences, i.e., disease progression and death, contagion, and the development of resistant strains 2.Treatment dropout rates in Argentina have risen over the last decade 3
This study aimed to identify the individual and environmental determinants of nonadherence to tuberculosis (TB) treatment in selected districts in the Buenos Aires Metropolitan Area, in Argentina
By using hierarchical factor analysis to explore different types of factors among a sample from selected districts of the Buenos Aires Metropolitan Area, the present study aims to identify individual and environmental determinants of nonadherence to TB treatment and investigate the influence of these different types of factors on adherence
Summary
Tuberculosis (TB) is a preventable and curable disease, it remains a significant public health problem in Argentina, where over 9,500 new cases are diagnosed and almost 800 people die from the disease every year 1. TB treatment in Argentina is free of charge, one of the main barriers to disease control is patient nonadherence to treatment and its consequences, i.e., disease progression and death, contagion, and the development of resistant strains 2.Treatment dropout rates in Argentina have risen over the last decade 3. TB treatment in Argentina is free of charge, one of the main barriers to disease control is patient nonadherence to treatment and its consequences, i.e., disease progression and death, contagion, and the development of resistant strains 2. A cohort study of patients with smear-positive pulmonary tuberculosis carried out in Argentina in 2010 showed a treatment dropout rate of 13.8% (compared to the international target of reducing rates to 5%). A study conducted between 2008 and 2010 that analyzed treatment strategies and sociodemographic factors associated with treatment adherence in districts in the Buenos Aires Metropolitan Area – that account for around 10% of the region’s total population – showed that higher poverty levels and being treated in hospitals (as opposed to primary healthcare centers) were the main explanatory factors for nonadherence. Several studies have been conducted worldwide to identify the personal, environmental and health care factors associated with adherence to treatment [4,5,6,7,8,9,10,11,12]
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