Treatment interruptions and duration associated with default among new patients with tuberculosis in six regions of Russia

Abstract

To determine the frequency and length of treatment interruptions among new pulmonary tuberculosis (TB) patients and to evaluate the duration of interruption associated with default in the tuberculosis services of six Russian regions. This was a retrospective study of all adult patients with new pulmonary TB enrolled for treatment from April 1 to September 30, 2003. Data from patients with treatment outcomes of default (n=84), failure (n=130), death (n=113), and success (n=1444) were analyzed. The default rate was 4.6%. Treatment interruptions were frequent: 63% of patients who defaulted and 36% of those successfully treated had interruptions of treatment during the intensive phase, and 30% of those who defaulted and 45% of those with a successful outcome had interrupted treatment during the continuation phase. The length of treatment interruptions was 1-125 days during the intensive phase and 1-127 days during the continuation phase among patients with outcomes other than default. Patients with treatment gaps of 2-8 weeks during the intensive phase included 15.5% of defaulters, 13.9% of those with an outcome of failure, and 4.4% of those with treatment success. The integrated probability of default was >or=50% in those patients who missed at least 2-3 consecutive days of treatment during the intensive phase and at least one day during the continuation phase. Treatment interruptions were frequent in TB patients in the six Russian regions. Interventions to improve treatment adherence in patients are necessary. Social support and incentive programs should be universally available for all patients from the start of the continuation phase of treatment, during the intensive phase for patients considered to be at risk for default, and for those patients who have missed at least 2-3 days of treatment during the intensive phase. Directly observed therapy (DOT) at home could be a recommendation for some patients.