Data from: Patient characteristics associated with tuberculosis treatment default: a cohort study in a high-incidence area of Lima, Peru

Background: Although tuberculosis (TB) is usually curable with antibiotics, poor adherence to medication can lead to increased transmission, drug resistance, and death. Prior research has shown several factors to be associated with poor adherence, but this problem remains a substantial barrier to global TB control. We studied patients in a high-incidence district of Lima, Peru to identify factors associated with premature termination of treatment (treatment default). Methods: We conducted a prospective cohort study of adult smear-positive TB patients enrolled between January 2010 and December 2011 with no history of TB disease. Descriptive statistics and multivariable logistic regression analyses were performed to determine risk factors associated with treatment default. Results: Of the 1233 patients studied, 127 (10%) defaulted from treatment. Patients who defaulted were more likely to have used illegal drugs (OR = 4.78, 95% CI: 3.05-7.49), have multidrug-resistant TB (OR = 3.04, 95% CI: 1.58-5.85), not have been tested for HIV (OR = 2.30, 95% CI: 1.50-3.54), drink alcohol at least weekly (OR = 2.22, 95% CI: 1.40-3.52), be underweight (OR = 2.08, 95% CI: 1.21-3.56), or not have completed secondary education (OR = 1.55, 95% CI: 1.03-2.33). Conclusions: Our study identified several factors associated with defaulting from treatment, suggesting a complex set of causes that might lead to default. Addressing these factors individually would be difficult, but they might help to identify certain high-risk patients for supplemental intervention prior to treatment interruption. Treatment adherence remains a barrier to successful TB care and reducing the frequency of default is important for both the patients’ health and the health of the community.背景：尽管结核病（tuberculosis, TB）通常可通过抗生素治愈，但服药依从性不佳会加剧疾病传播、诱导耐药性产生并导致患者死亡。既往研究已识别出多项与服药依从性不佳相关的影响因素，但该问题仍是全球结核病防控工作的重大障碍。本研究针对秘鲁利马某高发病率区域的患者开展研究，旨在明确与治疗过早中断（即治疗脱落）相关的危险因素。方法：本研究采用前瞻性队列研究设计，纳入2010年1月至2011年12月期间入组的、无结核病史的成人痰涂片阳性结核病患者。通过描述性统计分析与多变量logistic回归（multivariable logistic regression）分析，探究与治疗脱落相关的危险因素。结果：在纳入研究的1233例患者中，共有127例（占比10%）出现治疗脱落。与完成治疗的患者相比，发生治疗脱落的患者更易存在以下特征：吸食违禁药品（比值比（odds ratio, OR）=4.78，95%置信区间（confidence interval, CI）：3.05~7.49）、罹患耐多药结核病（multidrug-resistant TB）（OR=3.04，95%CI：1.58~5.85）、未接受人类免疫缺陷病毒（HIV）检测（OR=2.30，95%CI：1.50~3.54）、每周至少饮酒一次（OR=2.22，95%CI：1.40~3.52）、体重偏低（OR=2.08，95%CI：1.21~3.56），或未完成中等教育（OR=1.55，95%CI：1.03~2.33）。结论：本研究识别出多项与治疗脱落相关的影响因素，提示治疗脱落的致病机制较为复杂。单独针对各因素开展干预难度较大，但上述结果可用于识别治疗中断前需实施额外干预的高危患者。服药依从性仍是结核病诊疗成功的关键阻碍，降低治疗脱落率对患者个体健康与社区公共卫生均具有重要意义。