SETTING: An urban tuberculosis (TB) clinic, The Gambia. OBJECTIVE: To identify patient characteristics associated with increased rates of defaulting from treatment, specifically knowledge and cost factors amenable to intervention. DESIGN: Prospective cohort study of TB cases at least 15 years of age commencing treatment, interviewed by semi-structured questionnaire and followed for attendance at thrice-weekly directly observed treatment (DOT). RESULTS: Of 301 patients, 76 (25.2%) defaulted from treatment and 25 did not return for treatment. The defaulting rate was higher among those who said they were uncertain that their treatment would work (HR 3.64; 95%CI 1.42-9.31, P = 0.007) and among those who incurred significant time or money costs travelling to receive treatment (HR 2.67; 95%CI 1.05-6.81; P = 0.04). These factors had differing effects with respect to time: uncertainty over treatment success was important in the first 90 days of treatment, while increased cost of travelling to the clinic was important after 90 days. CONCLUSION: In The Gambia, risk groups for defaulting can be recognised at the start of treatment and are at highest risk at different times. Home-based self-administration of medications after 3 months of DOT should be considered as confidence in treatment success rises, and the costs of travelling to receive treatment start to take their toll.
SETTING: An urban tuberculosis (TB) clinic, The Gambia. OBJECTIVE: To identify patient characteristics associated with increased rates of defaulting from treatment, specifically knowledge and cost factors amenable to intervention. DESIGN: Prospective cohort study of TB cases at least 15 years of age commencing treatment, interviewed by semi-structured questionnaire and followed for attendance at thrice-weekly directly observed treatment (DOT). RESULTS: Of 301 patients, 76 (25.2%) defaulted from treatment and 25 did not return for treatment. The defaulting rate was higher among those who said they were uncertain that their treatment would work (HR 3.64; 95%CI 1.42-9.31, P = 0.007) and among those who incurred significant time or money costs travelling to receive treatment (HR 2.67; 95%CI 1.05-6.81; P = 0.04). These factors had differing effects with respect to time: uncertainty over treatment success was important in the first 90 days of treatment, while increased cost of travelling to the clinic was important after 90 days. CONCLUSION: In The Gambia, risk groups for defaulting can be recognised at the start of treatment and are at highest risk at different times. Home-based self-administration of medications after 3 months of DOT should be considered as confidence in treatment success rises, and the costs of travelling to receive treatment start to take their toll.
Authors: Merrin E Rutherford; John D Dockerty; Momodou Jasseh; Stephen R C Howie; Peter Herbison; David J Jeffries; Melissa Leach; Warren Stevens; Kim Mulholland; Richard A Adegbola; Philip C Hill Journal: Bull World Health Organ Date: 2009-03 Impact factor: 9.408
Authors: Sarah J Iribarren; Susan L Beck; Patricia F Pearce; Cristina Chirico; Mirta Etchevarria; Fernando Rubinstein Journal: J Mob Technol Med Date: 2014
Authors: Lisa M Puchalski Ritchie; Michael J Schull; Alexandra L C Martiniuk; Jan Barnsley; Tamara Arenovich; Monique van Lettow; Adrienne K Chan; Edward J Mills; Austine Makwakwa; Merrick Zwarenstein Journal: Implement Sci Date: 2015-03-28 Impact factor: 7.327
Authors: Ibrahim Sendagire; Maarten Schim Van der Loeff; Andrew Kambugu; Joseph Konde-Lule; Frank Cobelens Journal: PLoS One Date: 2012-05-02 Impact factor: 3.240