M E Kimerling1, L Petri. 1. University of Alabama at Birmingham 35233-6505, USA.
Abstract
SETTING: The rural Cambodian district of Banteay Meas, population 74,464. OBJECTIVE: To evaluate the effectiveness of a district based tracing program developed to improve tuberculosis control program treatment results. Specifically, to assess factors affecting patient non-adherence to therapy and return of patients to treatment. DESIGN: All patients started on treatment during 1992 were included. Standardized cohort analysis methods were applied to assess treatment outcome for all tuberculosis cases registered during Trimesters I-III. Absconders for the year were traced and followed as a separate cohort. Those returning to therapy were followed until the end of the study period in October 1993. RESULTS: Activity in 1992 included 171 admissions and 46 absconders. Of the 46, 57% were met at home. Among those met, 81% returned to treatment. Males absconded more than females even though females accounted for a majority of admissions. Socioeconomic factors (68%) were cited most often as the reason for non-adherence. Distance was not a factor. Cohort analysis showed improvement in the treatment completion rate (54.8% vs 69.2% vs 64%) coupled with a drop in the absconding rate (35.5% vs 25% vs 20%). Of the 21 patients returning, 76% have either completed or nearly completed treatment. CONCLUSION: These results support tracing as an effective means to improve patient adherence in rural Cambodia, thereby strengthening tuberculosis control programs at district level.
SETTING: The rural Cambodian district of Banteay Meas, population 74,464. OBJECTIVE: To evaluate the effectiveness of a district based tracing program developed to improve tuberculosis control program treatment results. Specifically, to assess factors affecting patient non-adherence to therapy and return of patients to treatment. DESIGN: All patients started on treatment during 1992 were included. Standardized cohort analysis methods were applied to assess treatment outcome for all tuberculosis cases registered during Trimesters I-III. Absconders for the year were traced and followed as a separate cohort. Those returning to therapy were followed until the end of the study period in October 1993. RESULTS: Activity in 1992 included 171 admissions and 46 absconders. Of the 46, 57% were met at home. Among those met, 81% returned to treatment. Males absconded more than females even though females accounted for a majority of admissions. Socioeconomic factors (68%) were cited most often as the reason for non-adherence. Distance was not a factor. Cohort analysis showed improvement in the treatment completion rate (54.8% vs 69.2% vs 64%) coupled with a drop in the absconding rate (35.5% vs 25% vs 20%). Of the 21 patients returning, 76% have either completed or nearly completed treatment. CONCLUSION: These results support tracing as an effective means to improve patient adherence in rural Cambodia, thereby strengthening tuberculosis control programs at district level.
Authors: James G Carlucci; Aniset Kamanga; Robb Sheneberger; Bryan E Shepherd; Cathy A Jenkins; John Spurrier; Sten H Vermund Journal: J Acquir Immune Defic Syndr Date: 2008-04-15 Impact factor: 3.731