Tuberculosis treatment default in a large tertiary care hospital in urban Nigeria: Prevalence, trend, timing and predictors

SummaryObjectivesFew studies have investigated tuberculosis treatment default in tertiary care settings. We aimed to determine the prevalence, trend, timing and predictors of defaulting from tuberculosis treatment in a Nigerian tertiary hospital.MethodsData entered from 2006 to 2010 in the Federal Medical Centre, Abakaliki, tuberculosis treatment register were sorted into six treatment outcomes. Five outcomes were combined into one variable called ‘non-defaulters’ and were compared with “defaulters”. The statistical analysis was conducted using SPSS.ResultsOf 671 tuberculosis patients, 192 (28.6%) defaulted. Of these, 126 (66%) were ≥30 years old, and 115 (60%) had pulmonary tuberculosis. Furthermore, 106 (55%) were males, and 125 (65%) lived in a rural area. The annual proportion of defaulters dropped from 34.8% to 20.6%, but the decreasing trend was not statistically significant (P = 0.132 for trend). Of the defaulters, 148 (77.1%) defaulted during their intensive phase of treatment. The median default time was 7 (IQR 5–8) weeks. The independent predictors of treatment default were older age (aOR 1.5), rural residence (aOR 2.3), and HIV seropositivity (aOR, 2.8).ConclusionTB treatment default is high and must be reduced. This may be achieved through improved rural DOT, further patient education, and enhanced coordination of TB/HIV care.

► We studied default from tuberculosis treatment in a tertiary hospital over a five-year period.
► About 29% of patients defaulted from tuberculosis treatment.
► 77% of the study patients defaulted during or at the end of the intensive phase of treatment.
► HIV positive status and rural residence were independent predictors of treatment default.
► TB and TB/HIV collaborative services should be further decentralized to rural settings in a patient-centered model.