Factors Associated With the Non-completion of Conventional Anti-Tuberculosis Treatment in Peru

BackgroundThe non-adherence to tuberculosis treatment is associated with increased infection, antibiotic resistance, increased costs and death. Our objective was to identify factors associated with lack of completion of conventional treatment for tuberculosis in Peru.Patients and methodsAn unmatched case–control study in patients diagnosed with tuberculosis from 2004 to 2005 who completed treatment until September 2006. The cases were defined as patients who discontinued treatment for ≥30 consecutive days, while the controls were defined as those who completed treatment without interruption. The factors were identified by logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI).ResultsWe studied 265 cases and 605 controls. The non-adherence to treatment in our study was associated with the male sex (OR = 1.62; CI: 1.07–2.44), having felt discomfort during treatment (OR = 1.76; CI: 1.19–2.62), a prior history of non-compliance (OR = 7.95; CI: 4.76–13.27) and illegal drug use (OR = 3.74; CI: 1.25–11.14). Also, if we consider the interaction of previous non-adherence history and poverty, the risk of non-completion increases (OR = 11.24; CI: 4–31.62). Conversely, having been properly informed about the disease (OR = 0.25; CI: 0.07–0.94) and being able to access health-care services within office hours (8 am–8 pm) (OR = 0.52; CI: 0.31–0.87) were associated with better adherence.ConclusionsThe non-compliance with anti-tuberculosis treatment was associated with non-modifiable factors (male sex, previous non-compliance) and with others whose control would improve compliance (malaise during treatment, illegal drug use and poverty). Likewise, providing access to the health-care system and improving the information given about tuberculosis should be the priorities.

ResumenAntecedentesEl abandono del tratamiento antituberculoso se asocia a mayor contagio, resistencia antibiótica, aumento de costes y muerte. Nuestro objetivo fue identificar factores asociados al abandono del tratamiento antituberculoso convencional en Perú.Pacientes y métodosEstudio de casos y controles no pareado en pacientes diagnosticados de tuberculosis durante 2004–2005 y que finalizaron tratamiento hasta septiembre de 2006. Se definieron como casos los pacientes que abandonaron el tratamiento por ≥ 30 días consecutivos, y como controles los que completaron el tratamiento sin interrupción. Los factores se identificaron mediante regresión logística, calculándose las odds ratios (OR) y los intervalos de confianza al 95% (IC).ResultadosSe estudiaron 265 casos y 605 controles. El abandono del tratamiento en nuestro estudio se asoció al sexo masculino (OR = 1,62; IC: 1,07–2,44), al hecho de sentir malestar durante el tratamiento (OR = 1,76; IC: 1,19–2,62), al antecedente de abandono previo (OR = 7,95; IC: 4,76–13,27) y al consumo de drogas recreativas (OR = 3,74; IC: 1,25–11,14). Así mismo, si tenemos en cuenta la interacción antecedente de abandono previo y pobreza, el riesgo de abandono aumenta (OR = 11,24; IC: 4–31,62). Por el contrario, recibir buena información sobre la enfermedad (OR = 0,25; IC: 0,07–0,94) y poder acceder al sistema sanitario en los horarios ofertados (08.00–20.00 h) (OR = 0,52; IC: 0,31–0,87) se asociaron a un mejor cumplimiento.ConclusionesEl abandono del tratamiento antituberculoso se asoció a factores no modificables (sexo masculino, abandono previo) y a otros cuyo control mejoraría el cumplimiento (malestar durante el tratamiento, consumo de drogas recreativas y pobreza). Así mismo, es prioritario facilitar el acceso al sistema sanitario y mejorar la información recibida sobre tuberculosis.