Noncompliance with directly observed therapy for tuberculosis : Epidemiology and effect on the outcome of treatment.
To describe the epidemiology and clinical consequences of noncompliance with directly observed therapy (DOT) for treatment of tuberculosis.
An urban tuberculosis control program that emphasizes DOT.
All patients treated with outpatient DOT from 1984 to 1994.
Measurements and results
We defined noncompliance as follows :
(1) missing =2 consecutive weeks of DOT ;
(2) prolongation of treatment>30 days due to sporadic missed doses ;
or (3) incarceration for presenting a threat to public health.
Poor outcomes of therapy were defined as a microbiologic or clinical failure of initial therapy, relapse, or death due to tuberculosis.
Fifty-two of 294 patients (18%) who received outpatient DOT fulfilled one or more criteria for noncompliance.
Using multivariate logistic regression, risk factors for noncompliance were alcohol abuse (odds ratio, 3.0 ; 95% confidence interval, 1.2 to 7.5 ; p=0.02) and homelessness (odds ratio, 3.2 ; 95% confidence interval, 1.5 to 7.2 ; p=0.004).
Noncompliant patients had poor outcomes from the initial course of therapy more often than compliant patients :
17 of 52 (32.7%) vs 8 of 242 (3.3%) ;
relative risk was 9.9 ;
95% confidence interval was 4.5 to 21.7 (p<0.001).
In an urban tuberculosis control program, noncompliance with DOT was common and was closely associated with alcoholism and homelessness. (...)
Mots-clés Pascal : Tuberculose, Mycobactériose, Bactériose, Infection, Poumon, Antituberculeux, Chimiothérapie, Observance thérapeutique, Alcoolisme, Sans domicile fixe, Etats Unis, Amérique du Nord, Amérique, Traitement, Epidémiologie, Homme, Appareil respiratoire pathologie, Poumon pathologie
Mots-clés Pascal anglais : Tuberculosis, Mycobacterial infection, Bacteriosis, Infection, Lung, Antituberculous agent, Chemotherapy, Treatment compliance, Alcoholism, Homeless, United States, North America, America, Treatment, Epidemiology, Human, Respiratory disease, Lung disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0316115
Code Inist : 002B02S02. Création : 12/09/1997.