Risk factors and timing of default from treatment for non-multidrug-resistant tuberculosis in Moldova

• Published in: The international journal of tuberculosis and lung disease Vol. 17; no. 3; pp. 373 - 380
• Main Authors: Jenkins, H. E., Ciobanu, A., Plesca, V., Crudu, V., Galusca, I., Soltan, V., Cohen, T.
• Format: Journal Article
• Language: English
• Published: Paris, France International Union Against Tuberculosis and Lung Disease 01-03-2013; International Union against Tuberculosis and Lung Disease
• Subjects: Adult; Antitubercular Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Continuity of Patient Care; Data processing; Drug Resistance; Eastern Europe; Female; Hospitalization; Human bacterial diseases; Human immunodeficiency virus; Humans; Infectious diseases; Institutionalization; Least-Squares Analysis; Linear Models; Male; Medical sciences; Medication Adherence; Moldova - epidemiology; Multivariate Analysis; Patient Discharge; Pneumology; Prisoners; Prisons; Proportional Hazards Models; Retrospective Studies; Risk Factors; Socioeconomic Factors; Time Factors; Treatment Outcome; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - microbiology; Tuberculosis and atypical mycobacterial infections; Eastern Europe; Europe; Moldova; Treatment resistance; Carceral environment; Respiratory disease; Eastern Europe; Hospitalization; Mycobacterial infection; Infection; Treatment; Tuberculosis; Mycobacterium tuberculosis; Mycobacteriales; Multiple resistance; Risk factor; prisons; Bacteriosis; Mycobacteriaceae; Temporal study; Bacteria; Actinomycetes; Timing; drug resistance
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.12.0464

SETTING: The Republic of Moldova, in Eastern Europe, has among the highest reported nationwide proportions of tuberculosis (TB) patients with multidrug-resistant tuberculosis (MDR-TB) worldwide. Default has been associated with increased mortality and amplification of drug resistance,
and may contribute to the high MDR-TB rates in Moldova.OBJECTIVE: To assess risk factors and timing of default from treatment for non-MDR-TB from 2007 to 2010.DESIGN: A retrospective analysis of routine surveillance data on all non-MDR-TB patients reported.RESULTS: A total of 14.7%
of non-MDR-TB patients defaulted from treatment during the study period. Independent risk factors for default included sociodemographic factors, such as homelessness, living alone, less formal education and spending substantial time outside Moldova in the year prior to diagnosis; and health-related
factors such as human immunodeficiency virus co-infection, greater lung pathology and increasing TB drug resistance. Anti-tuberculosis treatment is usually initiated within an institutional setting in Moldova, and the default risk was highest in the month following the phase of hospitalized
treatment (among civilians) and after leaving prison (among those diagnosed while incarcerated).CONCLUSIONS: Targeted interventions to increase treatment adherence for patients at highest risk of default, and improving the continuity of care for patients transitioning from institutional
to community care may substantially reduce risk of default.