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Correlates of default from anti-tuberculosis treatment: a case study using Kenya's electronic data system
J Sitienei1, H Kipruto2, O Mansour3
1Ministry of Health, Nairobi.
Summary
Human immunodeficiency virus infection and male gender increase tuberculosis treatment default. Family-based directly observed treatment and public sector care also contribute to default, while nutritional support improves adherence.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Tuberculosis (TB) remains a significant public health challenge in Kenya, with 120,000 new cases and 9,500 deaths estimated in 2012.
- A substantial proportion of TB cases (nearly 25%) go undetected, and 4% of notified cases result in treatment default.
Purpose of the Study:
- To identify key determinants influencing anti-tuberculosis treatment default in Kenya.
- To inform strategies for improving TB treatment adherence and program effectiveness.
Main Methods:
- Analysis of a national case-based electronic TB recording system data from 2012-2013.
- Comparative assessment of new pulmonary TB patients who interrupted treatment versus those who completed it.
Main Results:
- Human immunodeficiency virus (HIV) infection was the strongest predictor of default (adjusted odds ratio [aOR] 2.7).
- Family-based directly observed treatment (DOT) was associated with higher default rates (aOR 2.0) compared to DOT by healthcare workers.
- Male patients (aOR 1.6), and those treated in the public sector (aOR 0.86) showed increased default likelihood, while caloric nutritional support was linked to lower default rates (aOR 0.89).
Conclusions:
- Understanding factors like HIV status, DOT modality, and nutritional support is crucial for reducing TB treatment default.
- Identifying default determinants can guide program enhancements and shed light on barriers to accessing care for undetected TB cases.
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