Alcohol, hospital discharge, and socioeconomic risk factors for default from multidrug resistant tuberculosis treatment in rural South Africa : a retrospective cohort study
Date
2013-12-13
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS
Abstract
Background: Default from multidrug-resistant tuberculosis (MDR-TB) treatment remains a major barrier to cure and
epidemic control. We sought to identify patient risk factors for default from MDR-TB treatment and high-risk time
periods for default in relation to hospitalization and transition to outpatient care.
Methods: We retrospectively analyzed a cohort of 225 patients who initiated MDR-TB treatment between 2007
through 2010 at a rural TB hospital in the Western Cape Province, South Africa.
Results: Fifty percent of patients were cured or completed treatment, 27% defaulted, 14% died, 4% failed treatment,
and 5% transferred out. Recent alcohol use was common (63% of patients). In multivariable proportional hazards
regression, older age (hazard ratio [HR]= 0.97 [95% confidence interval 0.94-0.99] per year of greater age), formal
housing (HR=0.38 [0.19-0.78]), and steady employment (HR=0.41 [0.19-0.90]) were associated with decreased risk
of default, while recent alcohol use (HR=2.1 [1.1-4.0]), recent drug use (HR=2.0 [1.0-3.6]), and Coloured (mixed
ancestry) ethnicity (HR=2.3 [1.1-5.0]) were associated with increased risk of default (P<0.05). Defaults occurred
throughout the first 18 months of the two-year treatment course but were especially frequent among alcohol users
after discharge from the initial four-to-five-month in-hospital phase of treatment, with the highest default rates
occurring among alcohol users within two months of discharge. Default rates during the first two months after
discharge were also elevated for patients who received care from mobile clinics.
Conclusions: Among patients who were not cured or did not complete MDR-TB treatment, the majority defaulted
from treatment. Younger, economically-unstable patients and alcohol and drug users were particularly at risk. For
alcohol users as well as mobile-clinic patients, the early outpatient treatment phase is a high-risk period for default
that could be targeted in efforts to increase treatment completion rates.
Description
CITATION: Kendall, E. A. et al. 2013. Alcohol, hospital discharge, and socioeconomic risk
factors for default from multidrug resistant tuberculosis
treatment in rural South Africa : a retrospective cohort
study. PLoS ONE, 8(12): e83480, doi:10.1371/journal.pone.0083480.
The original publication is available at http://journals.plos.org/plosone
The original publication is available at http://journals.plos.org/plosone
Keywords
Multidrug-resistant tuberculosis -- Risk factors, Alcohol abuse, Drug abuse, Tuberculosis patients -- Treatment -- Defaulting
Citation
Kendall, E. A. et al. 2013. Alcohol, hospital discharge, and socioeconomic risk
factors for default from multidrug resistant tuberculosis
treatment in rural South Africa : a retrospective cohort
study. PLoS ONE, 8(12): e83480, doi:10.1371/journal.pone.0083480.