Factores convencionales y no convencionales asociados con fracaso al tratamiento antituberculoso: Medellín, 2003-2004 / Conventional and non-conventional factors associated to failure of anti-tuberculosis treatment: Medellín, 2003-2004

Objetivo: Determinar los factores asociados con fracaso al tratamiento de la tuberculosis en Medellín-Colombia, durante enero 2003 a diciembre 2004, para generar información útil que reoriente los programas de control. Metodología: Estudio de casos-controles, los casos fueron pacientes nuevos que iniciaron tratamiento antituberculoso en el Programa de Control de Tuberculosis de Medellín y que egresaron como fracaso con baciloscopia positiva al sexto mes de tratamiento. Los controles fueron pacientes nuevos que iniciaron tratamiento en el Programa y culminaron con esputo negativo al sexto mes. La muestra se conformó por todos los pacientes reportados como “Fracaso” y un número mayor de pacientes reportados como “Curados”, con una razón de 1:5. Resultados: Pertenecer al género masculino (OR=5,23 IC:1,24–25,35; p=0.009); pertenecer al grupo de familia no nucleada (OR=8,19 IC:8-39,83; p=0.03); recibir atención en una institución de salud privada (OR=6,67, IC:1,84–25,08; p=0.0005) se comportaron como un factor de riesgo para el fracaso en el tratamiento antituberculoso. Recibir atención en una institución pública es un factor de protección para el fracaso al tratamiento (OR=0,13 IC: 0,05–0,34; p=0.0005). Conclusiones: El fracaso de la Terapia debe ser intervenido para evitar la resistencia a medicamentos y la transmisión de enfermedad en la comunidad, dando prioridad a grupos de: hombres, sin familia constituida y del régimen privado de salud...

Objective: To determine the factors associated to the failure in the treatment of tuberculosis in Medellín, Colombia from January 2003 to December 2004, in order to gather useful information to redefine the control programs. Methodology: An analytical study of Cases and Controls was carried out. The chosen Cases were all patients that started anti-tuberculosis treatment in the Tuberculosis Control Program of Medellín and left the programas failing cases before the sixth months of treatment. The Control group was made up of patients who started the treatment in the program and were released as cured. The sample population was made up of all patients reported as “failure cases” and a five times bigger number of patients reported as “cured”. Results: It was found that being a male (OR= 5, 23.CI: 1,24-25,35; p= 0.009) and not belonging to a nuclear family group (OR= 8,19. CI: 8-39,83; p=0.003) were factors associated to TB treatment failure. In regards to non-conventional risk factors, it was found that being affiliated to Private health service institutions(OR=6,67. CI: 1,84-25,08; p=0.0005), becomes a risk factor with a strong association to TB treatment failure. On the other hand, receiving attention in Public institutions decreases the risk of TB treatment failure (OR=0,13. CI: 0,05-0,34; p= 0.0005). Conclusions: The failure of the therapy must be intervened to avoid resistance to medication and transmission of the disease in the community, giving priority to the group conformed by males, affiliated to the private health service system and whose don’t belong to a nuclear family.