Factores de riesgo para abandono (no adherencia) del tratamiento antituberculoso / Risk factors to non-compliance with TB treatment

RESUMEN

La tuberculosis (TBC), actualmente declarada como una urgencia mundial, enfrenta un obstáculo muy importante para su control el abandono del tratamiento, también llamado no adherencia, incumplimiento o falta de apego del paciente a la medicación. Implica graves consecuencias tanto para el enfermo, como para la comunidad, debido a que el paciente no se cura y continúa la cadena de transmisión de la enfermedad. Adicionalmente, la bacteria puede desarrollar resistencia a los medicamentos disponibles para el tratamiento, aumentando costos del mismo y la morbimortalidad de los pacientes. Las cifras de abandono en el mundo están reportadas entre 0 y 85%; para 1995, la OMS reportó una proporción general de abandono para América del 6% en Colombia se registró un 24% de abandono entre 1982-83 y 10% entre 1988-89. Estas cifras están por encima de las expectativas de la OMS (5%). En este artículo se revisan los factores de riesgo relacionados con el paciente, el tratamiento, el ambiente y los servicios de salud.

ABSTRACT

Risk factors to non-compliance with TB treatment Tuberculosis (TB), at present declared as a world emergency, faces a very important obstacle for their control which is the abandonment of treatment. It´s also called “no compliance”, no adherence, or, simply, the “patient misses his medication”. This has a serious consequences as for the sick person, as wells as for the community, because the patient is not treated and the transmission chain continues; in addition, the bacteria may develops resistance to current medications. This will Increases treatment costs, as well as, patient morbidity and mortality. The abandonment rates in the world are reported, being, among 0 to 85%. For 1995, WHO reported a general proportion of abandonment for the Americas, being of 6%; In Colombia, we have a registered 24% of abandonment between the years of 1982 to 1983 and 10% among 1988 to 1989. These rates are above the WHO´s expectations which are less than 5%. The abandonment associated with high incidence becomes a problem for public health of such as big dimensions. In this article we discuss the epidemiology of non compliance, the risk factors related with the patient, the patient’s treatment, the social environment and the health services.