Default during the intensive phase of treatment under DOTS programme.

ABSTRACT

Objective: To study default and its associated risk factors during the intensive phase of treatment among new sputum smear positive patients registered under a Directly Observed Treatment- Short Course (DOTS) programme in Tiruvallur district, Tamil Nadu. Design: Analysis of data collected from the Tuberculosis Register, treatment cards and interview schedules during May 1999 to December 2002. Results: Of the 1463 patients registered, drug regularity results were available for 1406 patients. The cure rate was 76% with an overall default rate of 15%, of which nearly three-fourth occurred during the intensive phase. The potential risk factors were identified by multivariate analysis. A higher likelihood of default was associated with age > 45 years (AOR=1.9; 95% CI=1.2-3.0), illiteracy (1.6; 1.0-2.4), alcoholism (2.7; 1.8-4.2), DOTS inconvenience (1.9; 1.1-3.4) and cases identified and referred by the community survey (1.8; 1.1-3.0). Of the 75 defaulters from two cohort periods visited separately, 53 defaulted during the intensive phase. Among these, only 31 patients were interviewed since 17 (32%) migrated, three died, one was untraceable at the address provided while another had treatment elsewhere. Drug related (84%) and work related (32%) problems were the other reasons for default reported by the patients interviewed. Conclusion: The majority of defaults occurred during intensive phase of treatment. All efforts should be made to retrieve these patients and return them to treatment to achieve the expected goal of the RNTCP.