Results obtained by using a self-administered treatment for tuberculosis

ABSTRACT

Tuberculosis (TB) has a higher incidence in populations with socio-economic deficits and requires prolonged antibiotic therapy to heal, which hinders adherence to the treatment, with an abandonment rate ranging between 15 and 30% in those with self-administered treatment. Objectives: to assess the rate of abandonment and to identify predisposing factors in patients monitored at the hospital with self-administered treatment, implemented with weekly controls during the attack phase, and then monthly controls (consolidation phase) until completing the planned schedule. Materials and methods: all the patients who started treatment between January 1st and December 31st, 2015 were included. A descriptive analysis of the results obtained up to December 31st, 2016 was performed. An interruption ≥ 14 days during the attack phase and ≥ 2 months during the consolidation phase was defined as abandonment by comparing the characteristics of this group with the compliant group using the chi-square test. Results: 73 patients (38 males) aged 34±15 years were included, 32 were Argentine (44%), and the rest was comprised of 33 Bolivians, 5 Paraguayans, 2 Peruvians and 1 Chilean. In 47 cases (64%), TB was pulmonary. The extrapulmonary damage included 11 pleural, 5 nodal, 3 bone (one with a concomitant impact on the psoas and another one on the lung), 2 laryngeal and pulmonary, 2 peritoneal, 2 meningeal and 1 intestinal. In all the cases (except for one that started treatment empirically), the disease was confirmed by direct AFB smear or culture, or by finding granulomas in biopsies performed in a compatible clinical context. Fifty-two patients completed the treatment (71.2%), 1 patient passed away and 20 abandoned it (27.4%); of the latter, 4 restarted and completed the treatment. The most frequent comorbidities were alcoholism (n = 7), diabetes (n = 6), and HIV positives (n = 6). Compared to the group that completed the treatment, alcoholism was a significant predictive factor for abandonment (2 in 52 vs. 5 in 20; p < .01). There were no significant differences regarding HIV positives (4 in 52 vs. 2 in 20) or gender (9 out of 38 males abandoned treatment vs. 11 out of 34 females). Likewise, there were no differences regarding age, nationality or education level. Conclusion: with the self-administered treatment system, we obtained an abandonment rate no higher than the expected one at our hospital. Alcoholism was associated with a higher risk of abandonment. Identifying other predisposing factors will help to improve adherence to the treatment by defining specific follow-up strategies.