Work

Factors Associated with Loss to Follow-up during Treatment for Multidrug-Resistant Tuberculosis, the Philippines, 2012–2014

Year: 2016

Type: article

Abstract: To identify factors associated with loss to follow-up during treatment for multidrug-resistant (MDR) tuberculosis (TB) in the Philippines, we conducted a case-control study of adult patients who began receiving treatment for rifampin-resistant TB during July 1-December 31, 2012.Among 91 case-patients (those lost to follow-up) and 182 control-patients (those who adhered to treatment), independent factors associated with loss to follow-up included patients' higher self-rating of the severity of vomiting as an adverse drug reaction and alcohol abuse.Protective factors included receiving any type of assistance from the TB program, better TB knowledge, and higher levels of trust in and support from physicians and nurses.These results provide insights for designing interventions aimed at reducing patient loss to follow-up during treatment for MDR TB.T he Philippines is 1 of 22 countries considered to have a high burden of tuberculosis (TB) (1), including multidrug-resistant (MDR) TB (resistant to isoniazid and rifampin) (1).Compared with treatment for drug-susceptible TB, treatment for MDR TB is longer, more expensive, and less effective, and it causes more medication side effects (2-5).Resistance to anti-TB drugs has been detected in all regions of the Philippines; an estimated 8,500 MDR TB cases occurred in 2013 (6).Programmatic Management of Drug-resistant Tuberculosis (PMDT) was jointly initiated in the Philippines in October 2000 by the private Makati Medical Center in Metro Manila and the Tropical Disease Foundation, Inc., in collaboration with the National TB Control Program and the local government unit, as the first directly observed therapy (DOTS)-plus pilot project for the management of MDR TB approved by the Green Light Committee (7).In 2003, a grant proposal from the Philippines for Round 2 of the Global Fund to Fight AIDS, Tuberculosis and Malaria included treatment for 500 patients with MDR TB (National Tuberculosis Control Program, the Philippines, 2013 Aug 25-Sep 6. Report of the Joint Program Review; 2013 Sep 30, unpub.data).This funding was approved and subsequently expanded to 2,500 MDR TB patients approved to receive treatment according to a Round 5 proposal.In 2010, a new coordination team for PMDT was established by the National TB Control Program/Department of Health; the Lung Center of the Philippines was the implementing arm for PMDT.As of September 2014, a total of 44 PMDT health facilities were located in 16 of 17 regions.The annual number of patients with drug-resistant TB who began receiving treatment under PMDT increased from 191 in the 2005 cohort to 2,056 in the 2012 cohort.Despite substantial progress made by PMDT in the Philippines, the proportion of patients for whom treatment was successful decreased from 73% in the 2005 cohort to 46% in the 2010 cohort, while the proportion of loss to follow-up increased from 13% to 38%, respectively (8).Even with recent efforts to improve retention of patients receiving treatment for TB (e.g., providing transportation allowance, financial incentives at treatment milestones, food baskets, and halfway houses for patients from remote areas), the proportion of patients lost to follow-up remains substantial.

Source: Emerging infectious diseases

DOI: 10.3201/eid2203.151788