Alcohol, hospital discharge, and socioeconomic risk factors for default from multidrug resistant tuberculosis treatment in rural South Africa : a retrospective cohort study

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dc.contributor.authorKendall, Emily A.en_ZA
dc.contributor.authorTheron, Danieen_ZA
dc.contributor.authorFranke, Molly F.en_ZA
dc.contributor.authorVan Helden, Paulen_ZA
dc.contributor.authorVictor, Thomas C.en_ZA
dc.contributor.authorMurray, Megan B.en_ZA
dc.contributor.authorWarren, Robin M.en_ZA
dc.contributor.authorJacobson, Karen R.en_ZA
dc.date.accessioned2014-07-07T12:18:30Z
dc.date.available2014-07-07T12:18:30Z
dc.date.issued2013-12-13
dc.descriptionCITATION: Kendall, E. A. et al. 2013. Alcohol, hospital discharge, and socioeconomic risk factors for default from multidrug resistant tuberculosis treatment in rural South Africa : a retrospective cohort study. PLoS ONE, 8(12): e83480, doi:10.1371/journal.pone.0083480.
dc.descriptionThe original publication is available at http://journals.plos.org/plosone
dc.description.abstractBackground: Default from multidrug-resistant tuberculosis (MDR-TB) treatment remains a major barrier to cure and epidemic control. We sought to identify patient risk factors for default from MDR-TB treatment and high-risk time periods for default in relation to hospitalization and transition to outpatient care. Methods: We retrospectively analyzed a cohort of 225 patients who initiated MDR-TB treatment between 2007 through 2010 at a rural TB hospital in the Western Cape Province, South Africa. Results: Fifty percent of patients were cured or completed treatment, 27% defaulted, 14% died, 4% failed treatment, and 5% transferred out. Recent alcohol use was common (63% of patients). In multivariable proportional hazards regression, older age (hazard ratio [HR]= 0.97 [95% confidence interval 0.94-0.99] per year of greater age), formal housing (HR=0.38 [0.19-0.78]), and steady employment (HR=0.41 [0.19-0.90]) were associated with decreased risk of default, while recent alcohol use (HR=2.1 [1.1-4.0]), recent drug use (HR=2.0 [1.0-3.6]), and Coloured (mixed ancestry) ethnicity (HR=2.3 [1.1-5.0]) were associated with increased risk of default (P<0.05). Defaults occurred throughout the first 18 months of the two-year treatment course but were especially frequent among alcohol users after discharge from the initial four-to-five-month in-hospital phase of treatment, with the highest default rates occurring among alcohol users within two months of discharge. Default rates during the first two months after discharge were also elevated for patients who received care from mobile clinics. Conclusions: Among patients who were not cured or did not complete MDR-TB treatment, the majority defaulted from treatment. Younger, economically-unstable patients and alcohol and drug users were particularly at risk. For alcohol users as well as mobile-clinic patients, the early outpatient treatment phase is a high-risk period for default that could be targeted in efforts to increase treatment completion rates.
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083480
dc.description.versionPublisher's version
dc.format.extent8 pages
dc.identifier.citationKendall, E. A. et al. 2013. Alcohol, hospital discharge, and socioeconomic risk factors for default from multidrug resistant tuberculosis treatment in rural South Africa : a retrospective cohort study. PLoS ONE, 8(12): e83480, doi:10.1371/journal.pone.0083480.
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0083480
dc.identifier.urihttp://hdl.handle.net/10019.1/93367
dc.language.isoen
dc.publisherPLoS
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectMultidrug-resistant tuberculosis -- Risk factorsen_ZA
dc.subjectAlcohol abuseen_ZA
dc.subjectDrug abuseen_ZA
dc.subjectTuberculosis patients -- Treatment -- Defaultingen_ZA
dc.titleAlcohol, hospital discharge, and socioeconomic risk factors for default from multidrug resistant tuberculosis treatment in rural South Africa : a retrospective cohort studyen_ZA
dc.typeArticle
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