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Treatment Default amongst Patients with Tuberculosis in Urban Morocco: Predicting and Explaining Default and Post-Default Sputum Smear and Drug Susceptibility Results

Author

Listed:
  • Imad Cherkaoui
  • Radia Sabouni
  • Iraqi Ghali
  • Darya Kizub
  • Alexander C Billioux
  • Kenza Bennani
  • Jamal Eddine Bourkadi
  • Abderrahmane Benmamoun
  • Ouafae Lahlou
  • Rajae El Aouad
  • Kelly E Dooley

Abstract

Setting: Public tuberculosis (TB) clinics in urban Morocco. Objective: Explore risk factors for TB treatment default and develop a prediction tool. Assess consequences of default, specifically risk for transmission or development of drug resistance. Design: Case-control study comparing patients who defaulted from TB treatment and patients who completed it using quantitative methods and open-ended questions. Results were interpreted in light of health professionals’ perspectives from a parallel study. A predictive model and simple tool to identify patients at high risk of default were developed. Sputum from cases with pulmonary TB was collected for smear and drug susceptibility testing. Results: 91 cases and 186 controls enrolled. Independent risk factors for default included current smoking, retreatment, work interference with adherence, daily directly observed therapy, side effects, quick symptom resolution, and not knowing one’s treatment duration. Age >50 years, never smoking, and having friends who knew one’s diagnosis were protective. A simple scoring tool incorporating these factors was 82.4% sensitive and 87.6% specific for predicting default in this population. Clinicians and patients described additional contributors to default and suggested locally-relevant intervention targets. Among 89 cases with pulmonary TB, 71% had sputum that was smear positive for TB. Drug resistance was rare. Conclusion: The causes of default from TB treatment were explored through synthesis of qualitative and quantitative data from patients and health professionals. A scoring tool with high sensitivity and specificity to predict default was developed. Prospective evaluation of this tool coupled with targeted interventions based on our findings is warranted. Of note, the risk of TB transmission from patients who default treatment to others is likely to be high. The commonly-feared risk of drug resistance, though, may be low; a larger study is required to confirm these findings.

Suggested Citation

  • Imad Cherkaoui & Radia Sabouni & Iraqi Ghali & Darya Kizub & Alexander C Billioux & Kenza Bennani & Jamal Eddine Bourkadi & Abderrahmane Benmamoun & Ouafae Lahlou & Rajae El Aouad & Kelly E Dooley, 2014. "Treatment Default amongst Patients with Tuberculosis in Urban Morocco: Predicting and Explaining Default and Post-Default Sputum Smear and Drug Susceptibility Results," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    • Handle: RePEc:plo:pone00:0093574
    DOI: 10.1371/journal.pone.0093574
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    References listed on IDEAS

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    1. Salla A Munro & Simon A Lewin & Helen J Smith & Mark E Engel & Atle Fretheim & Jimmy Volmink, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," PLOS Medicine, Public Library of Science, vol. 4(7), pages 1-16, July.
    2. Salla A Munro, 2007. "Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research," Working Papers id:1107, eSocialSciences.
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    1. Seup Park & Narae Moon & Byungkwon Oh & Miyeon Park & Kilho Kang & Ilham Sentissi & Sung-Heui Bae, 2021. "Improving Treatment Adherence with Integrated Patient Management for TB Patients in Morocco," IJERPH, MDPI, vol. 18(19), pages 1-12, September.

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