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A community based case control study on risk factors for treatment interruptions in people with tuberculosis in Kollam district, Kerala, southern India

Shameer K. M., Manjunath K., Sam D. Marconi, Krishnaveni V., Rakesh P. S., Jasmin H. Prasad.

Abstract
Background: Treatment adherence to anti-TB treatment is a critical determinant of treatment outcomes, prognosis and further emergence of drug resistance. The objective of the study was to identify the risk factors for treatment interruptions among the newly diagnosed patients with tuberculosis registered for treatment under Revised National Tuberculosis Control Program in Kollam District, Kerala, southern India.
Methods: A community based case control study was undertaken with cases being patients registered for TB treatment under category I in two randomly selected TB Units of Kollam districts with ‘treatment interruption’ as defined by missing at least three consecutive doses of anti TB medicines. Controls were those who successfully completed the anti-tuberculosis treatment regimen. Interview was conducted with a structured questionnaire. Univariate and multivariate analysis was done and odds ratios with 95% confidence interval for the risk factors for treatment interruption were calculated.
Results: A total of 47 cases and 94 controls were interviewed. In the final logistic regression model, hazardous alcohol use (Adjusted OR 16.67, 95% CI 3.22-61.42) and adverse drug reactions (Adjusted OR 2.46, 95% CI 1.07-6.14) were found as statistically significant risk factors for treatment interruption.
Conclusions: Hazardous use of alcohol and adverse effects to drugs are identified as the potential risk factors for treatment interruptions among the people with TB initiated on Category 1 DOTS regimen in Kollam district, Kerala, India. Alcohol use disorder and hazardous drinking among TB patients is a matter of concern that needs to be translated to an effective intervention program.

Key words: Alcohol, DOTS, Treatment adherence, Treatment interruption, Tuberculosis



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