Impact of patient and program factors on default during treatment of multidrug-resistant tuberculosis

Int J Tuberc Lung Dis. 2012 Jul;16(7):955-60. doi: 10.5588/ijtld.11.0502. Epub 2012 May 7.


Setting: In the Philippines, programmatic treatment of drug-resistant tuberculosis (TB) was initiated by the Tropical Disease Foundation in 1999 and transitioned to the National TB Program in 2006.

Objective: To determine patient and socio-demographic characteristics associated with default, and the impact of patient support measures on default.

Design: Retrospective cohort analysis of 583 MDR-TB patients treated from 1999 to 2006.

Results: A total of 88 (15%) patients defaulted from treatment. The median follow-up time for patients who defaulted was 289 days (range 1-846). In multivariate analysis adjusted for age, sex and previous TB treatment, receiving a greater number of treatment drugs (≥ 5 vs. 2-3 drugs, HR 7.2, 95%CI 3.3-16.0, P < 0.001) was significantly associated with an increased risk of default, while decentralization reduced the risk of default (HR 0.3, 95%CI 0.2-0.7, P < 0.001).

Conclusion: Improving access to treatment for MDR-TB through decentralization of care to centers near the patient's residence reduced the risk of default. Further research is needed to evaluate the feasibility, impact and cost-effectiveness of decentralized care models for MDR-TB treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use*
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Medication Adherence*
  • Middle Aged
  • Motivation
  • Patients
  • Philippines
  • Retrospective Studies
  • Risk Factors
  • Socioeconomic Factors
  • Treatment Refusal
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • Tuberculosis, Pulmonary / drug therapy*
  • Young Adult


  • Antitubercular Agents