Risk Factors Associated with Treatment Default Among Tuberculosis Patients in Adamawa State, Nigeria

Abstract

Background. Tuberculosis is an infectious disease caused by bacteria called Mycobacterium tuberculosis. The treatment of drug-resistant tuberculosis is complex, costly, and usually has poor outcomes. Treatment default is well known as a very significant factor associated with drug-resistant tuberculosis. The aim of this study was to investigate the hazard ratios associated with treatment default among tuberculosis patients in Adamawa State, Nigeria. Materials and Methods. The Cox proportional hazards regression was used to determine the hazard ratios associated with tuberculosis patient treatment default in Adamawa State, Nigeria. The Kaplan-Meier method was used to analyze time-to-event data. The study assessed the survival status and treatment outcomes of tuberculosis patients over a six-month period (January 2019 to June 2019). Data analysis was done using R - Programming Software and the statistical significance was considered at p < 0.05. Results. Out of the 197 (124 males and 73 females) tuberculosis patients, 148 (75.1%) individuals were diagnosed with pulmonary tuberculosis and 49 (24.9%) individuals were diagnosed with extrapulmonary tuberculosis. The treatment outcomes were as follows: 33 (16.8%) patients were cured; 36 (18.3%) individuals completed their treatment; 3 (1.5%) patients died during treatment; 105 (53.3%) subjects defaulted; 8 (4.1%) patients were lost to follow-up; the remaining 12 (6.1%) individuals were still on treatment at the end of the study. According to the Cox proportional hazards analysis, HIV-positive status (p < 0.05, 95% CI [0.361 - 0.879]), primary education level (p < 0.01, 95% CI [1.248 - 3.354]), poor quality of life (p < 0.01, 95% CI [1.239 - 3.511]) and age over 60 years old (p < 0.05, 95% CI [0.569 - 2.206]) were significant hazard ratios to experience the event (treatment default) in the study area. Conclusions. This study revealed that HIV-positive tuberculosis patients, older patients, patients with primary education, and those with poor quality of life are significant risk factors to experience treatment default in the study area. Therefore, it is recommended that stakeholders managing the treatment and care of tuberculosis patients should be dedicated and intentional in the provision of psychosocial therapy to patients with poor quality of life.