Resumen de Incidencia y factores asociados al abandono del tratamiento antituberculoso

Flor de María Cáceres Manrique, Luis Carlos Orozco Vargas

• español

  Introducción. La tuberculosis es un problema de salud pública. El abandono del tratamiento aumenta la morbimortalidad, continúa el contagio y genera resistencia bacteriana. Es necesario conocer la incidencia y los factores asociados al abandono para desarrollar intervenciones.Objetivo. Determinar la incidencia y los factores asociados al abandono del tratamiento antituberculoso.Materiales y métodos. Estudio de seguimiento a una cohorte de adultos con tuberculosis, residentes en área urbana. Se definió abandono como faltar durante un mes o más al tratamiento. Los pacientes fueron entrevistados al ingreso y seguidos hasta el abandono, la muerte o el egreso del programa. La variable de salida fue tiempo al abandono. Se calcularon las tasas de abandono, las curvas de supervivencia y se elaboró un modelo de regresión deCox para ajustar las variables asociadas.Resultados. Se les hizo seguimiento a 261 personas, 39 (14,9%; IC95% 10,8-19,9)abandonaron (tasa: 0,4 episodios por 1.000 días-paciente, IC95% 0,2-0,8). Fueron factoresprotectores: tener apoyo familiar (HR, hazard ratio=0,36, IC95% 0,15-0,90), efectos secundarios (HR=0,22, IC95% 0,09-0,58) y recibir tratamiento donde se le hizo el diagnóstico (HR=0,28,IC95% 0,12-0,63). Los factores de riesgo fueron los siguientes: inicio de síntomas mayor dedos meses (HR=14,25, IC95% 1,80-112,7), estrato socioeconómico bajo (HR=3,90, IC95% 2,11-9,26), tener entre 21 y 30 años (HR=20,61, IC95% 2,43-175,4), haber estado detenido (HR=2,23, IC95% 1,00-5,36), tener más de dos faltas al tratamiento (HR=6,62, IC95% 2,81-15,586) y tener VIH/sida (HR=2,94, IC95% 1,60-5,39).Conclusiones. El abandono es mayor que en los reportes anteriores y que en otros lugares. Se recomienda hacer diagnóstico temprano, tratamiento oportuno, fomentar el apoyo familiar,realizar intervenciones ante faltas al tratamiento, especialmente en personas con VIH/sida, deestratos bajos y con antecedentes carcelarios.

• English

  Introduction. Tuberculosis is a public health problem. Non-compliance with treatment regimes increases morbidity-mortality, perpetuates transmission and generates bacterial resistance. It is necessary to know incidence and associated factors to non-compliance for performance interventions.Objective. The incidence of and associated factors associated with non-compliance to antituberculous treatment were investigated.Materials and methods. A follow-up study was conducted in an adult cohort with tuberculosis, living in an urban area. Non-compliance was defined as treatment default of 30 days or more. Patients were interviewed at the initiation of treatment and and re-interviewed in subsequent intervals. Outcome was defined as the period of time until treatment abandonment. Noncompliance rates were calculated, as well as survival curves; the Cox regression model was used to adjust for associated variables.Results. Of the 261 patients who were interviewed, 39 (14.9%) had abandoned treatment (rate 0.4 episodes/1,000 days-person, 95%CI 0.2-0.8). Factors associated with compliance were family support (HR=0.4, 95%CI 0.2-0.9), secondary drug effects (HR=0.2, 95%CI 0.1-0.6) and opportunity to receive treatment at the clinic where tuberculosis was diagnosed (HR=0.3, 95%CI 0.1-0.6). Risk factors for non-compliance were as follows: treatment requiring >2 months (HR=14.3, 95%CI 1.8-112.7), low socioeconomic status (HR=3.90, 95%CI 2.1-9.3), age between 21-30 years (HR=20.6, 95%CI 2.4-175.4), history of incarceration (HR=2.2, 95%CI 1.0-5.4), skipping treatments more that twice (HR=6.6, 95%CI 2.8-15.6) and co-infection with HIV/AIDS (HR=2.9, 95%CI 1.6-5.4).Conclusion. Non-compliance rate is higher than previously reported. The data recommend the following strategies for improving compliance with antituberculosis treatment: (1) early diagnosis, (2) opportune treatment, (3) improved family support and (4) immediate intervention if a treatment is missed -especially in patients with HIV/AIDS, from low socioeconomic strata, or with record of incarceration.