Factors associated with referrals for directly observed treatment and unsuccessful treatment

Abstract

<sec id="st1"><title>OBJECTIVE</title>To describe the characteristics of people indicated for directly observed treatment (DOT) in Spain, and the factors associated with unsuccessful treatment.</sec><sec id="st2"><title>METHODS</title>This was a multicentre observational study based on a prospective follow-up of patients over 18 years old diagnosed with TB between 2006 and 2019 from the registry of the Programa Integrado de Investigación en Tuberculosis (PII-TB). Sociodemographic and clinical variables were collected. Adjusted odds ratios (aORs) were calculated for the indication of DOT and for having an unsuccessful treatment.</sec><sec id="st3"><title>RESULTS</title>A total of 7,883 patients were included. The indication of DOT was associated with being homeless (aOR 5.93, 95% CI 3.03–11.59), inactivity status (aOR 2.55, 95% CI 2.02–3.23), alcohol consumption (aOR 1.94, 95% CI 1.51–2.48), parenteral drug use (aOR 1.77, 95% CI 1.06–2.95) and HIV diagnosis (aOR 1.96, 95% CI 1.16–3.29). Unsuccessful treatment was associated with having an HIV diagnosis (aPR 2.31, 95% CI 1.31–4.08), having a worse clinical and radiological evolution (clinical progression: APR 15.59, 95% CI 8.21–29.60; radiological progression: aPR 12.84, 95% CI 6.46–25.52), need for hospitalisation (aPR 1.73, 95% CI 1.10–2.73), unsatisfactory tolerability (aPR 2.82, 95% CI 1.49–5.29), the existence of difficulties in understanding the prescribed treatment (aPR 1.92, 95% CI 1.21–3.06), as well as worse treatment satisfaction (aPR 7.27, 95% CI 4.32–12.24).</sec><sec id="st4"><title>CONCLUSION</title>The prioritisation of vulnerable populations is a key aspect to carry out the new Global Plan to End TB 2023–2030. In these groups DOT indication should be increased to ensure adherence and patient follow-up and outcomes.</sec>