Patient and disease characteristics, and outcome of treatment defaulters from the Singapore TB control unit - a one-year retrospective survey

SETTING: The Singapore Tuberculosis Control Unit. OBJECTIVES: 1) TO identify any demographic, social, disease or treatment-re lated characteristics which may be predictive of patients defaulting from t reatment; 2) to assess the effectiveness of home visits as a means of defau lter recall; 3) to ascertain outcome in these patients. DESIGN: A retrospective, case-controlled study of TB treatment defaulters, defined as patients who missed their scheduled appointments and required a home visit to recall for treatment. Controls were randomly selected, non-de faulting patients who started treatment on the same dates as the defaulters . RESULTS: Forty-four patients required home visits in 1996. Compared to cont rols, defaulters were more likely to be non-Chinese, and to live on their o wn or with friends. There was no significant association of defaulting with age, sex, marital or employment status, disease characteristics, or treatm ent-related factors. Seventy per cent defaulted during the continuation pha se of treatment. Home visits did not result in contact with the patient (or any other person) 41% of the time. Although 48% of the defaulters remained lost to follow-up at the time of the survey, all but one of the sputum-pos itive patients had bacteriologically converted by the time of default. CONCLUSION: Non-Chinese ethnicity and lack of family support were found to be factors strongly predictive of default. Age, sex, marital and employment status, treatment-related factors and disease characteristics were not sig nificant in distinguishing those at risk for defaulting.