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Open Access Research article

Factors associated with excessively lengthy treatment of tuberculosis in the eastern Paris region of France in 2004

Nadia Valin1*, Gilles Hejblum235, Isabelle Borget3, Henri-Pierre Mallet4, Fadi Antoun5, Didier Che6 and Christos Chouaid357

Author Affiliations

1 AP-HP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, F-75012 France

2 AP-HP, Hôpital Saint Antoine, Unité de Santé Publique, Paris, F-75012 France

3 INSERM, U707, Paris, F-75012 France

4 Direction de l'Action Sociale de l'Enfance et de la Santé, Cellule Tuberculose, Paris, F-75020 France

5 UPMC Univ Paris 06, UMR S 707, Paris, F-75012 France

6 Institut de Veille Sanitaire, Saint-Maurice, F-94415 France

7 AP-HP, Hôpital Saint-Antoine, Service de Pneumologie, Paris, F-75012 France

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BMC Public Health 2010, 10:495  doi:10.1186/1471-2458-10-495

Published: 18 August 2010

Abstract

Background

Few data are available on prescriber adherence to tuberculosis (TB) treatment guidelines. In particular, excessively long treatment carries a risk of avoidable adverse effects and represents a waste of healthcare resources. We examined factors potentially associated with excessively long treatment.

Methods

We reviewed the medical records of patients diagnosed with TB in 2004 in the eastern Paris region. Sociodemographic and clinical factors associated with excessively long treatment were identified by logistic regression analyses. Based on contemporary guidelines, excessively long treatment was defined as more than 6 months of a four-drug regimen for thoracic TB with full sensitive strains, and more than 12 months for patients with extrathoracic TB.

Results

Analyses concerned 478 patients with a median age of 36.0 ± 13.5 years, of whom 48% were living in precarious conditions (i.e. poor living conditions and/or no health insurance), 80% were born abroad, and 17% were HIV-seropositive. TB was restricted to the chest in 279 patients (isolated pulmonary, pleuropulmonary, and isolated pleural TB in 245, 13, and 21 patients, respectively), exclusively extrathoracic in 115 patients, and mixed in the remaining 84 patients. Treatment was prescribed by a chest specialist in 211 cases (44.1%) and 295 patients (61.7%) were managed in a single institution. The treatment duration complied with contemporary guidelines in 316 cases (66.1%) and was excessively long in 162 cases (33.9%). The median duration of excessively long treatment was 313 days (IQR: 272-412). In multivariate analysis, isolated thoracic TB, previous TB, HIV infection, a prescriber other than a chest specialist, and management in more than one healthcare center during treatment were independently associated with excessively lengthy treatment.

Conclusion

One-third of TB patients received excessively long treatment, reflecting inadequate awareness of management guidelines or unwillingness to implement them.