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Cited by 257Tuberculosis Research and EpidemiologyMedication Adherence and ComplianceHIV/AIDS Research and Interventions

Nonadherence in Tuberculosis treatment: Predictors and Consequences in New York City

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Pablos-Méndez, MD, MPH, Ariel, Knirsch, MD, MPH, Charles A, Barr, MD, R.Graham, Lerner, MD, PhD, Barron H, Frieden, MD, MPH, Thomas R·1997·The American Journal of Medicine
DOI 10.1016/s0002-9343(96)00402-0
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Abstract

BACKGROUND: Poor adherence to antituberculosis treatment is the most important obstacle to tuberculosis control. PURPOSE: To identify and analyze predictors and consequences of nonadherence to antituberculosis treatment. PATIENTS AND METHODS: Retrospective study of a citywide cohort of 184 patients with tuberculosis in New York City, newly diagnosed by culture in April 1991-before the strengthening of its control program-and followed up through 1994. Follow-up information was collected through the New York City tuberculosis registry. Nonadherence was defined as treatment default for at least 2 months. RESULTS: Eighty-eight of the 184 (48%) patients were nonadherent. Greater nonadherence was noted among blacks (unadjusted relative risk [RR] 3.0, 95% confidence interval [CI] 1.1 to 8.6, compared with whites), injection drug users (RR 1.5, 95% CI 1.1 to 2.0), homeless (RR 1.4, 95% CI 1.0 to 1.8), alcoholics (RR 1.4, 95% CI 1.0 to 1.9), and HIV-infected patients (RR 1.4, 95% CI 1.1 to 1.9); also, census-derived estimates of household income were lower among nonadherent patients (P = 0.018). In multivariate analysis, only injection drug use and homelessness predicted nonadherence, yet 46 (39%) of 117 patients who were neither homeless nor drug users were nonadherent. Nonadherent patients took longer to convert to negative culture (254 versus 64 days, P < 0.001), were more likely to acquire drug resistance (RR 5.6, 95% CI 0.7 to 44.2), required longer treatment regimens (560 versus 324 days, P < 0.0001), and were less likely to complete treatment (RR 0.5, 95% CI 0.4 to 0.7). There was no association between treatment adherence and all-cause mortality. CONCLUSIONS: In the absence of public health intervention, half the patients defaulted treatment for 2 months or longer. Although common among the homeless and injection drug users, the problem occurred frequently and unpredictably in other patients. Nonadherence may contribute to the spread of tuberculosis and the emergence of drug resistance, and may increase the cost of treatment. These data lend support to directly observed therapy in tuberculosis.

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  • Poor adherence to TB treatment leads to delayed sputum culture conversion, treatment failure, relapse, prolonged infectiousness, development of drug resistance, and increased morbidity and mortality.

    “The consequences of poor adherence include delayed sputum culture conversion, treatment failure, relapse, prolonged infectiousness, development of drug resistance, and increased morbidity and mortality [4,5].”

    From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [5]

    The Consequences of Nonadherence section reports slower culture conversion, more treatment failures, and a higher but statistically nonsignificant rate of acquired drug resistance; it also records one relapse in a nonadherent patient. Prolonged infectiousness and increased morbidity were not directly established, and the section reports no significant difference in all-cause mortality by adherence status. The Discussion likewise notes a lack of correlation between nonadherence and mortality (page numbers unavailable). (LLM, conf=0.89)

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  • Patients who do not adhere to TB treatment may take substantially longer to achieve culture conversion and often require longer treatment courses.

    “Patients who do not adhere to treatment may take substantially longer to achieve culture conversion and often require longer treatment courses [5].”

    From Psychosocial Interventions for Improving Treatment Adherence in Tuberculosis Patients: A Scoping Review of Evidence-Based Approaches. (2026) · cites this paper as [5]

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Research works printed but not linked: 5

  1. Barnes PF, Barrows SA. Tuberculosis in the 1990's. Ann Intern Med. 1993;119:400-410.
  2. Bayer R, Wilkinson D. Directly observed therapy: history of an idea. Lancet. 1995;345:1545-1548.
  3. Sumartojo E. When tuberculosis treatment fails. Am Rev Respir Dis. 1993;147:1311-1320.
  4. Approaches to improving adherence to antituberculosis therapy-South Carolina and New York, 1986-1991. MMWR. 1993;42:74-75.
  5. American Thoracic Society. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med. 1994;149:1359- 1374.

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Authors
Pablos-Méndez, M., Knirsch, M., Barr, M., Lerner, M., & Frieden, M.
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1997-02
Volume
102
Issue
2
Pages
164-170
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/s0002-9343(96)00402-0
OpenAlex
W2006094917
Cited by
256
References
54
Citations by year
2026: 4 · 2025: 6 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 11 · 2020: 7 · 2019: 10 · 2018: 8 · 2017: 9 · 2016: 7 · 2015: 6 · 2014: 12 · 2013: 15 · 2012: 13
FWCI
7.02
Type
journal article
Language
en
Open access
Licence
Locations
  • The American Journal of Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Keywords
treatment default, antitubercular agents, predictors of non-adherence, people who inject drugs, homelessness, HIV infection, drug resistance, tuberculosis control, household income, tuberculosis mortality, treatment completion, public health interventions, social determinants of health, racial disparities in health care access, alcoholism, intravenous drug use
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Black or African American, Child, Child, Preschool, Female, Ill-Housed Persons, Humans, Income, Infant, Male, Middle Aged, New York City, Patient Compliance, Retrospective Studies, Risk Factors, Tuberculosis, Urban Health, Cohort Studies, Substance Abuse, Intravenous, Confidence Intervals, AIDS-Related Opportunistic Infections

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