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Nonadherence in Tuberculosis Treatment: Predictors and Consequences in New York City
Open accessAbstract
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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“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]
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“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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Mathew, T. A., Shields, A. L., Imasheva, A., Shin, S. S., Mishustin, S. P., Gg, P., Strelis, A. K., Yanova, G. V., Greenfield, S. F., & Furin, J. J. (2009) · Culture Medicine and Psychiatry · doi:10.1007/s11013-009-9148-0 · Cited by 7
Yen, Y., Hu, B.-S., Lin, Y.-S., Li, L.-H., Su, L., Chuang, P., Lin, N.-C., Jiang, X., Shie, Y.-H., Chang, H.-H., et al. (2013) · Scandinavian Journal of Infectious Diseases · doi:10.3109/00365548.2013.768354 · Cited by 7
“However, IDUs have poor adherence to screening and treatment for LTBI [23,25].”
BackgroundMagidson, J. F., Listhaus, A., Seitz‐Brown, C. J., Safren, S. A., Lejuez, C. W., & Daughters, S. B. (2014) · Journal of Behavioral Medicine · doi:10.1007/s10865-014-9606-1 · Cited by 7
“Adherence to multiple other forms of medication is likely challenging, and in particular, lowincome, African American HIV-positive individuals have been shown to be least likely to be adherent to other forms of medication (i.e., to TB medication; Pablos-Méndez et al., 1997).”
BackgroundUsing Naïve Bayes and Bayesian Networkfor Prediction of Potential Problematic Cases in Tuberculosis
Ali, A., Elfaki, M., & Norhayati, D. (2012) · International Journal of Informatics and Communication Technology (IJ-ICT) · doi:10.11591/ij-ict.v1i2.1424 · Cited by 7
“Furthermore, there were more research studies that tends to address TB problems but all these articles regard medical studies for example the articles [13] and [14].”
BackgroundKuchukhidze, G., Baliashvili, D., Adamashvili, N., Kasradze, A., Kempker, R. R., & Magee, M. J. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab127 · Cited by 7
“In addition, patients who are LFU have increased risk of acquiring additional resistance to TB drugs [5, 6].”
BackgroundPaediatric tuberculosis in a Pacific Islands community in New Zealand
VOSS, L. M., Campbell, M., Tildesley, C., Hay, D., Vaughan, A., & Thornley, C. (2006) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.2006.00809.x · Cited by 7
Tuberculosis and Substance Abuse
Rastegar, D. A. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.183 · Cited by 7
Santosa, A., Juniarti, N., Pahria, T., & Susanti, R. D. (2025) · Multidisciplinary Respiratory Medicine · doi:10.5826/mrm.2025.1016 · Cited by 6
“…understanding of TB treat-ment protocols [23,24,28,35,42,56,58,63,80,86,90, 94–96, 106,107, Economic factors, such as low-income levels [23,31,33,39,41,53,85,86,88,97,102], financial hard-ship [38,52,56,60,84,100,101,106,112], lack of health insurance [39,56,97,99], or travel-related costs…”
InfluentialCharokopos, N., Τσίρος, Γ., Foka, A., Voila, P., Chrysanthopoulos, K., Spiliopoulou, I. T., & Jelastopulu, E. (2013) · Rural and Remote Health · doi:10.22605/rrh2114 · Cited by 6
Khan, F. A., Fox, G. J., & Menzies, D. (2017) · Springer eBooks · doi:10.1007/978-1-4939-0694-9_13 · Cited by 6
Otu, A. A., Umoh, V. A., Habib, A., & Ansa, V. O. (2013) · The Clinical Respiratory Journal · doi:10.1111/crj.12065 · Cited by 6
“This could thus result in treatment failure and foster emergence of DR-TB and may increase the cost of treatment (17, 18).”
BackgroundNonadherence Predictors to Tuberculosis Medications among TB Patients in Gambella Region of Ethiopia
Kebede, T., Jing, W. G., Girma, A., & Woldemichael, K. (2022) · Canadian Journal of Infectious Diseases and Medical Microbiology · doi:10.1155/2022/9449070 · Cited by 5
“)e previous study in Kenya [58] did not report this relationship, where TB disease was positively associated with poverty and low-income status of the TB patient’s household.”
ResultTuberculosis en pacientes ancianos: Formas de presentación
Lado, F. L. L., Bastida, V. T., Gómez, A. L. G., de Barrón, A. C. O., & del Molino, M. L. P. (2002) · Anales de Medicina Interna · doi:10.4321/s0212-71992002000300002 · Cited by 5
Tabarsi, P., Baghaei, P., Hemmati, N., Mirsaeidi, M. S., Dizaji, M. K., Mansouri, D., & Masjedi, M. R. (2009) · PubMed · Cited by 5
Siemion-Szcześniak, I., & Kuś, J. (2012) · Advances in respiratory medicine · doi:10.5603/arm.27555 · Cited by 4
“velopment of drug resistance, and increases treatment costs [5, 6].”
BackgroundMunawaroh, I., Kurniawati, N. D., Purwaningsih, P., Romantika, D. D., & Karingga, D. D. (2022) · Prisma Sains Jurnal Pengkajian Ilmu dan Pembelajaran Matematika dan IPA IKIP Mataram · doi:10.33394/j-ps.v10i3.5321 · Cited by 3
“Where poor adherence to TB treatment can have detrimental effects, such as the potential for further TB transmission, recurrence, acquired drug resistance, treatment failure, and death (Kliiman & Altraja, 2010; Pablos-Méndez et al., 1997).”
BackgroundȚigău, M., & Zaharie, A.-M. (2021) · Pneumologia · doi:10.2478/pneum-2023-0004 · Cited by 3
Oh, A. L., Makmor‐Bakry, M., Islahudin, F. H., Ting, C. Y., Chan, S. K., & Tie, S. T. (2024) · Tropical Medicine & International Health · doi:10.1111/tmi.13987 · Cited by 3
Sahile, Z., Perimal‐Lewis, L., Arbon, P., & Maeder, A. J. (2021) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 3
Terpenning, M. S. (1998) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1998.tb02548.x · Cited by 3
George, L. J. (2008) · Social Work in Health Care · doi:10.1300/j010v46n04_05 · Cited by 3
Wainberg, M. L., & Cournos, F. (2000) · New Directions for Mental Health Services · doi:10.1002/yd.23320008712 · Cited by 3
Luzzati, R., Confalonieri, M., Cazzadori, A., Loggia, P. D., Cifaldi, R., Fabris, C., Biolo, M., Borelli, M., Longo, C., & Concia, E. (2015) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2011.229 · Cited by 3
Rosado-Quiab, U. (2014) · Mycobacterial Diseases · doi:10.4172/2161-1068.1000166 · Cited by 3
“Adherence to treatment for tuberculosis worldwide is between 18% to 80% [11,23-26] rates in Mexico adhesion provided by research studies ranging from 94% in Veracruz and 72.”
Background
Metadata
- 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)
- 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
- hybrid
- doi.org
- 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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