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Failure to complete treatment for latent tuberculosis infection in Portugal, 2013–2017: geographic-, sociodemographic-, and medical-associated factors

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Abstract

There is conflicting evidence about factors associated with failure to complete treatment (FCT) for latent tuberculosis infection (LTBI). We aim to identify the geographic, sociodemographic, and medical factors associated with FCT in Portugal, highlighting the two main metropolitan areas of Porto and Lisbon. We performed a retrospective cohort study including LTBI patients that started treatment in Portugal between 2013 and 2017. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using multivariable logistic regression to identify geographic, sociodemographic, and medical factors associated with FCT. Data on completion of treatment were available for 15,478 of 17,144 patients (90.3%). Of those, 2132 (13.8%) failed to complete treatment. Factors associated with FCT were being older than 15 years (aOR, 1.65 (95% CI = 1.34–2.05) for those aged 16 to 29), being born abroad (aOR, 2.04 (95% CI = 1.19–3.50) for Asia; aOR, 1.57 (95% CI = 1.24–1.98) for Africa), having a chronic disease (aOR, 1.29 (95% CI = 1.04–1.60)), alcohol abuse (aOR, 2.24 (95% CI = 1.73–2.90)), and being intravenous drug user (aOR, 1.68 (95% CI = 1.05–2.68)). Three-month course treatment with isoniazid plus rifampicin was associated with decreased FCT when compared with 6- or 9-month courses of isoniazid-only (aOR, 0.59 (95% CI = 0.45–0.77)). In Lisbon metropolitan area, being born in Africa, and in Porto metropolitan area, alcohol abusing and being intravenous drug user were distinctive factors associated with FCT. Sociodemographic and medical factors associated with FCT may vary by geographical area and should be taken into account when planning interventions to improve LTBI treatment outcomes. This study reinforces that shorter course treatment for LTBI might reduce FCT.

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Acknowledgements

The authors would like to thank all the healthcare workers that contribute to screening, treatment, and notification of TB and LTBI cases in Portugal. In addition, many thanks are given to Daniel Thomas and Graça Lima, for all their support and supervision to Alexis Sentís during his European Programme for Intervention Epidemiology Training (EPIET) fellowship.

Funding

Mònica Guxens is funded by a Miguel Servet II fellowship (CPII18/00018) awarded by the Spanish Institute of Health Carlos III. The rest of the authors have declared no funding.

Author information

Authors and Affiliations

  1. Directorate-General of Health, Lisbon, Portugal

    Alexis Sentís, Paula Vasconcelos, Rita Sá Machado, Vasco Peixoto, Raquel Duarte, Isabel Carvalho & Carlos Carvalho

  2. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden

    Alexis Sentís, Paula Vasconcelos, Rita Sá Machado & Vasco Peixoto

  3. ISGlobal, Barcelona, Spain

    Alexis Sentís & Mònica Guxens

  4. Pompeu Fabra University (UPF), Barcelona, Spain

    Alexis Sentís & Mònica Guxens

  5. Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

    Alexis Sentís & Mònica Guxens

  6. Foundation of Tuberculosis Research Unit of Barcelona, Barcelona, Spain

    Joan A. Caylà

  7. Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam, The Netherlands

    Mònica Guxens

  8. Public Health Science and Medical Education Department, Faculty of Medicine, University of Porto, Porto, Portugal

    Raquel Duarte

  9. EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal

    Raquel Duarte

  10. Pulmonology Department, Hospital Centre of Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal

    Raquel Duarte

  11. Department of Public Health, Northern Regional Health Administration, Porto, Portugal

    Carlos Carvalho

  12. Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal

    Carlos Carvalho

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  1. Alexis Sentís
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  2. Paula Vasconcelos
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  5. Mònica Guxens
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Contributions

AS and CC designed the study. AS cleaned the database, reviewed scientific literature, performed the statistical analysis, and drafted the manuscript. AS and CC interpreted the results. All the authors collaborated in the critical review and approved the final manuscript.

Corresponding author

Correspondence to Carlos Carvalho.

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The authors declare that they have no conflicts of interest.

Ethical approval

In this study, patients were not directly involved; anonymized data were extracted from the national TB clinical notification and follow-up surveillance system (SVIG-TB) and analysed by authors at Directorate-General of Health, as part of their routine functions of surveillance and control of communicable diseases. The study was performed following the indications of the Helsinki Declaration (reviewed in Tokio, October 2004).

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Patient’s data were anonymized prior to analysis and, for that reason, informed consent was not required.

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Sentís, A., Vasconcelos, P., Machado, R.S. et al. Failure to complete treatment for latent tuberculosis infection in Portugal, 2013–2017: geographic-, sociodemographic-, and medical-associated factors. Eur J Clin Microbiol Infect Dis 39, 647–656 (2020). https://doi.org/10.1007/s10096-019-03765-y

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