Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India.

Thomas, A.; Gopi, P.G.; Santha, T.; Chandrasekaran, V.; Subramani, R.; Selvakumar, N.; Eusuff, S.I.; Sadacharam, K.; Narayanan, P.R.

International Journal of Tuberculosis and Lung Disease; 2005; 9; 556–561.

Objective: To identify risk factors associated with relapse among cured tuberculosis (TB) patients in a DOTS programme in South India.

Design: Sputum samples collected from a cohort of TB patients registered between April 2000 and December 2001 were examined by fluorescence microscopy for acid-fast bacilli and by culture for Mycobacterium tuberculosis at 6, 12 and 18 months after treatment completion.

Results: Of the 534 cured patients, 503 (94%) were followed up for 18 months after treatment completion. Of these, 62 (12%) relapsed during the 18-month period; 48 (77%) of the 62 relapses occurred during the first 6 months of follow-up. Patients who took treatment irregularly were twice more likely to have a relapse than adherent patients (20% vs. 9%; adjusted odds ratio [aOR] 2.5; 95%CI 1.4–4.6). Other independent predictors of relapse were initial drug resistance to isoniazid and/or rifampicin (aOR 4.8; 95%CI 2.0–11.6) and smoking (aOR 3.1; 95%CI 1.6–6.0). The relapse rate among nonsmoking, treatment adherent patients with drug-sensitive organisms was 4.8%.

Conclusions: The relapse rate under the DOTS programme may be reduced by ensuring that patients take their treatment regularly and are counselled effectively about quitting smoking.

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