Setting

The Republic of Moldova, Eastern Europe, 2007–2010. Moldova has among the highest reported nationwide proportions of TB patients with multidrug-resistant tuberculosis (MDR-TB) worldwide.

Objective

To assess risk factors and timing of default from treatment for non-MDR-TB. Default has been associated with increased mortality and amplification of drug resistance and may contribute to the high MDR-TB rates in Moldova.

Design

A retrospective analysis of routine surveillance data on all non-MDR-TB patients reported.

Results

14.7% of non-MDR-TB patients defaulted from treatment during the study period. Independent risk factors for default included sociodemographic factors (i.e. homelessness, living alone, less formal education and spending substantial time outside Moldova in the year prior to diagnosis) and health-related factors (i.e. HIV-coinfection, greater lung pathology, and increasing TB drug resistance). TB treatment is usually initiated within an institutional setting in Moldova and the default risk was highest in the month following the hospitalized treatment phase (among civilians) and after leaving prison (among those diagnosed while incarcerated).

Conclusions

Targeted interventions to increase treatment adherence for patients at highest risk of default and improving the continuity of care for patients transitioning from institutional to community care may substantially reduce the default risk.