Association of MDR-TB treatment outcomes and HIV status in Zimbabwe: A retrospective study

ABSTRACT Introduction: Multi drug resistant-TB (MDR-TB) threatens global TB control and is a major public health concern in several countries. The present study was undertaken to detect the epidemiological correlates and treatment outcomes among patients with MDR-TB previously or currently admitted in Department of Respiratory Medicine and Pulmonary and Critical Medicine, KGMU, Lucknow. Material & Methods: This retrospective study included 2370 TB patients admitted in the Department of Respiratory Medicine and Pulmonary and Critical Medicine, KGMU, Lucknow between years 2012 to 2015. Treatment outcomes were observed. SPSS software was used for data analysis. Results: The total number of MDR-TB cases enrolled were 2370. There were 772 (32.6%) males (95% CI: 30.7 % -34.5%) and 1598 (67.4%) females (95% CI: 65.5% -69.3%) registered for MDR-TB treatment. The treatment outcomes were as follows: majority (77.1%) were under treatment, 279 (11.8%) patients were declared cured, 10 (0.4%) were failure cases, while 64 (2.7%) were defaulters, 149 (6.3%) had died and 41(1.7%) were transferred out. Conclusion: Emergence of MDR-TB has the potential to be a serious public health problem in Northern India and this necessitates strengthening of TB control and improved continuous monitoring of therapy.

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Multidrug-resistant tuberculosis in the Kharkiv Region, Ukraine

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0508 ◽

2020 ◽

Vol 24 (5) ◽

pp. 485-491

Author(s):

D. Butov ◽

C. Lange ◽

J. Heyckendorf ◽

I. Kalmykova ◽

T. Butova ◽

...

Keyword(s):

Treatment Outcomes ◽

Drug Susceptibility ◽

Multidrug Resistant ◽

Drug Susceptibility Testing ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Poor Treatment ◽

Mdr Tb ◽

Observational Cohort

OBJECTIVE: To document the level of drug resistance in MDR-TB patients and to characterize management capacities for their medical care and MDR-TB treatment outcomes in the Kharkiv region of Ukraine. This area has one of the highest frequencies of MDR-TB worldwide.METHODS: A retrospective observational cohort study was performed on registry data from the regional anti-TB dispensary in Kharkiv. All microbiologically confirmed MDR-TB patients registered in 2014 were included. Diagnostic, treatment and post-treatment follow-up data were analysed.RESULTS: Of 169 patients with MDR-TB, 55.0% had pre-extensively drug-resistant (pre-XDR) or XDR resistant patterns. Rapid molecular diagnosis by GeneXpert and liquid M. tuberculosis cultures were only available for 66.9% and 56.8% of patients, respectively. Phenotypic drug-susceptibility testing (DST) for high priority TB drugs (bedaquiline, linezolid, clofazimine) were not available. DST for later generation fluroquinolones was available only in 53.2% of patients. 50.9% of patients had less than 4 drugs in the treatment regimen proven to be effective by DST. More than 23.1% of patients with MDR-TB failed their treatment and only 45.0% achieved a cure.CONCLUSION: The high prevalence of MDR-TB and poor MDR-TB treatment outcomes in the Kharkiv region, is associated with substantial shortages in rapid molecular and phenotypic DST, a lack of high priority MDR-TB drugs, poor treatment monitoring and follow-up capacities.

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Time to revise WHO-recommended definitions of MDR-TB treatment outcomes

The Lancet Respiratory Medicine ◽

10.1016/s2213-2600(18)30104-8 ◽

2018 ◽

Vol 6 (4) ◽

pp. 246-248 ◽

Cited By ~ 3

Author(s):

Christoph Lange ◽

Frank van Leth ◽

Carole D Mitnick ◽

Keertan Dheda ◽

Gunar Günther

Keyword(s):

Treatment Outcomes ◽

Tb Treatment ◽

Mdr Tb

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Treatment success using novel and adapted treatment regimens in registered DR-TB children in Dushanbe, Tajikistan, 2013-2019

The Journal of Infection in Developing Countries ◽

10.3855/jidc.14798 ◽

2021 ◽

Vol 15 (09.1) ◽

pp. 7S-16S

Author(s):

Bobojon Pirmahmadzoda ◽

Katrina Hann ◽

Kristina Akopyan ◽

Ruzanna Grigoryan ◽

Evgenia Geliukh ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Short Treatment ◽

Female Ratio ◽

Treatment Regimens ◽

Tb Treatment ◽

National Tuberculosis ◽

Mdr Tb ◽

Pediatric Tb ◽

Culture Conversion

Introduction: Approximately 3% of all pediatric TB cases develop MDR-TB, with only 3–4% of such children receiving MDR-TB treatment. In Tajikistan, children as a proportion of all DR-TB in the country increased from 4.3 to 7.5% during 2013-2018. Despite limited evidence on the use of new anti-TB drugs in children, WHO has updated its guidelines for DR-TB treatment for children, and Tajikistan did so in 2013 and 2017. Novel and adapted regimens included individual regimens for RR/MDR, XDR (with and without Bedaquiline and Delamanid) and short treatment regimens with and without injectables. It is important to document the outcomes of the treatment regimens. Therefore, the aim of this study was to describe characteristics of children receiving different treatment regimens for DR-TB, the culture conversion and treatment outcomes. Methodology: Cohort study of children enrolled in DR-TB treatment by the National Tuberculosis Program in Dushanbe, Tajikistan, January 2013 to July 2019. Results: The study included 60 DR-TB children. The male to female ratio was 1:2 and mean age 13.6 years. Median time to culture conversion was 66 days [IQR:31-103; Range:2-232]. In children with treatment outcomes (N = 58), 93% had favorable outcomes. There were four children (7%) with unfavorable treatment outcomes, all of whom were female 15-17 years, on standard (RR/MDR) treatment during 2013-2015. Favorable outcomes by DR-TB type were 91%, 90%, and 100% in RR/MDR, PreXDR, and XDR-TB patients, respectively. Conclusions: All children enrolled after the introduction of modified guidelines for novel and adapted regimens for DR-TB showed positive TB treatment outcomes.

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Risk factors for poor treatment outcomes of 2,266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study

10.21203/rs.2.12034/v4 ◽

2020 ◽

Author(s):

Le Hong Van ◽

Phan Trieu Phu ◽

Dao Nguyen Vinh ◽

Vo Thanh Son ◽

Nguyen Thi Hanh ◽

...

Keyword(s):

Risk Factors ◽

Treatment Outcomes ◽

Multidrug Resistant ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Poor Treatment ◽

Mdr Tb ◽

History Of ◽

Poor Outcomes ◽

Poor Treatment Outcome

Abstract Background: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcomes. Predictors of poor outcomes vary in different regions. Vietnam is among the top 30 high burden of MDR-TB countries. We describe demographic characteristics and identify risk factors for poor outcome among patients with MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam.Methods: This retrospective study included 2,266 patients who initiated MDR-TB treatment between 2011-2015 in HCMC. Treatment outcomes were available for 2,240 patients. Data was collected from standardized paper-based treatment cards and electronic records. A Kruskal Wallis test was used to assess changes in median age and body mass index (BMI) over time, and a Wilcoxon test was used to compare the median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression with multiple imputation for missing data was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program.Results: Among 2,266 eligible cases, 60.2% had failed on a category I or II treatment regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. The notification rate increased 24.7% from 2011-2015. The treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty or 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1kg/m2 of BMI for patients with BMI<21).Conclusion: The number of patients diagnosed with MDR-TB in HCMC increased by almost a quarter between 2011-2015. Patients with HIV, high smear grade, malnutrition or a history of previous MDR-TB treatment are at greatest risk of poor treatment outcome.

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Predictors of Intensive Phase Treatment Outcomes among Patients with Multi-Drug Resistant Tuberculosis in Zaria, North-Western Nigeria

Journal of Community Medicine and Primary Health Care ◽

10.4314/jcmphc.v32i2.8 ◽

2020 ◽

Vol 32 (2) ◽

pp. 95-107

Author(s):

A. Oyefabi ◽

B. Adelekan ◽

E. Adetiba ◽

L. Emmanuel ◽

O. Jimoh

Keyword(s):

Treatment Outcome ◽

Treatment Outcomes ◽

Successful Treatment ◽

Treatment Success ◽

Case Fatality ◽

Training Centre ◽

Intensive Phase ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Mdr Tb

Background: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a threat to successful TB treatment outcomes in developing nations like Nigeria. This study determined the predictors of intensive phase treatment outcomes in MDR-TB patients in Zaria, Nigeria.Methods: This was a retrospective cross-sectional review of the records of 124 MDR-TB patients registered between September 2012 and August 2017 at the National Tuberculosis and Leprosy Training Centre, Saye, Zaria. Data were analyzed using IBM SPSS version 25.0 and the StataCorp STATA/SE 14.Results: The median age (IQR) of the respondents was 32 (15) years. The gene Xpert test detected Mycobacterium Tuberculosis (MTB) and rifampicin resistance (RIF) in 119 (96.0%) cases. The treatment success rate was 97 (78.2%). MDR-TB and HIV co-infection rate was 17 (13.7%) while the case fatality rate was 16.1%. Bivariate analysis showed that being male (p=0.001), not currently in marital union (p=0.01) and positive smear results at 1 month (p=0.027)) were significantly associated with treatment success. Multivariate logistic regression showed that the odds for successful treatment outcome was 4 times higher for the MDR-TB patients who were employed than the unemployed (AOR= 3.98, 95% CI= 1.15-13.74). No significant relationship between MDR-TB-HIV comorbidity (AOR=1.89, 95% CI=0.44-8.19), MDR-TB susceptible to Isoniazid (AOR= 0.49, 95% CI =0.15-1.56) and successful treatment outcome.Conclusion: Unemployment was a predictor of poor treatment outcome in this study. Cause-specific mortality due to the MDR TB was high in this setting. We advocate for optimization of access to treatment and social support system, especially for the female patients. Keywords: Gene Xpert; Intensive phase; MDR-TB; Treatment outcomes; Nigeria.

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Determinants of tuberculosis treatment outcomes in Asia and Africa

International Journal of Health Sciences ◽

10.53730/ijhs.v5n3.1666 ◽

2021 ◽

Vol 5 (3) ◽

pp. 386-399

Author(s):

Yuliyani Yuliyani ◽

Ratu Ayu Dewi Sartika

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Control Strategies ◽

Scientific Evidence ◽

External Factors ◽

Hiv Status ◽

Screening Criteria ◽

Global Challenge ◽

Tb Treatment ◽

Internal And External Factors

Tuberculosis (TB) is a disease that is both infectious and deadly. Although it can be prevented and treated, the increasing number of TB patients is a nation-wide and global challenge, and thus it requires efforts to control the disease appropriately leading to good treatment outcomes. Identifying the determinants of treatment outcomes is necessary to improve control strategies and programs for TB. Scientific evidence on this issue is still limited. This systematic review aims to describe the potential determinants of TB treatment outcomes regarding the patient’s internal and external factors. The review was carried out using the procedures specified in the PRISMA guidelines. Five databases were used to identify studies related to the determinants of treatment outcomes obtained. There were 829 articles meeting the screening criteria, 23 meeting the criteria for full article review, and 21 for analysis. Most scientific evidence reports the age, sex, HIV status, and location of TB as determinants of treatment outcomes. Sorting and selecting data consistently are necessary in reporting the results of TB treatment which then becomes the foundation for formulating appropriate, targeted, effective, and most needed policies or interventions in improving treatment outcomes and reducing incidence of TB.

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