Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan

Abstract

The spread of drug-resistant tuberculosis (DR TB) poses significant challenges to the control and successful eradication of TB globally. The current retrospective study was designed to evaluate the treatment outcomes and identify the risk factors associated with unsuccessful outcomes among DR TB patients. A total of 277/308 eligible DR TB patients were enrolled for treatment at the programmatic management unit of DR TB at the Pakistan Institute of Medical Sciences, Islamabad between January 2014 and July 2019. Treatment outcomes were defined according to the WHO recommendations. Death, treatment failure, and lost to follow-up (LTFU) were collectively grouped as unsuccessful treatment outcomes, whereas cured and treatment completed were summed up together as successful treatment outcomes. Out of the total 277 patients, 265 (95.67%) were multidrug/rifampicin-resistant TB (MDR/RR-TB) cases, 8 (2.89%) were isoniazid resistant cases, and 4 (1.44%) were extensively drug-resistant ones. In the current cohort, a total of 177 (63.9%) achieved successful treatment outcomes. Among them, 153 (55.2%) were declared cured and 24 (8.7%) completed their treatment. Of the remaining 100 (36.1%) patients with unsuccessful outcomes, 60 (21.7%) died, 32 (11.5%) were LTFU, and 8 (2.9%) had failed treatment. The proportion of male patients was relatively higher (55.2%), within the age group of 21–40 years (47.3%) and lived in rural areas (66.8%). The multivariate analysis revealed that unsuccessful outcomes had a statistically significant association with being male (adjusted odds ratio, AOR: 1.92, 95% confidence interval (CI): 1.10–3.36), being in an age group above 60 years (AOR: 3.34, 95% CI: 1.09–10.1), suffering from any comorbidity (AOR: 2.69, 95% CI: 1.35–5.38), and the history of use of second-line drugs (AOR; 3.51, 95% CI 1.35–9.12). In conclusion, treatment outcomes among DR TB patients at the study site were poor and did not achieve the treatment success target (≥75%) set by the World Health Organization.

Comparative effectiveness of individualized longer and standardized shorter regimens in the treatment of multidrug resistant tuberculosis in a high burden country

“…In multivariate analysis the emergence of patients age of 41-60 and > 60 years as predictors of unsuccessful end treatment outcomes among MDR-TB patients is in line with the previous studies (Kurbatova et al, 2012;Ahmad et al, 2015;Khan et al, 2019;Atif et al, 2020;Wahid et al, 2021). The concomitant presence of multiple factors like general physical deterioration, compromised immunity, multiple comorbidities, and complex medication schedule make older patients more likely to develop unsuccessful treatment outcomes (Kurbatova et al, 2012;Ahmad et al, 2015;Khan et al, 2019;Atif et al, 2020;Wahid et al, 2021;Khan et al, 2022b). In the current study, those patients who had a baseline body weight of > 30 kg were significantly less likely to develop unsuccessful treatment outcomes than their counterparts with a baseline body weight of <30 kg.…”

Assessment of Adverse Drug Events, Their Risk Factors, and Management Among Patients Treated for Multidrug-Resistant TB: A Prospective Cohort Study From Pakistan

“…Multidrug TB treatment has long therapy duration (18 months to 2 years), and the number of drugs used for the treatment is comparatively more complex than that for drug-susceptible TB ( Khan et al, 2022 ). Numerous side effects are identified that result in patients’ non-compliance and predictably poor outcomes ( Tahaoğlu et al, 2001 ; Mukherjee et al, 2004 ).…”

Perceptions of healthcare professionals and patients on the role of the pharmacist in TB management in Pakistan: A qualitative study

“…This partially might be attributed to a shortage of TB management staff, lengthy treatment courses, side effects associated with anti-TB drugs, resistance to first-line anti-TB drugs, and the disappearance of signs and symptoms of TB after partial anti-tuberculosis treatment (ATT) ( Atif et al, 2014 ; Atif et al, 2017a ). Alongside poor health literacy, stigma associated with the disease, and poor financial status of TB patients and their families, these factors further complicate the TB treatment cascade ( Khan et al, 2022a ). In addition, inequality in healthcare services and/or limited access to alternative treatment, for example, for patients residing in rural areas or distant areas, halts the achievement of national TB-related targets ( Khan et al, 2022a ).…”

“…Alongside poor health literacy, stigma associated with the disease, and poor financial status of TB patients and their families, these factors further complicate the TB treatment cascade ( Khan et al, 2022a ). In addition, inequality in healthcare services and/or limited access to alternative treatment, for example, for patients residing in rural areas or distant areas, halts the achievement of national TB-related targets ( Khan et al, 2022a ). With regard to healthcare professionals, Pakistan’s Ministry of Finance in Economic Survey 2020–2021 indicated that a single physician caters to the needs of hundreds of patients requiring treatment ( Ministry of Finance, 2021 ).…”

“…Given the aforementioned facts, including increase in TB burden ( World Health Organization, 2021 ), shortage of TB management staff and poor patient adherence, integration of pharmacists in TB management seems very much value-added ( Kulkarni et al, 2013 ; Atif et al, 2016d ; Khan et al, 2022a ). Unfortunately, the importance of pharmacists in direct patient care is not recognized as an important and integral part of the Pakistani healthcare system ( Atif et al, 2017a ), regardless of the fact that the Drug Regulatory Authority of Pakistan (DRAP) Act 2012 acknowledges the advanced patient-oriented roles of pharmacists.…”