Diagnosis and Treatment Pathway of MDR/RR-TB in Taizhou, Zhejiang Province, China

Abstract

This study aims to understand MDR/RR-TB patients’ experience from seeking TB-related health care to diagnosis and treatment completion, as well as the social determinants with the waiting time for DST and treatment, pre-treatment attrition, and treatment outcome based on a retrospective cohort study. Univariate and multi-variate logistic regressions were used to analyze the associated factors. The median time of waiting time for DST and treatment was 24.00 and 30.00 days, respectively. Non-residential patients (aOR: 2.89, 95% CI: 1.14–7.70), registered before 2018 (aOR: 19.93, 95% CI: 8.99–48.51), first visited a county-level hospital (aOR: 4.65, 95% CI: 1.08–21.67), sputum smear-negative (aOR: 3.54, 95% CI: 1.28–10.16), and comorbid with pneumoconiosis (aOR: 7.10, 95% CI: 1.23–47.98) had a longer DST delay. The pre-treatment attrition was 26.9% (82/305). Elderly, non-residential patients and patients registered before 2018 were more likely to refuse MDR/RR treatment. However, in housekeeping/unemployment and farmer/fisherman, recurrent patients tended to take therapeutic measures actively. The successful treatment rate was 62.1% (105/169). Elderly, comorbidity with diabetes and sputum smear conversion time >1 month may lead to poorer outcomes. Immediate interventions should be taken to smooth diagnosis and treatment pathways and improve the social protections further so as to encourage patients to cooperate with the treatment actively.