Intermittent treatment interruption and its effect on multidrug resistant tuberculosis treatment outcome in Ethiopia

Abstract

Treatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4–2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.

Treatment interruption and associated factors among patients registered on drug-resistant tuberculosis treatment in Amhara regional state, Ethiopia: 2010–2017

“…However, the magnitude of treatment interruption in our study was higher than studies from China [12], and Ethiopia [13]. The definition used across studies was one of the possible reasons for the difference in treatment interruption.…”

“…Many previous works of scholars have noted some of the characteristics associated with an increased probability of interrupting treatment among DR-TB patients [10][11][12][13]. These include basic patient-related factors such as educational status, sex, alcoholism, and cigarette smoking.…”

Survival status and its predictors among multi-drug resistance tuberculosis treated patients in Ethiopia: Multicenter observational study

“…Habteyes et . al found treatment interruption was significantly associated with unsuccessful treatment outcomes (ARR = 1.9; 95% CI [1.4–2.6]) [ 24 ].…”

All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era

“…There has been substantial interest in the relationship between suboptimal implementation and various intermediate and final treatment outcomes. Largely using simple percentage adherence thresholds across the entire treatment period, suboptimal implementation has been associated with unsuccessful treatment outcomes in a variety of settings from Malawi to Israel, in both observational and randomised controlled trial datasets, and using a variety of methods to define and measure implementation [37,[45][46][47][48][49][50]. In observational datasets from Russia and the USA, this association extends to the development of drug resistance [51,52], although in simulations it has not been consistently proven [53].…”