Predictors of poor treatment outcomes in multidrug-resistant tuberculosis patients: a retrospective cohort study

Javaid, Arshad; Ullah, Imran; Masud, Haleema; Basit, Anila; Ahmad, Waqas; Butt, Zahid A; Qasim, Muhammad

doi:10.1016/j.cmi.2017.09.012

Cited by 32 publications

(41 citation statements)

References 22 publications

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“…Patients with smear test result negative and patients with co-morbid conditions were more likely to have poor treatment outcomes. This nding is in line with studies done in Ethiopia, India, and Pakistan, where patients with smear-negative results have a higher risk of poor treatment outcomes [8,14,15].…”

Section: Discussionsupporting

confidence: 90%

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Multi-Drug Resistant Tuberculosis Treatment Outcome and Associated Factors in Addis Ababa, Ethiopia: A Retrospective Cross-Sectional Study

Alemu¹,

Amogne²,

Berhe³

2020

Preprint

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BackgroundDrug-resistant tuberculosis continues to be a public health threat around the globe especially in developing countries. In 2018, the number of new cases of rifampicin-resistant tuberculosis was half a million and about 78% of them had multi-drug resistant tuberculosis. In Ethiopia, the overall proportion of multi-drug resistant tuberculosis was 11.6%. The latest treatment outcome data for people with multi-drug resistant tuberculosis show a global treatment success rate of 56%. Therefore, this study was aimed at assessing multi-drug resistant tuberculosis treatment outcomes and associated factors at St. Peter Specialized Hospital, Ethiopia, 2019. MethodsA retrospective cross-sectional study was done. A total of 384 patient medical charts selected by simple random sampling method were reviewed. The data was collected using a checklist from the patients’ medical charts. The collected data were analyzed with SPSS version 23 computer software package. Summary statistics of a given data for each variable were calculated. A logistic regression model was used to measure the association between the outcome and the predictor variable. Statistical significance was declared at p-value<0.05. Direction and strength of association were expressed using OR and 95% CI. ResultFrom a total of 384 patients, the majority of 245(63.8%) of the study subjects were females. The rate of poor treatment outcome was 173(45.1%). Male patients and patients in the age category of 39-60 years were less likely to have poor treatment outcome compared to female patients and patients in the age category of 18-38 years (AOR = 0.43, 95%CI (0.19, 0.10) and (AOR = 0.28, 95%CI (0.15, 0.52) respectively. Patients with a history of second-line TB drug resistance are more likely to have poor treatment outcomes (AOR = 3.81, 95%CI (1.84, 7.91). Poor treatment outcome was higher among patients with longer treatment duration (AOR = 3.23, 95%CI (1.82, 5.74) compared to patients with short treatment duration. ConclusionThe proportion of poor treatment outcome in patients with multi-drug resistant tuberculosis was high. Therefore, a concerted effort should be done at all levels to improve the treatment outcome of the MDR-TB.

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Section: Discussionsupporting

confidence: 90%

“…Patients who have a history of second-line anti-TB drug resistance were more likely to have poor treatment outcomes. The nding of this study is in line with studies done in India, Pakistan, and Tanzania [14,15,16].…”

Section: Discussionsupporting

confidence: 90%

Multi-Drug Resistant Tuberculosis Treatment Outcome and Associated Factors in Addis Ababa, Ethiopia: A Retrospective Cross-Sectional Study

Alemu¹,

Amogne²,

Berhe³

2020

Preprint

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“…And deficient regimen and insufficient treatment are among the main causes which led to more drug resistance and treatment failure. 22 , 23 …”

Section: Discussionmentioning

confidence: 99%

<p>Challenges Faced by Multidrug-Resistant Tuberculosis Patients in Three Financially Affluent Chinese Cities</p>

Zhang

Song

et al. 2020

RMHP

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Purpose The aim of this study was to analyze socioeconomic burdens and other difficulties that multidrug-resistant tuberculosis (MDR-TB) patients in cities are facing, to identify major obstacles and which groups of patients are most affected. Methods Face-to-face and phone-call interviews were conducted in early 2018 to follow-up with patients newly diagnosed with MDR-TB in 2017 in three tuberculosis hospitals in three financially affluent Chinese cities. Demographic data and information on their medical care, insurance coverage, and medical expenses were collected and analyzed. Results A total of 144 newly diagnosed MDR-TB cases were reviewed during the study period, excluding 38 who were lost to follow-up and 29 patients who refused to participate, 77 patients were enrolled in this study. A total of 61 (79%) of these patients were hospitalized after MDR-TB diagnosis with an average hospital stay of 14 days, of them 57 (74%) were sputum positive on diagnosis. The proportion of patients who failed community care were 48% married, 56% in white collar employment and 43% in temp jobs/unemployed. In terms of insurance coverage, the proportion of patients who failed community care were 23% with no insurance and/or New Rural Co-operative Medical Care Scheme (NRCMS) and 45% with Urban Employee Basic Medical Insurance (UEBMI)/Urban Residents Basic Medical Insurance (URBMI) and commercial insurance. Difficulties patients encountered were, financial pressure (33%), psychological stress (26%), adverse drug reactions (23%), repulsive reaction to injections (17%). Fourty-eight percent of the patients spent over ¥2000 (USD300) per month on TB treatment. Conclusion Despite insurance coverage, financial hardship remains the number one difficulty MDR-TB patients encountered in relatively financially affluent cities. Among them, the married working class were found to be the most financially sensitive group and have the highest tendency to fail community care. It is of utmost urgency to enhance the current medical policy to improve treatment adherence.

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“…The pain and uncomfortable experience with injection discouraged most patients from adhering to treatment. And deficient regimen and insufficient treatment are among the main causes which led to more drug resistance and treatment failure [34,35].…”

Section: Problems Faced During Treatment and Possible Solutionsmentioning

confidence: 99%

The married middle working class turned out to be the most financially fragile group when facing multidrug-resistant tuberculosis in China cities

Zhang¹,

Xu²,

Song³

et al. 2019

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INTRODUCTION With the emergence of multi-drug resistant tuberculosis and the threat it poses to public health, and the consequential cost involved in its treatment, constant effort has been put on evaluating and improving patient care to avoid treatment interference due to impoverishment of the household.OBJECTIVE The aim of this study was to analyze socioeconomic burdens and other difficulties MDR-TB patients in cities are facing to identify major obstacles and which group of patients are most affected.METHODS Face-to-face and phone-call interviews were conducted in early 2018 to follow up with patients newly diagnosed with MDR-TB in 2017 in three tuberculosis clinics in China.Demographic data and information on their medical care, insurance coverage, medical expenses were collected and analyzed.RESULTS A total of 144 newly-diagnosed MDR-TB cases were reviewed during the study period, among them 38 lost follow-up and 29 patients refused to participate. Eventually, 77 patients with MDR-TB were included in this study. 61 of these patients were hospitalized after MDR-TB diagnosis with an average hospital stay of 14.45 days, of them 57 were sputum positive on diagnosis. Ratio of home-discharged patients failing community care and returned to work were 48% and 8% for married and single persons ( p = 0.001). In terms of insurance coverage, proportion of patients went back to work were 23% with no insurance and/or NRCMS and 45% with UEBMI / URBMI and commercial insurance. Significant difference was shown between these two insurance coverage groups (χ 2 = 5.059, p = 0.033). Difficulties patients encountered were financial pressure (33%), psychological stress (26%), adverse drug reactions (23%), repulsive reaction to injections (17%). 48% of the patients spent over CNY2,000 (USD300) per month on TB treatment. CONCLUSION The married "middle working class" were found to be the most vulnerable group being affected financially. They have the highest tendency to fail community care schedule despite treatment status. It is of utmost urgency to enhance the current medical policy to cater for this group and improve treatment adherence.

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Predictors of poor treatment outcomes in multidrug-resistant tuberculosis patients: a retrospective cohort study

Abstract: Approximately 75% of the treatment success rate set by the Global Plan to Stop TB was achieved. Resistance to second-line drugs and presence of extensively drug-resistant TB are the main risk factors for poor treatment outcomes.

Cited by 32 publications

References 22 publications

Multi-Drug Resistant Tuberculosis Treatment Outcome and Associated Factors in Addis Ababa, Ethiopia: A Retrospective Cross-Sectional Study

Multi-Drug Resistant Tuberculosis Treatment Outcome and Associated Factors in Addis Ababa, Ethiopia: A Retrospective Cross-Sectional Study

<p>Challenges Faced by Multidrug-Resistant Tuberculosis Patients in Three Financially Affluent Chinese Cities</p>

The married middle working class turned out to be the most financially fragile group when facing multidrug-resistant tuberculosis in China cities

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