Treatment Outcomes of Extensively Drug-Resistant Tuberculosis in Pakistan: A Countrywide Retrospective Record Review

Abstract

Background: The current study is conducted with the aim to the fill the gap of information regarding treatment outcomes and variables associated with unsuccessful outcome among XDR-TB patients from Pakistan.Methods: A total of 404 culture confirmed XDR-TB patients who received treatment between 1st May 2010 and June 30, 2017 at 27 treatment centers all over Pakistan were retrospectively followed until their treatment outcomes were reported. A p-value <0.05 reflected a statistical significant association.Results: The patients had a mean age 32.9 ± 14.1 years. The overall treatment success rate was 40.6% (95% confidence interval [CI]:35.80–45.60%). A total of 155 (38.4%) patients were declared cured, 9 (2.2%) completed treatment, 149 (36.9%) died, 60 (14.9%) failed treatment and 31 (7.7%) were lost to follow up (LTFU). The results of the multivariate binary logistic regression analysis revealed that the patients’ age of >60 years (OR = 4.69, 95%CI:1.57–15.57) and receiving high dose isoniazid (OR = 2.36, 95%CI:1.14–4.85) had statistically significant positive association with death, whereas baseline body weight >40 kg (OR = 0.43, 95%CI:0.25–0.73) and sputum culture conversion in the initial two months of treatment (OR = 0.33, 95%CI:0.19–0.58) had statistically significant negative association with death. Moreover, male gender had statistically significant positive association (OR = 1.92, 95%CI:1.04–3.54) with LTFU.Conclusion: The treatment success rate (40.6%) of XDR-TB patients in Pakistan was poor. Providing special attention and enhanced clinical management to patients with identified risk factors for death and LTFU in the current cohort may improve the treatment outcomes.

Frequency, management and impact of adverse events on treatment outcomes in patients with multidrug resistant tuberculosis in Balochistan, Pakistan

“…Unfortunately, Pakistan is currently ranked as 5th highest burden country in the world for MDR-TB, with an estimated occurrence of 4.5% in new TB patients and 18% in patients who have previously undergone TB treatment (Abudl Wahid et al, 2021 ). The programmatic management of DR-TB (PMDT) was initiated in Pakistan in 2010, and currently, there are 33 PMDT centres in the country (Abubakar et al, 2021 ). At these centres, MDR-TB patients receive care according to uniform protocols recommended by the World Health Organization (WHO) and adopted by the National TB Control Program (NTP) (Abubakar, Ahmad, Atif, Khan, & Ghafoor, 2022 ; Javaid et al, 2018 ; Khan et al, 2019 ; Naz et al, 2021 ).…”

“…The programmatic management of DR-TB (PMDT) was initiated in Pakistan in 2010, and currently, there are 33 PMDT centres in the country (Abubakar et al, 2021 ). At these centres, MDR-TB patients receive care according to uniform protocols recommended by the World Health Organization (WHO) and adopted by the National TB Control Program (NTP) (Abubakar, Ahmad, Atif, Khan, & Ghafoor, 2022 ; Javaid et al, 2018 ; Khan et al, 2019 ; Naz et al, 2021 ). While there is significant information available from Pakistan regarding the treatment outcomes and predictors of unsuccessful outcomes among MDR-TB patients (Abubakar et al, 2021 ; N Ahmad et al, 2015 ; Atif et al, 2017 ; Javaid et al, 2018 ; Javaid, Shaheen, et al, 2017 ; Khan et al, 2019 ; Naz et al, 2021 ; Abdul Wahid et al, 2022 ), there is scarcity of detailed information regarding the occurrence and management of AEs during MDR-TB treatment as well as their impact on treatment outcomes (Atif et al, 2022 ; Massud et al, 2022 ) from Pakistan in general and Balochistan in particular, which is the largest province in Pakistan in terms of area.…”

“…At these centres, MDR-TB patients receive care according to uniform protocols recommended by the World Health Organization (WHO) and adopted by the National TB Control Program (NTP) (Abubakar, Ahmad, Atif, Khan, & Ghafoor, 2022 ; Javaid et al, 2018 ; Khan et al, 2019 ; Naz et al, 2021 ). While there is significant information available from Pakistan regarding the treatment outcomes and predictors of unsuccessful outcomes among MDR-TB patients (Abubakar et al, 2021 ; N Ahmad et al, 2015 ; Atif et al, 2017 ; Javaid et al, 2018 ; Javaid, Shaheen, et al, 2017 ; Khan et al, 2019 ; Naz et al, 2021 ; Abdul Wahid et al, 2022 ), there is scarcity of detailed information regarding the occurrence and management of AEs during MDR-TB treatment as well as their impact on treatment outcomes (Atif et al, 2022 ; Massud et al, 2022 ) from Pakistan in general and Balochistan in particular, which is the largest province in Pakistan in terms of area. Since early detection, monitoring, and appropriate management of AEs are crucial for optimising MDR-TB treatment, therefore, the current study was conducted with the objectives to evaluate the pattern, frequency, management, and risk factors associated with AEs and as well as their impact on treatment outcomes among MDR-TB patients.…”

Safety and effectiveness of all-oral and injectable-containing, bedaquiline-based long treatment regimen for pre-XDR tuberculosis in Vietnam

“…Furthermore, the emergence of rifampicin resistant TB (RR-TB) has threatened global efforts in ending the disease. Treatment of RR-TB, especially in patients with more advanced resistance patterns such as pre-extensively drug-resistant tuberculosis (pre-XDR-TB) had poor outcomes until the recent introduction of bedaquiline (Abubakar et al, 2021). According to 2020 World Health Organization (WHO)'s global TB report, about 57% of patients with RR-TB were successfully treated and, compared to 47% of patients with pre-XDR-TB (World Health Organization, 2020).…”

Structural Rigidification of N-Aryl-pyrroles into Indoles Active against Intracellular and Drug-Resistant Mycobacteria

“…It is also estimated that close to a quarter of the global population is latently infected with Mtb, and the risk of progression to the symptomatic TB disease is about 5–10% over a lifetime. , First-line treatment of active TB hinges on gruelling six-month regimens comprising isoniazid, rifampicin, ethambutol, and pyrazinamide at a cost of around $40 USD per patient. MDR-TB that is resistant to isoniazid and rifampicin requires a more protracted course of treatment, which is not only inordinately expensive (≥$1000 USD per person) but also involves more toxic drugs and is vitiated by poor adherence. ,, Reports of more severe forms of TB, including pre-extensively drug-resistant (pre-XDR) TB that displays greater recalcitrance to the current anti-TB drug armamentarium and below-par therapy success rates, paint a grim picture. − These exigencies necessitate intensified and sustained TB mitigation efforts, all the more so in light of the unprecedented COVID-19 pandemic that has cast a shadow over strides made thus far.…”