BACKGROUND: The success of the current treatment regimen for multidrug-resistant (MDR) tuberculosis is poor partly owing to a high default rate. Many studies have explored predictors of poor outcomes, but very few have assessed the effects of treatment interruptions on treatment outcomes for MDR tuberculosis. METHODS: We conducted a retrospective analysis among patients with MDR tuberculosis enrolled in 2 MDR tuberculosis programs using regimens recommended by the World Health Organization under directly observed therapy. Treatment outcomes were defined as successful if the patient was cured or completed treatment and unsuccessful if the patient died or defaulted from treatment or if treatment failed. The effect of patterns of interruptions on treatment outcomes was assessed through multivariate logistic regression. RESULTS: A total of 393 patients with MDR tuberculosis were included in the study; 171 (43.5%) had a successful outcome, and 222 (56.5%) an unsuccessful outcome: 39 (9.9%) died, 56 (14.3%) had failed treatment, and 127 (32.3%) defaulted from treatment. In multivariate analysis, long interruptions (≥3 days) (adjusted odds ratio, 3.87; 95% confidence interval, 1.66-8.98) and short gaps (<10 days) between interruptions (3.94; 1.76-8.81) were independently associated with an unsuccessful treatment outcome. DISCUSSION: This study shows that in a directly observed therapy-based MDR tuberculosis program, treatment interruptions at short intervals of ≥3 days directly affect treatment outcome.
BACKGROUND: The success of the current treatment regimen for multidrug-resistant (MDR) tuberculosis is poor partly owing to a high default rate. Many studies have explored predictors of poor outcomes, but very few have assessed the effects of treatment interruptions on treatment outcomes for MDR tuberculosis. METHODS: We conducted a retrospective analysis among patients with MDR tuberculosis enrolled in 2 MDR tuberculosis programs using regimens recommended by the World Health Organization under directly observed therapy. Treatment outcomes were defined as successful if the patient was cured or completed treatment and unsuccessful if the patient died or defaulted from treatment or if treatment failed. The effect of patterns of interruptions on treatment outcomes was assessed through multivariate logistic regression. RESULTS: A total of 393 patients with MDR tuberculosis were included in the study; 171 (43.5%) had a successful outcome, and 222 (56.5%) an unsuccessful outcome: 39 (9.9%) died, 56 (14.3%) had failed treatment, and 127 (32.3%) defaulted from treatment. In multivariate analysis, long interruptions (≥3 days) (adjusted odds ratio, 3.87; 95% confidence interval, 1.66-8.98) and short gaps (<10 days) between interruptions (3.94; 1.76-8.81) were independently associated with an unsuccessful treatment outcome. DISCUSSION: This study shows that in a directly observed therapy-based MDR tuberculosis program, treatment interruptions at short intervals of ≥3 days directly affect treatment outcome.
Authors: Bella Hwang; Amir Shroufi; Tinne Gils; Sarah Jane Steele; Anna Grimsrud; Andrew Boulle; Anele Yawa; Sasha Stevenson; Lauren Jankelowitz; Marije Versteeg-Mojanaga; Indira Govender; John Stephens; Julia Hill; Kristal Duncan; Gilles van Cutsem Journal: PLoS One Date: 2019-03-12 Impact factor: 3.240
Authors: Helen R Stagg; Ibrahim Abubakar; Colin Nj Campbell; Andrew Copas; Marcia Darvell; Robert Horne; Karina Kielmann; Heinke Kunst; Mike Mandelbaum; Elisha Pickett; Alistair Story; Nicole Vidal; Fatima B Wurie; Marc Lipman Journal: BMJ Open Date: 2019-12-17 Impact factor: 2.692
Authors: Helen R Stagg; Mary Flook; Antal Martinecz; Karina Kielmann; Pia Abel Zur Wiesch; Aaron S Karat; Marc C I Lipman; Derek J Sloan; Elizabeth F Walker; Katherine L Fielding Journal: ERJ Open Res Date: 2020-11-02
Authors: Helen R Stagg; James J Lewis; Xiaoqiu Liu; Shitong Huan; Shiwen Jiang; Daniel P Chin; Katherine L Fielding Journal: Ann Am Thorac Soc Date: 2020-04
Authors: Habteyes H Tola; Kourosh Holakouie-Naieni; Mohammad A Mansournia; Mehdi Yaseri; Ephrem Tesfaye; Zemedu Mahamed; Million Molla Sisay Journal: Sci Rep Date: 2019-12-27 Impact factor: 4.379