期刊
MONALDI ARCHIVES FOR CHEST DISEASE
卷 91, 期 1, 页码 -出版社
PAGEPRESS PUBL
DOI: 10.4081/monaldi.2021.1677
关键词
Default; case fatality; treatment failure; home-based treatment; directly observed treatment (DOT); family DOT
资金
- United States Agency for International Development
In Armenia, a significant proportion of RR/MDR-TB patients experience unfavorable treatment outcomes, with those with pre-XDR-TB and XDR-TB at higher risk. Home-based treatment and treatment with new drugs significantly reduce the risk of unfavorable treatment outcomes.
Rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) is recognized as a major public health concern globally. In Armenia, the proportion of RR/MDR-TB is increasing among all people affected with TB. We conducted a nationwide cohort study involving analysis of programmatic data to investigate the rates of and factors associated with unfavourable treatment outcomes among patients with RR/MDR-TB registered by the national TB programme from 2014 to 2017 in Armenia. We used Cox regression to identify factors associated with the outcome. Among 451 RR/MDR-TB patients, 80% were men and median age was 46 years. Of them, 53 (11.8%) had extensively drug-resistant tuberculosis (XDR-TB) and 132 (29.3%) had pre-XDR-TB. Almost half (224, 49.7%) of the patients had unfavourable treatment outcome, which included 26.8% loss to follow-up (LTFU), 13.3% failures and 9.5% deaths. In multivariable analysis, people with pre-XDR-TB [adjusted hazard ratio [aHR] 3.13, 95% confidence intervals [CI] 2.16-4.55] and XDR-TB (aHR 4.08, 95% CI 2.45-6.79) had a higher risk of unfavourable outcomes. Patients receiving home-based treatment (71/451, 15.7%) and treatment with new drugs (172/451, 38.1%) had significantly lower risk (aHR 0.45, 95% CI 0.28-0.72 and aHR 0.26, 95% CI 0.18-0.39) of unfavourable treatment outcome. The proportion of MDR-TB patients reaching favourable treatment outcome in Armenia was substantially lower than the recommended level (75%). The most common treatment outcome was LTFU indicating the need for further assessment of underlying determinants. Home-based treatment looks promising and future studies are required to see if expanding it to all RR/MDR-TB patients is feasible and cost-effective.
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