IngentaConnect Speaking the same language: treatment outcome definitions for mul...

Authors: Laserson, K.F.¹; Thorpe, L.E.²; Leimane, V.³; Weyer, K.⁴; Mitnick, C.D.⁵; Riekstina, V.³; Zarovska, E.³; Rich, M.L.⁶; Fraser, H.S.F.⁶; Alarcón, E.⁷; Cegielski, J.P.¹; Grzemska, M.⁸; Gupta, R.⁸; Espinal, M.⁸

Source: The International Journal of Tuberculosis and Lung Disease, Volume 9, Number 6, June 2005 , pp. 640-645(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: Globally it is estimated that 273000 new cases of multidrug-resistant tuberculosis (MDR-TB, resistance to isoniazid and rifampicin) occurred in 2000. To address MDR-TB management in the context of the DOTS strategy, the World Health Organization and partners have been promoting an expanded treatment strategy called DOTS-Plus. However, standard definitions for MDR-TB patient registration and treatment outcomes do not exist.

OBJECTIVE: To propose a standardized set of case registration groups and treatment outcome definitions for MDR-TB and procedures for conducting cohort analyses under the DOTS-Plus strategy.

DESIGN: Using published definitions for drug-susceptible TB as a guide, a 2-year-long series of meetings, conferences, and correspondence was undertaken to review published literature and country-specific program experience, and to develop international agreement.

RESULTS: Definitions were designed for MDR-TB patient categorization, smear and culture conversion, and treatment outcomes (cure, treatment completion, death, default, failure, transfer out). Standards for conducting outcome analyses were developed to ensure comparability between programs.

CONCLUSION: Optimal management strategies for MDR-TB have not been evaluated in controlled clinical trials. Standardized definitions and cohort analyses will facilitate assessment and comparison of program performance. These data will contribute to the evidence base to inform decision makers on approaches to MDR-TB control.

Keywords: multidrug-resistant TB; definitions; treatment outcome; cohort analysis

Document Type: Regular paper

Affiliations: 1: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 2: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and New York City Department o 3: State Center for Tuberculosis and Lung Diseases, Riga, Latvia 4: Medical Research Council, Pretoria, South Africa 5: Program in Infectious Disease and Social Change, Harvard Medical School, Boston, Massachusetts, USA 6: Partners In Health, Harvard Medical School, Boston, Massachusetts, USA 7: National Tuberculosis Program, Lima, Peru; and International Union Against Tuberculosis and Lung Disease, Paris, France 8: World Health Organization, Geneva, Switzerland

Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis