Free Content Public-private collaboration for multidrug-resistant tuberculosis control in New York City

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Abstract:

SETTING: An urban tuberculosis control program where an enhanced multidrug-resistant tuberculosis (MDR-TB) management plan coordinated care with multiple providers.

OBJECTIVE: To evaluate treatment outcomes of primary MDR-TB patients treated by multiple providers.

DESIGN: Retrospective cohort study of tuberculosis patients from 1992–1997 provided that 1) their Mycobacterium tuberculosis isolates were resistant to at least isoniazid and rifampin, and 2) they had had ≤30 days of anti-tuberculosis treatment prior to the collection of the first MDR-TB specimen.

RESULTS: More than 100 facilities and providers reported 856 MDR-TB patients. Treatment completion reached 70% among non-HIV-infected and 30% among HIV-infected persons; 57.2% of the cohort died prior to treatment completion, 26.5% completed treatment, 16.0% transferred out, refused treatment or were lost to follow-up and 0.2% are still in care. Diagnosis in the later years of the study or cavitation on chest radiograph was independently associated with increased completion among HIV-infected patients. Eight of the 227 (3.5%) patients who completed treatment relapsed (relapse rate 1.01/100 person-years), two with drug-susceptible strains.

CONCLUSION: A comprehensive MDR-TB control program improved the outcomes of both HIV-infected and non-infected individuals, despite management by multiple providers. Relapse was infrequent among patients who completed the recommended regimens.

Keywords: drug therapy; multidrug-resistant; treatment effectiveness; treatment outcome; tuberculosis

Document Type: Regular Paper

Affiliations: New York City Department of Health and Mental Hygiene, New York, New York, USA

Publication date: June 1, 2006

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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