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Open Access Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India

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Setting: India has one of the highest global rates of multidrug-resistant tuberculosis (MDR-TB), which is associated with poor treatment outcomes. A better understanding of the risk factors for unfavourable outcomes is needed.

Objectives: To describe 1) the demographic and clinical characteristics of MDR-TB patients registered in three states of India during 2009–2011, 2) treatment outcomes, and 3) factors associated with unfavourable outcomes.

Design: A retrospective cohort study involving a record review of registered MDR-TB patients.

Results: Of 788 patients, 68% were male, 70% were aged 15–44 years, 90% had failed previous anti-tuberculosis treatment or were retreatment smear-positive, 60% had a body mass index < 18.5 kg/m2 and 72% had additional resistance to streptomycin and/or ethambutol. The median time from sputum collection to the start of MDR-TB treatment was 128 days (IQR 103–173). Unfavourable outcomes occurred in 40% of the patients, mostly from death or loss to follow-up. Factors significantly associated with unfavourable outcomes included male sex, age  45 years, being underweight and infection with the human immunodeficiency virus. Adverse drug reactions were reported in 24% of patients, with gastrointestinal disturbance, psychiatric morbidity and ototoxicity the most common.

Conclusion: Long delays from sputum collection to treatment initiation using conventional methods, along with poor treatment outcomes, suggest the need to scale up rapid diagnostic tests and shorter regimens for MDR-TB.
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Keywords: India; MDR-TB; operational research; treatment outcomes

Document Type: Research Article

Affiliations: 1: Department of Clinical Research, National Institute for Research in Tuberculosis, Chennai, India 2: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India 3: The Union, Paris, France, London School of Hygiene & Tropical Medicine, London, UK 4: Indian Council of Medical Research, New Delhi, India

Publication date: 21 March 2017

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