Multi- and extensively drug-resistant tuberculosis in Latvia: trends, characteristics and treatment outcomes
Objective: To document trends, characteristics and treatment outcomes of registered patients with multi-drug-resistant (MDR-) and extensively drug-resistant (XDR-) TB in Latvia from 2000 to 2010.
Design: A retrospective national cohort study.
Results: Of 1779 patients, 1646 (92%) had MDR- and 133 (8%) XDR-TB. Over 11 years, the proportion of XDR-TB among MDR-TB patients increased from 2% to 18%. Compared to MDR-TB patients, those with XDR-TB were significantly more likely to have failed MDR-TB treatment (OR 8.4, 95%CI 4.3–16.2), have human immunodeficiency virus infection (OR 3.2, 95%CI 1.8–5.7), be illegal drug users (OR 5.7, 95%CI 2.6–11.6) or have had contact with MDR-TB patients (OR 1.9, 95%CI 1.3–2.8). Cure rates for XDR-TB were 50%. Compared with MDR-TB patients, those with XDR-TB had a higher risk of treatment failure (29% vs. 8%, respectively, P < 0.001). Unfavourable treatment outcomes were significantly associated with being male; having smear-positive disease; pulmonary cavities; failure, default or relapse after previous MDR-TB treatment; and a history of incarceration.
Conclusion: More MDR-TB in Latvia is now also XDR-TB. This study identified several risk factors for XDR-TB and, for unfavourable treatment outcomes, highlighting the importance of early diagnosis and appropriate management of MDR-/XDR-TB.
Document Type: Research Article
Affiliations: 1: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia, Riga Stradins University, Riga, Latvia 2: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia 3: Medical Department, Operational Center Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg 4: Tuberculosis and M/ XDR-TB Programme, Division of Communicable Diseases, Health Security & Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark 5: International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK
Publication date: October 21, 2014
Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.
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