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Free Content Outcome definitions for multidrug-resistant tuberculosis treated with shorter treatment regimens

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OBJECTIVE: To assess whether the revised 2013 World Health Organization (WHO) definitions for multidrug-resistant tuberculosis (MDR-TB) treatment outcomes apply to shorter treatment regimens in low- and middle-income countries and to propose modified criteria.

METHODS: Criteria for ‘failure' and ‘cure' outcomes were assessed using data on 1006 patients enrolled in an observational study on the standardised 9–11 month shorter MDR-TB regimen in Africa.

RESULTS: Absence of conversion in the intensive phase, a WHO criteria for failure, was the worst performing criterion; reversion had low sensitivity and other criteria provided limited added value. Based on our study results, we propose new definitions for ‘treatment failure' as treatment termination or the permanent discontinuation of 2 anti-tuberculosis drugs due to 1) positive culture after 6 months of treatment (except for one isolated positive culture) or 2) at least two consecutive grade 2+ positive sputum smears after 6 months of treatment if culture is not available; and for ‘cure' as treatment completion without proof of failure AND two consecutive negative cultures taken 30 days apart, one of which should be after 6 months of treatment.

CONCLUSION: The proposed new definitions are applicable to shorter regimens in low- and middle-income countries, and should also work for the newly recommended longer regimens.
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Keywords: MDR-TB; definition; outcome; shorter regimen; treatment

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Paris, France 2: International Union Against Tuberculosis and Lung Disease, Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 3: International Union Against Tuberculosis and Lung Disease, Paris, France, Institut de Recherche pour le Développement, Mère et Enfant face aux Infections tropicales, Paris 5 University, Sorbonne Paris Cité, Paris, France 4: International Union Against Tuberculosis and Lung Disease, Paris, France, Institut de Médecine Tropicale, Anvers, Belgium 5: Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Tuberculosis Consultant Services, Kirchlindach, Switzerland

Publication date: May 1, 2019

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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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