Treatment quality and outcome for multidrug-resistant tuberculosis patients in four regions of China: a cohort study

查看全文 作　　者：Xu-Bin [1]Zheng;Vinod [2]K.Diwan;Qi [1]Zhao;Yi [1]Hu;Judith [3,4]Bruchfeld;Wei-Li [1]Jiang;Sven [2]Hoffner;Biao [1,2]Xu

机构地区：[1]Department of Epidemiology,School of Public Health and Key Laboratory of Public Health Safety(Ministry of Education),Fudan University,130 Dong An Road,Shanghai 200032,China;[2]Department of Global Public Health,Karolinska Institutet,Stockholm,Sweden;[3]Department of Infectious Diseases,Karolinska University Hospital,Stockholm,Sweden;[4]Division of Infectious Diseases,Department of Medicine Solna,Karolinska Institutet,Stockholm,Sweden

出　　处：《Infectious Diseases of Poverty》索引2020年第9卷第4期,共9页

基　　金：This study was supported by the Swedish Research Council(No.540-2013-8797 to Sven Hoffner);the National Natural Science Foundation of China(No.81361138019 to Biao Xu)joint project(VR-NSFC).The funders of the study had no role in study design,data collection,data analysis,data interpretation,or writing of the manuscript. 摘　　要：Background:China incurs an extremely low treatment coverage of multidrug-resistant tuberculosis(MDR-TB).This study aimed to understand the experience of MDR-TB patients on quality of health care,and the clinical impact through an up to six-year follow-up.Methods:Cohorts of MDR-TB patients were built in TB/MDR-TB designated hospitals in four regions of China from 2014 to 2015.Patients were followed up during treatment course,and yearly confirmation afterward until 2019.Delay in MDR-TB diagnosis and treatment was calculated upon bacteriological confirmation and treatment initiation.Risk factors for unfavourable outcomes were identified by multivariate logistic regression.Results:Among 1168 bacteriological-positive TB patients identified from a 12-million population,58(5.0%)MDR-TB cases were detected.The median delay for MDR-TB diagnosis was 90.0 days,with 13.8%having a delay above 180.0 days.MDR-TB treatment was only recommended to 19(32.8%)participants,while the rest continued with regimen for drug-susceptible TB.In MDR-TB treatment group,36.8%achieved treatment success,while the others had incomplete treatment(21.1%),loss to follow-up(36.8%)and TB relapse(5.3%).For non-MDR-TB treatment group,33.3%succeeded,25.6%relapsed,2.6%failed,23.1%died,and 15.4%were lost to follow-up.Overall,only 35.7%(20/56)of detected MDR-TB patients had favourable outcomes and higher education level was positively associated with it(adjusted odds ratio[aOR]:3.60,95%confidence interval[CI]:1.04-12.5).Conclusions:A large proportion of patients did not receive MDR-TB treatment and had unfavourable outcomes.Delayed MDR-TB diagnosis resulted in poor quality of MDR-TB care.Rapid diagnosis,regulated patient management and high-quality MDR-TB treatment should be enhanced in China. 关键词：MULTIDRUG-RESISTANT TUBERCULOSIS DELAY Treatment FOLLOW-UP China

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Treatment quality and outcome for multidrug-resistant tuberculosis patients in four regions of China: a cohort study

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