Treatment outcomes of multidrug-resistant tuberculosis in Taiwan: Tackling loss to follow-up

Ming Chih Yu, Chen Yuan Chiang, Jen Jyh Lee, Shun Tien Chien, Chou Jui Lin, Shih Wei Lee, Chih Bin Lin, Wen Ta Yang, Ying Hsun Wu, Yi Wen Huang

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background The proportion of treatment success among patients with multidrug-resistant tuberculosis (MDR-TB) enrolled between 1992 and 1996 was 51.2%, and that among patients enrolled between 2000 and April 2007 was 61%. To address the challenge of MDR-TB, the Taiwan MDR-TB Consortium (TMTC) was established in May 2007. To assess the performance of the TMTC, we analyzed the data of patients enrolled in its first 5 years. Methods Comprehensive care was provided at no cost to patients, who were usually hospitalized for 1 month initially. Treatment regimens consisted of 4-5 drugs and the duration of treatment was 18-24 months. A case manager and a directly observed therapy provider were assigned to each patient. Psychosocial support was provided to address emotional stress and stigma. Financial support was offered to avoid the financial hardship faced by patients and their families. We assessed treatment outcomes at 30 months using internationally recommended outcome definitions. Results Of the 692 MDR-TB patients, 570 (82.4%) were successfully treated, 84 (12.1%) died, 18 (2.6%) had treatment failure, and 20 (2.9%) were lost to follow-up. Age ≥65 years (adjusted odds ratio [aOR], 6.78 [95% confidence interval {CI}, 3.14-14.63]), cancer (aOR, 11.82 [95% CI, 5.55-25.18]), and chronic kidney disease (aOR, 3.62 [95% CI, 1.70-7.71]) were significantly associated with death. Resistance to fluoroquinolone (aOR, 10.89 [95% CI, 3.97-29.88]) was significantly associated with treatment failure. Conclusions The TMTC, which operates under a strong collaboration between the public health authority and clinical teams, has been a highly effective model of care in the management of MDR-TB.

Original languageEnglish
Pages (from-to)202-210
Number of pages9
JournalClinical Infectious Diseases
Volume67
Issue number2
DOIs
Publication statusPublished - Jul 2 2018

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Multidrug-Resistant Tuberculosis
Taiwan
Odds Ratio
Confidence Intervals
Treatment Failure
Directly Observed Therapy
Financial Support
Lost to Follow-Up
Fluoroquinolones
Chronic Renal Insufficiency
Psychological Stress
Therapeutics
Public Health
Costs and Cost Analysis
Pharmaceutical Preparations

Keywords

  • MDR
  • multidrug resistance
  • outcome
  • tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Treatment outcomes of multidrug-resistant tuberculosis in Taiwan : Tackling loss to follow-up. / Yu, Ming Chih; Chiang, Chen Yuan; Lee, Jen Jyh; Chien, Shun Tien; Lin, Chou Jui; Lee, Shih Wei; Lin, Chih Bin; Yang, Wen Ta; Wu, Ying Hsun; Huang, Yi Wen.

In: Clinical Infectious Diseases, Vol. 67, No. 2, 02.07.2018, p. 202-210.

Research output: Contribution to journalArticle

Yu, MC, Chiang, CY, Lee, JJ, Chien, ST, Lin, CJ, Lee, SW, Lin, CB, Yang, WT, Wu, YH & Huang, YW 2018, 'Treatment outcomes of multidrug-resistant tuberculosis in Taiwan: Tackling loss to follow-up', Clinical Infectious Diseases, vol. 67, no. 2, pp. 202-210. https://doi.org/10.1093/cid/ciy066
Yu, Ming Chih ; Chiang, Chen Yuan ; Lee, Jen Jyh ; Chien, Shun Tien ; Lin, Chou Jui ; Lee, Shih Wei ; Lin, Chih Bin ; Yang, Wen Ta ; Wu, Ying Hsun ; Huang, Yi Wen. / Treatment outcomes of multidrug-resistant tuberculosis in Taiwan : Tackling loss to follow-up. In: Clinical Infectious Diseases. 2018 ; Vol. 67, No. 2. pp. 202-210.
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abstract = "Background The proportion of treatment success among patients with multidrug-resistant tuberculosis (MDR-TB) enrolled between 1992 and 1996 was 51.2{\%}, and that among patients enrolled between 2000 and April 2007 was 61{\%}. To address the challenge of MDR-TB, the Taiwan MDR-TB Consortium (TMTC) was established in May 2007. To assess the performance of the TMTC, we analyzed the data of patients enrolled in its first 5 years. Methods Comprehensive care was provided at no cost to patients, who were usually hospitalized for 1 month initially. Treatment regimens consisted of 4-5 drugs and the duration of treatment was 18-24 months. A case manager and a directly observed therapy provider were assigned to each patient. Psychosocial support was provided to address emotional stress and stigma. Financial support was offered to avoid the financial hardship faced by patients and their families. We assessed treatment outcomes at 30 months using internationally recommended outcome definitions. Results Of the 692 MDR-TB patients, 570 (82.4{\%}) were successfully treated, 84 (12.1{\%}) died, 18 (2.6{\%}) had treatment failure, and 20 (2.9{\%}) were lost to follow-up. Age ≥65 years (adjusted odds ratio [aOR], 6.78 [95{\%} confidence interval {CI}, 3.14-14.63]), cancer (aOR, 11.82 [95{\%} CI, 5.55-25.18]), and chronic kidney disease (aOR, 3.62 [95{\%} CI, 1.70-7.71]) were significantly associated with death. Resistance to fluoroquinolone (aOR, 10.89 [95{\%} CI, 3.97-29.88]) was significantly associated with treatment failure. Conclusions The TMTC, which operates under a strong collaboration between the public health authority and clinical teams, has been a highly effective model of care in the management of MDR-TB.",
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AU - Chiang, Chen Yuan

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AU - Chien, Shun Tien

AU - Lin, Chou Jui

AU - Lee, Shih Wei

AU - Lin, Chih Bin

AU - Yang, Wen Ta

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AU - Huang, Yi Wen

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AB - Background The proportion of treatment success among patients with multidrug-resistant tuberculosis (MDR-TB) enrolled between 1992 and 1996 was 51.2%, and that among patients enrolled between 2000 and April 2007 was 61%. To address the challenge of MDR-TB, the Taiwan MDR-TB Consortium (TMTC) was established in May 2007. To assess the performance of the TMTC, we analyzed the data of patients enrolled in its first 5 years. Methods Comprehensive care was provided at no cost to patients, who were usually hospitalized for 1 month initially. Treatment regimens consisted of 4-5 drugs and the duration of treatment was 18-24 months. A case manager and a directly observed therapy provider were assigned to each patient. Psychosocial support was provided to address emotional stress and stigma. Financial support was offered to avoid the financial hardship faced by patients and their families. We assessed treatment outcomes at 30 months using internationally recommended outcome definitions. Results Of the 692 MDR-TB patients, 570 (82.4%) were successfully treated, 84 (12.1%) died, 18 (2.6%) had treatment failure, and 20 (2.9%) were lost to follow-up. Age ≥65 years (adjusted odds ratio [aOR], 6.78 [95% confidence interval {CI}, 3.14-14.63]), cancer (aOR, 11.82 [95% CI, 5.55-25.18]), and chronic kidney disease (aOR, 3.62 [95% CI, 1.70-7.71]) were significantly associated with death. Resistance to fluoroquinolone (aOR, 10.89 [95% CI, 3.97-29.88]) was significantly associated with treatment failure. Conclusions The TMTC, which operates under a strong collaboration between the public health authority and clinical teams, has been a highly effective model of care in the management of MDR-TB.

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