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

7 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

    Fingerprint

Keywords

  • MDR
  • multidrug resistance
  • outcome
  • tuberculosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Yu, M. C., Chiang, C. Y., Lee, J. J., Chien, S. T., Lin, C. J., Lee, S. W., Lin, C. B., Yang, W. T., Wu, Y. H., & Huang, Y. W. (2018). Treatment outcomes of multidrug-resistant tuberculosis in Taiwan: Tackling loss to follow-up. Clinical Infectious Diseases, 67(2), 202-210. https://doi.org/10.1093/cid/ciy066