Outcomes and follow-up of patients treated for multidrug-resistant tuberculosis in Orel, Russia, 2002-2005

• Type of Material: Article
• Authors: J. S. Cavanaugh, Centers for Disease Control and Prevention; B. Y. Kazennyy, Orel Oblast Central Tuberculosis Dispensary, Orel, Russia; Minhly Nguyen, Emory University; E. V. Kiryanova, Orel Oblast Central Tuberculosis Dispensary, Orel, Russia; E. Vitek, Centers for Disease Control and Prevention; T. M. Khorosheva, Orel Oblast Central Tuberculosis Dispensary, Orel, Russia; E. Nemtsova, Orel Oblast Central Tuberculosis Dispensary, Orel, Russia; J. Cegielski, Emory University
• Language: English
• Date: 2012-08-01
• Publisher: International Union Against Tuberculosis and Lung Disease
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 The Union.
• Final Published Version (URL): http://dx.doi.org/10.5588/ijtld.11.0696
• Title of Journal or Parent Work: The International Journal of Tuberculosis and Lung Disease
• Volume: 16
• Issue: 8
• Start Page: 1069
• End Page: 1074
• Grant/Funding Information: This work was supported by the US Agency for International Development and the US Centers for Disease Control and Prevention.
• Keywords: Retrospective cohort; Default; Life Sciences & Biomedicine; Science & Technology; recurrence; Implementation; Recurrence; Respiratory System; Management; Risk-factors; Metaanalysis; Alcohol; Infectious Diseases; XDR-TB; alcohol; MDR-TB; default
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

SETTING: Multidrug-resistant tuberculosis (MDR-TB) treatment facility, Orel Oblast, Russian Federation. OBJECTIVES: To determine factors associated with poor outcome and to document status of patients after recording of TB outcomes. DESIGN: Retrospective review of prospective single cohort. RESULTS: Among 192 patients, factors significantly associated with poor outcome in multivariate analysis include three or more treatment interruptions during the intensive phase of therapy and alcohol or drug addiction (adjusted OR [aOR] 2.1, 95%CI 1.0-4.3 and aOR 1.9, 95%CI 1.0-3.7). Previous treatment was associated with poor outcome, but only among smear-positive patients (aOR 3.1, 95%CI 1.3-7.3). Ten patients (5%) developed extensively drug-resistant TB (XDR-TB) during treatment; of 115 patients with at least 6 months of follow-up data after outcomes were recorded, 13 (11%) developed XDR-TB. CONCLUSION: Interventions focused on supporting patient adherence during the intensive phase of treatment; the management of drug and alcohol addiction should be developed and studied. A substantial proportion of patients developed XDR-TB during and after treatment. Longer term follow-up data of patients treated for MDR-TB are needed to better inform programmatic policy.