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Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies

BACKGROUND: Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) is a key issue that cannot be ignored. There is a paucity of evidence that...

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Autores principales: Kibret, Kelemu Tilahun, Moges, Yonatan, Memiah, Peter, Biadgilign, Sibhatu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240443/
https://www.ncbi.nlm.nih.gov/pubmed/28093078
http://dx.doi.org/10.1186/s40249-016-0214-x
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author Kibret, Kelemu Tilahun
Moges, Yonatan
Memiah, Peter
Biadgilign, Sibhatu
author_facet Kibret, Kelemu Tilahun
Moges, Yonatan
Memiah, Peter
Biadgilign, Sibhatu
author_sort Kibret, Kelemu Tilahun
collection PubMed
description BACKGROUND: Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) is a key issue that cannot be ignored. There is a paucity of evidence that assessed studies on the treatment of MDR-TB, which focus on the effectiveness of the directly observed treatment, short-course (DOTS)-Plus program. Therefore, it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years. The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus. METHODS: A systematic review and meta-analysis of published literature was conducted. Original studies were identified using the databases MEDLINE®/PubMed®, Hinari, and Google Scholar. Heterogeneity across studies was assessed using the Cochran’s Q test and I(2) statistic. Pooled estimates of treatment outcomes were computed using the random effect model. RESULTS: Based on the 14 observational studies included in the meta-analysis, it was determined that 5 047 patients reported treatment outcomes. Of these, the pooled prevalence, 63.5% (95% CI: 58.4–68.5%) successfully completed full treatment (cured or treatment completed) with a pooled cure rate of 55.6%, whereas 12.6% (95% CI: 9.0–16.2%) of the patients died, 14.2% (95% CI: 11.6–16.8%) defaulted from therapy, and 7.6% (95% CI: 5.6–9.7%) failed therapy. Overall 35.4% (95% CI: 30–40.8%) of patients had unsuccessful treatment outcomes. An unsatisfactorily high percentage 43% (95% CI: 32–54%) of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens. CONCLUSION: This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%. The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations. A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones. Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40249-016-0214-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-52404432017-01-23 Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies Kibret, Kelemu Tilahun Moges, Yonatan Memiah, Peter Biadgilign, Sibhatu Infect Dis Poverty Research Article BACKGROUND: Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) is a key issue that cannot be ignored. There is a paucity of evidence that assessed studies on the treatment of MDR-TB, which focus on the effectiveness of the directly observed treatment, short-course (DOTS)-Plus program. Therefore, it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years. The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus. METHODS: A systematic review and meta-analysis of published literature was conducted. Original studies were identified using the databases MEDLINE®/PubMed®, Hinari, and Google Scholar. Heterogeneity across studies was assessed using the Cochran’s Q test and I(2) statistic. Pooled estimates of treatment outcomes were computed using the random effect model. RESULTS: Based on the 14 observational studies included in the meta-analysis, it was determined that 5 047 patients reported treatment outcomes. Of these, the pooled prevalence, 63.5% (95% CI: 58.4–68.5%) successfully completed full treatment (cured or treatment completed) with a pooled cure rate of 55.6%, whereas 12.6% (95% CI: 9.0–16.2%) of the patients died, 14.2% (95% CI: 11.6–16.8%) defaulted from therapy, and 7.6% (95% CI: 5.6–9.7%) failed therapy. Overall 35.4% (95% CI: 30–40.8%) of patients had unsuccessful treatment outcomes. An unsatisfactorily high percentage 43% (95% CI: 32–54%) of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens. CONCLUSION: This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%. The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations. A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones. Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40249-016-0214-x) contains supplementary material, which is available to authorized users. BioMed Central 2017-01-17 /pmc/articles/PMC5240443/ /pubmed/28093078 http://dx.doi.org/10.1186/s40249-016-0214-x Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kibret, Kelemu Tilahun
Moges, Yonatan
Memiah, Peter
Biadgilign, Sibhatu
Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies
title Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies
title_full Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies
title_fullStr Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies
title_full_unstemmed Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies
title_short Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies
title_sort treatment outcomes for multidrug-resistant tuberculosis under dots-plus: a systematic review and meta-analysis of published studies
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240443/
https://www.ncbi.nlm.nih.gov/pubmed/28093078
http://dx.doi.org/10.1186/s40249-016-0214-x
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