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Treatment Outcomes of Multidrug-Resistant Tuberculosis in Taiwan: Tackling Loss to Follow-up

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 es...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030934/
https://www.ncbi.nlm.nih.gov/pubmed/29394358
http://dx.doi.org/10.1093/cid/ciy066
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author 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
author_facet 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
author_sort Yu, Ming-Chih
collection PubMed
description 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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spelling pubmed-60309342018-07-10 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 Clin Infect Dis Articles and Commentaries 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. Oxford University Press 2018-07-15 2018-01-31 /pmc/articles/PMC6030934/ /pubmed/29394358 http://dx.doi.org/10.1093/cid/ciy066 Text en © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Articles and Commentaries
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
title Treatment Outcomes of Multidrug-Resistant Tuberculosis in Taiwan: Tackling Loss to Follow-up
title_full Treatment Outcomes of Multidrug-Resistant Tuberculosis in Taiwan: Tackling Loss to Follow-up
title_fullStr Treatment Outcomes of Multidrug-Resistant Tuberculosis in Taiwan: Tackling Loss to Follow-up
title_full_unstemmed Treatment Outcomes of Multidrug-Resistant Tuberculosis in Taiwan: Tackling Loss to Follow-up
title_short Treatment Outcomes of Multidrug-Resistant Tuberculosis in Taiwan: Tackling Loss to Follow-up
title_sort treatment outcomes of multidrug-resistant tuberculosis in taiwan: tackling loss to follow-up
topic Articles and Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030934/
https://www.ncbi.nlm.nih.gov/pubmed/29394358
http://dx.doi.org/10.1093/cid/ciy066
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