Treatment quality and outcome for multidrug-resistant tuberculosis patients in four regions of China: a cohort study

Background:China incurs an extremely low treatment coverage of multidrug-resistant tuberculosis(MDR-TB).This study aimed to understand the experience of MDR-TB patients on quality of health care,and the clinical impact through an up to six-year follow-up.Methods:Cohorts of MDR-TB patients were built in TB/MDR-TB designated hospitals in four regions of China from 2014 to 2015.Patients were followed up during treatment course,and yearly confirmation afterward until 2019.Delay in MDR-TB diagnosis and treatment was calculated upon bacteriological confirmation and treatment initiation.Risk factors for unfavourable outcomes were identified by multivariate logistic regression.Results:Among 1168 bacteriological-positive TB patients identified from a 12-million population,58(5.0%)MDR-TB cases were detected.The median delay for MDR-TB diagnosis was 90.0 days,with 13.8%having a delay above 180.0 days.MDR-TB treatment was only recommended to 19(32.8%)participants,while the rest continued with regimen for drug-susceptible TB.In MDR-TB treatment group,36.8%achieved treatment success,while the others had incomplete treatment(21.1%),loss to follow-up(36.8%)and TB relapse(5.3%).For non-MDR-TB treatment group,33.3%succeeded,25.6%relapsed,2.6%failed,23.1%died,and 15.4%were lost to follow-up.Overall,only 35.7%(20/56)of detected MDR-TB patients had favourable outcomes and higher education level was positively associated with it(adjusted odds ratio[aOR]:3.60,95%confidence interval[CI]:1.04-12.5).Conclusions:A large proportion of patients did not receive MDR-TB treatment and had unfavourable outcomes.Delayed MDR-TB diagnosis resulted in poor quality of MDR-TB care.Rapid diagnosis,regulated patient management and high-quality MDR-TB treatment should be enhanced in China.

Rising challenge of multidrug-resistant tuberculosis in China:a predictive study using Markov modeling

Background:Multidrug-resistant tuberculosis(MDR-TB)is on the rise in China.This study used a dynamic Markov model to predict the longitudinal trends of MDR-TB in China by 2050 and to assess the effects of alternative control measures.Methods:Eight states of tuberculosis transmission were set up in the Markov model using a hypothetical cohort of 100000 people.The prevalence of MDR-TB and bacteriologically confirmed drug-susceptible tuberculosis(DS-TB+)were simulated and MDR-TB was stratified into whether the disease was treated with the recommended regimen or not.Results:Without any intervention changes to current conditions,the prevalence of DS-TB+was projected to decline 67.7%by 2050,decreasing to 20 per 100000 people,whereas that of MDR-TB was expected to triple to 58/100000.Furthermore,86.2%of the MDR-TB cases would be left untreated by the year of 2050.In the case where MDR-TB detection rate reaches 50%or 70%at 5%per year,the decline in prevalence of MDR-TB would be 25.9 and 36.2%respectively.In the case where treatment coverage was improved to 70%or 100%at 5%per year,MDR-TB prevalence in 2050 would decrease by 13.8 and 24.1%,respectively.If both detection rate and treatment coverage reach 70%,the prevalence of MDR-TB by 2050 would be reduced to 28/100000 by a 51.7%reduction.Conclusions:MDR-TB,especially untreated MDR-TB,would rise rapidly under China’s current MDR-TB control strategies.Interventions designed to promote effective detection and treatment of MDR-TB are imperative in the fights against MDR-TB epidemics.