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

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Infectious Diseases of Poverty 2020年第4期9卷 75-83页

作者： Xu-Bin Zheng Vinod K.Diwan Qi Zhao Yi Hu judith bruchfeld Wei-Li Jiang Sven Hoffner Biao Xu Department of Epidemiology School of Public Health and Key Laboratory of Public Health Safety(Ministry of Education)Fudan University130 Dong An RoadShanghai 200032China Department of Global Public Health Karolinska InstitutetStockholmSweden Department of Infectious Diseases Karolinska University HospitalStockholmSweden Division of Infectious Diseases Department of Medicine SolnaKarolinska InstitutetStockholmSweden

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.

关键词： Multidrug-resistant Tuberculosis Delay Treatment Follow-up China

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