Unsuccessful treatment outcome and associated risk factors. A prospective study of DR-TB patients from a high burden country, Pakistan

• Published in: PloS one Vol. 18; no. 8; p. e0287966
• Main Authors: Massud, Asif, Khan, Amer Hayat, Syed Sulaiman, Syed Azhar, Ahmad, Nafees, Shafqat, Muhammad, Ming, Long Chiau
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.08.2023
• Subjects: Adult; Antitubercular Agents - therapeutic use; Biology and Life Sciences; Care and treatment; Cavitation; Clinical outcomes; Communicable diseases; Data collection; Diagnosis; Drug dosages; Drug resistance; Drug resistance in microorganisms; Evaluation; Female; Health risks; Humans; Infectious diseases; Laboratories; Male; Medical diagnosis; Medical research; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Mortality; Observational studies; Pakistan; Pakistan - epidemiology; Patient outcomes; Patients; People and Places; Physical Sciences; Prospective Studies; Regression analysis; Research and Analysis Methods; Retrospective Studies; Risk Factors; Statistical analysis; Treatment Outcome; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis, Multidrug-Resistant - drug therapy; World health; Young Adult; Pakistan; India
• DOI: 10.1371/journal.pone.0287966
• ISSN: 1932-6203

Tuberculosis (TB), a curable and preventable infectious disease, becomes difficult to treat if resistance against most effective and tolerable first line anti-TB drugs is developed. The objective of the present study was to evaluate the treatment outcomes and predictors of poor outcomes among drug-resistant tuberculosis (DR-TB) patients treated at a programmatic management unit of drug resistant tuberculosis (PMDT) unit, Punjab, Pakistan. This prospective observational study was conducted at a a PMDT unit in Multan, Punjab, Pakistan. A total of 271 eligible culture positive DR-TB patients enrolled for treatment at the study site between January 2016 and May 2017 were followed till their treatment outcomes were recorded. World Health Organization's (WHO) defined criteria was used for categorizing treatment outcomes. The outcomes of cured and treatment completed were collectively placed as successful outcomes, while death, lost to follow-up (LTFU) and treatment failure were grouped as unsuccessful outcomes. Multivariable binary logistic regression analysis was employed for getting predictors of unsuccessful treatment outcomes. A p-value <0.05 was considered statistically significant. Of the 271 DR-TB patients analysed, nearly half (51.3%) were males. The patient's (Mean ± SD) age was 36.75 ± 15.69 years. A total of 69% patients achieved successful outcomes with 185 (68.2%) patients being cured and 2 (0.7%) completed therapy. Of the remaining 84 patients with unsuccessful outcomes, 48 (17.7%) died, 2 (0.7%) were declared treatment failure, 34 (12.5%) were loss to follow up. After adjusting for confounders, patients' age > 50 years (OR 2.149 (1.005-4.592) with p-value 0.048 and baseline lung cavitation (OR 7.798 (3.82-15.919) with p-value <0.001 were significantly associated with unsuccessful treatment outcomes. The treatment success rate (69%) in the current study participants was below the target set by WHO (>75%). Paying special attention and timely intervention in patients with high risk of unsuccessful treatment outcomes may help in improving treatment outcomes at the study site.