Risk factors for unfavourable treatment outcomes among rifampicin-resistant tuberculosis patients in Tajikistan.

ABSTRACT

SETTING: Tajikistan is among the 30 countries with the highest multidrug-resistant tuberculosis (MDR-TB) burden. OBJECTIVE: To investigate the risk factors for unfavourable treatment outcomes among rifampicin-resistant (RR)/MDR-TB patients. DESIGN: Retrospective medical chart review of RR/MDR-TB patients enrolled for treatment in 2012-2013. RESULTS: Of 601 RR/MDR-TB patients, 58 (9.7%) had pre-extensively drug-resistant TB (pre-XDR-TB; i.e., MDR-TB with additional resistance to a fluoroquinolone or second-line injectable agent) and 45 (8%) had XDR-TB (MDR-TB with additional resistance to both). Treatment failure and death were reported in respectively 40 (7%) and 89 (15%) cases; 60 (10%) patients were lost to follow-up (LTFU). In multivariable analysis, treatment failure was associated with pre-XDR-TB (adjusted odds ratio [aOR] 3.67, 95%CI 1.47-9.18) or XDR-TB (aOR 8.61, 95%CI 3.48-21.34). Death was associated with age >45 years vs. <25 years (aOR 3.47, 95%CI 1.68-7.19) and no record of any adverse event during treatment (aOR 2.55, 95%CI 1.48-4.39). Changing place of residence during treatment was an independent predictor of LTFU (aOR 4.61, 95%CI 2.41-8.8). CONCLUSIONS: Our findings highlight the need for 1) the use of regimens with new anti-tuberculosis drugs; 2) good handover of TB patients and 3) effective tracing mechanisms if patients change a place of residence to prevent LTFU.