Effectiveness of a government-organized and hospital-initiated treatment for multidrug-resistant tuberculosis patients--a retrospective cohort study

Abstract

Background: In contrast to the conventional model of hospital-treated and government directly observed treatment (DOT) for multidrug-resistant tuberculosis (MDR-TB) patient care, the Taiwan MDR-TB Consortium (TMTC) was launched in May 2007 with the collaboration of five medical care groups that have provided both care and DOT. This study aimed to determine whether the TMTC provided a better care model for MDR-TB patients than the conventional model.

Methods and findings: A total of 651 pulmonary MDR-TB patients that were diagnosed nation-wide from January 2000-August 2008 were enrolled. Of those, 290 (45%) MDR-TB patients whose initial sputum sample was taken in January 2007 or later were classified as patients in the TMTC era. All others were classified as patients in the pre-TMTC era. The treatment success rate at 36 months was better in the TMTC era group (82%) than in the pre-TMTC era group (61%) (p<0.001). With multiple logistic regressions, diagnosis in the TMTC era (adjusted odds ratio (aOR) 2.8, 95% confidence interval (CI) 1.9-4.2) was an independent predictor of a higher treatment success rate at 36 months. With the time-dependent proportional hazards method, a higher treatment success rate was still observed in the TMTC era group compared to the pre-TMTC era group (adjusted hazard ratio 6.3, 95% CI 4.2-9.5).

Conclusion: The improved treatment success observed in the TMTC era compared to the pre-TMTC era is encouraging. The detailed TMTC components that contribute the most to the improved outcome will need confirmation in follow-up studies with large numbers of MDR-TB patients.

Figure 1. Patient selection.

NSNCD, National Surveillance Network of Communicable Disease. MDR, multiple-drug resistance; TB, tuberculosis.

Figure 2. A comparison of the cumulative sputum conversion rates of multidrug-resistant tuberculosis (MDR-TB) cases in the pre-Taiwan MDR-TB Consortium (TMTC) era and the TMTC era.

Dashed line, pre-TMTC era; solid line, TMTC era; dotted line, 95% confidence interval (p<0.001 by the log-rank test).

Figure 3. Treatment outcomes of 651 multidrug-resistant tuberculosis (MDR-TB) patients after the administration of second-line drugs.

The cumulative success rate reveals that patients in the Taiwan MDR-TB Consortium (TMTC) era had a higher probability of treatment success than patients in the pre-TMTC era. Dashed line, pre-TMTC era; solid line, TMTC era; dotted line, 95% confidence interval (p<0.001 by the log-rank test).