Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 15;28(2):10.7196/AJTCCM.2022.v28i2.177.
doi: 10.7196/AJTCCM.2022.v28i2.177. eCollection 2022.

Comparison of treatment outcome definitions in drug-resistant tuberculosis patients with high incidence of acquired second-line drug resistance

K Anderson  1   2 , E Pietersen  1 , K Dheda  1   3   4 , Y F van der Heijden  5   6   7
Affiliations

Comparison of treatment outcome definitions in drug-resistant tuberculosis patients with high incidence of acquired second-line drug resistance

K Anderson et al. Afr J Thorac Crit Care Med. .

Abstract

Background: Simplified drug-resistant tuberculosis (DR-TB) treatment outcome definitions, mostly centred around receipt of treatment and sputum culture status at 6 months after treatment initiation, have been proposed, but have not been widely evaluated in resource-limited settings.

Objectives: To compare DR-TB treatment outcomes, as defined by the World Health Organization (WHO) at the time of treatment, with simplified definitions.

Methods: We performed retrospective folder reviews of a cohort of 246 South African DR-TB patients, most of whom developed second-line drug resistance. Sequential treatment outcomes were assigned retrospectively using both simplified Tuberculosis Network European Trials Group (TBNET)-based and 2013 WHO-based definitions.

Results: Of 246 patients, 40% were HIV-positive, and 88% developed second-line drug resistance. Patients were observed for a median of 38 (interquartile range 24 - 63) months from DR-TB treatment initiation. Using WHO-based definitions, 93% of patients had >1 sequential outcome, whereas with simplified definitions, 25% of patients had >1 outcome. Fewer outcomes of cure (3% v. 9%) and more outcomes of treatment failure (42% v. 22%) were assigned using simplified definitions.

Conclusion: Simplified outcome definitions applied to real-world patients with long, often complex treatment histories resulted in underestimating cures and overestimating treatment failures compared with WHO-based definitions. Simplified definitions may identify more individuals at higher risk for treatment failure than WHO-based definitions, but without consistent programmatic follow-up it may be difficult to distinguish cure, failure and loss to follow-up.

Keywords: DR-TB treatment outcome; Drug resistant tuberculosis.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: None.

Figures

Fig. 1
Fig. 1
Comparison of most recent drug-resistant tuberculosis treatment outcomes in 246 adult patients using simplified Tuberculosis Network European Trials Group (TBNET)-based definitions v. World Health Organization (WHO)-based definitions.
See this image and copyright information in PMC

References

    1. World Health Organization [Internet] Geneva: WHO; 2006. [16 May 2021]. Guidelines for the programmatic management of drug-resistant tuberculosis 2006. https://www.who.int/tb/publications/2006/pmdt_guidelines_2006.pdf
    1. World Health Organization [Internet] Geneva: WHO; 2008. [16 May 2021]. Guidelines for the programmatic management of drugresistant tuberculosis – emergency update 2008. http://apps.who.int/iris/bitstream/handle/10665/43965/9789241547581_eng...
    1. World Health Organization [Internet] WHO; 2013. [2 March 2021]. Definitions and reporting framework for tuberculosis – 2013 revision (updated December 2014 and January 2020) https://apps.who.int/iris/bitstream/handle/10665/79199/9789241505345_en...
    1. Furin J, Alirol E, Allen E, et al. Drug-resistant tuberculosis clinical trials: Proposed core research definitions in adults. Int J Tuberc Lung Dis. 2016;20(3):290–294. doi: 10.5588/ijtld.15.0490. - DOI - PMC - PubMed
    1. Günther G, Alexandru S, Altet N, et al. Treatment outcomes in multidrug-resistant tuberculosis. N Engl J Med. 2016;375(11):1103–1105. doi: 10.1056/NEJMc1603274. - DOI - PubMed

LinkOut - more resources