Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study

Bin Chen; Xinyi Chen; Yanli Ren; Ying Peng; Fei Wang; Lin Zhou; Biao Xu

doi:10.1016/j.jiph.2023.05.012

Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study

J Infect Public Health. 2023 Jul;16(7):1073-1080. doi: 10.1016/j.jiph.2023.05.012. Epub 2023 May 12.

Authors

Bin Chen¹, Xinyi Chen², Yanli Ren³, Ying Peng², Fei Wang², Lin Zhou², Biao Xu⁴

Affiliations

¹ School of Public Health, Fudan University, Shanghai 200433, People's Republic of China; Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People's Republic of China.
² Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People's Republic of China.
³ School of Public Health, Hangzhou Normal University, Hangzhou 311121, People's Republic of China.
⁴ School of Public Health, Fudan University, Shanghai 200433, People's Republic of China; Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200433, People's Republic of China. Electronic address: bxu@shmu.edu.cn.

PMID: 37209611
DOI: 10.1016/j.jiph.2023.05.012

Abstract

Objectives: To address gaps in health services for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), a treatment cascade model was used to evaluate patient retention and attrition at each successive step required to achieve a successful treatment outcome.

Methods: From 2015-2018, a four-step treatment cascade model was established in patients with confirmed MDR/RR-TB in southeast China. Step 1: diagnosis of MDR/RR-TB, step 2: Initiation of treatment, step 3: still under treatment at 6 month and step 4: cure or completion of MDR/RR-TB treatment, with each successive step including a gap that shows attrition of patients between steps. The retention and attrition of each step were graphed. Multi-variate logistic regression was carried out to further identify potential factors associated with the attrition.

Results: In the treatment cascade consisting of 1752 MDR/RR-TB patients, the overall patient attrition rate was 55.8% (978/1752), with 28.0% (491/1752), 19.9% (251/1261), and 23.4% (236/1010) of patients attrition in the first, second, and third gap. Factors associated with MDR/RR-TB patients not initiating treatment included age ≥60 years (OR:2.875), and time for diagnosis ≥30 days (OR: 2.653). Patients who were diagnosed with MDR/RR-TB through rapid molecular test (OR: 0.517) and non-migrant residents of Zhejiang Province (OR: 0.273) both exhibited a lower likelihood of attrition during the treatment initiation phase. Meanwhile, old age (OR: 2.190) and non-resident migrants to the province were factors associated with not completing ≥ 6 months of treatment. Old age (OR: 3.883), retreatment (OR: 1.440), and time to diagnosis ≥30 days (OR: 1.626) were factors contributing to poor treatment outcomes.

Conclusion: Several programmatic gaps were identified in the MDR/RR-TB treatment cascade. Future policies should provide more comprehensive support for vulnerable populations to improve the care quality at each step.

Keywords: Multidrug-resistant tuberculosis; Retention in care; Rifampicin-resistant tuberculosis; Treatment cascade.

MeSH terms

Antitubercular Agents / therapeutic use
China / epidemiology
Humans
Infant
Middle Aged
Mycobacterium tuberculosis*
Retrospective Studies
Rifampin / therapeutic use
Treatment Outcome
Tuberculosis, Multidrug-Resistant* / diagnosis
Tuberculosis, Multidrug-Resistant* / drug therapy
Tuberculosis, Multidrug-Resistant* / epidemiology

Substances

Rifampin
Antitubercular Agents