S3 Factors for successful treatment completion among MDR TB cases in the UK

Abstract

Background: UK guidelines recommend at least 18 months treatment for patients with multi-drug resistant tuberculosis (MDR TB). Prior to 2008, treatment completion was only available for 12 months nationally in the UK, therefore the proportion completing treatment was unknown. There is also a lack of recent guidance for the treatment and management of MDR TB cases in resource rich low TB incidence settings. Aims: To report the treatment outcome at 24 months for MDR TB patients between 2004 and 2007 and examine treatment regimens and management associated with successful outcomes, taking clinical, social and demographic factors into account. Methods A retrospective cohort study was used to follow-up MDR TB patients at 24 months. Patients were identified using the national surveillance system which contains demographic and clinical characteristics of cases and is matched routinely to reference laboratory data. Questionnaires were sent out to case managers to collect information on outcome of care and associated risk factors for treatment completion. Results: 69.6% (142/204) of patients completed treatment at 24 months and 2.9% (6) of these completed treatment within 12 months. 4.4% (9) were still on treatment, 6.9% (14) had their treatment stopped, 6.9% (14) died, 7.8% (16) were lost to follow-up and 4.4% (9) were transferred overseas. Only 40.3% (77/191) patients started on treatment received directly observed therapy at any time. Treatment with a recommended fluoroquinolone (OR=2.3; 95% CI 1.2 to 4.2, p<0.000) or a bacteriostatic (OR 2.86; 95% CI 1.6 to 5.3, p=0.001), a change in treatment regimen (OR=2.2; 95% CI 1.2 to 4.0, p=0.01) and treatment with four or more effective drugs (OR=2.0; 95% CI 1.1 to 3.8, p=0.02) were significantly associated with a successful treatment outcome. Conclusion: The proportion of MDR TB cases completing treatment is similar to cases with drug susceptible disease due to the use of individualised treatment regimens. However, treatment completion still remains below World Health Organization targets.