Factors associated with unfavourable treatment outcomes among people with rifampicin-resistant tuberculosis in Armenia, 2014-2017

Abstract

Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) is recognized as a major public health concern globally. In Armenia, the proportion of RR/MDR-TB is increasing among all people affected with TB. We conducted a nationwide cohort study involving analysis of programmatic data to investigate the rates of and factors associated with unfavourable treatment outcomes among patients with RR/MDR-TB registered by the national TB programme from 2014 to 2017 in Armenia. We used Cox regression to identify factors associated with the outcome. Among 451 RR/MDR-TB patients, 80% were men and median age was 46 years. Of them, 53 (11.8%) had Extensively Drug-Resistant Tuberculosis (XDR-TB) and 132 (29.3%) had pre-XDR-TB. Almost half (224, 49.7%) of the patients had unfavourable treatment outcome, which included 26.8% Loss To Follow-Up (LTFU), 13.3% failures and 9.5% deaths. In multivariable analysis, people with pre-XDR-TB [adjusted Hazard Ratio [aHR] 3.13, 95% confidence intervals [CI] 2.16-4.55] and XDR-TB (aHR 4.08, 95% CI 2.45-6.79) had a higher risk of unfavourable outcomes. Patients receiving home-based treatment (71/451, 15.7%) and treatment with new drugs (172/451, 38.1%) had significantly lower risk (aHR 0.45, 95% CI 0.28-0.72 and aHR 0.26, 95% CI 0.18-0.39) of unfavourable treatment outcome.  The proportion of MDR-TB patients reaching favourable treatment outcome in Armenia was substantially lower than the recommended level (75%). The most common treatment outcome was LTFU indicating the need for further assessment of underlying determinants. Home-based treatment looks promising and future studies are required to see if expanding it to all RR/MDR-TB patients is feasible and cost-effective.

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Author Biographies

Ajay M.V. Kumar, International Union Against Tuberculosis and Lung Disease, Paris

International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi;
Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India

Kristina Akopyan, Tuberculosis Research and Prevention Center, Yerevan

World Health Organization,  Regional Office for Europe, Copenhagen, Denmark

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Published
2021-01-14
Info
Issue
Section
Thematic Articles
Keywords:
Default, case fatality, treatment failure, home-based treatment, directly observed treatment (DOT), family DOT
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How to Cite
Khachatryan, L., Grigoryan, R., Dadu, A., Kumar, A. M., Akopyan, K., Dumchev, K., Harutyunyan, H., & Matteelli, A. (2021). Factors associated with unfavourable treatment outcomes among people with rifampicin-resistant tuberculosis in Armenia, 2014-2017 . Monaldi Archives for Chest Disease, 91(1). https://doi.org/10.4081/monaldi.2021.1677

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