https://doi.org/10.4081/monaldi.2021.1677
Factors associated with unfavourable treatment outcomes among people with rifampicin-resistant tuberculosis in Armenia, 2014-2017
Published: January 14, 2021
Abstract Views: 1149
PDF: 591
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
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.
WHO. Global tuberculosis report 2019. Geneva: World Health Organization; 2019. Accessed on: 2019 Nov 22. Available from: https://www.who.int/tb/publications/global_report/en/
Acosta CD, Dadu A, Ramsay A, et al. Drug-resistant tuberculosis in Eastern Europe: challenges and ways forward. Public Heal Action 2014;4:S3-12.
WHO. Armenia country review report 2019. Geneva: World Health Organization; 2019.
WHO Regional Office for Europe. Tuberculosis surveillance and monitoring report in Europe 2019. Accessed 2020 Jul 1. Available from: https://www.euro.who.int/en/health-topics/communicable-diseases/tuberculosis/publications/2019/tuberculosis-surveillance-and-monitoring-report-in-europe-2019
WHO. Armenia TB profile 2018. Geneva: World Health Organization; 2019.
Migliori GB, Tiberi S, Zumla A, et al. MDR/XDR-TB management of patients and contacts: challenges facing the new decade. The 2020 clinical update by the global tuberculosis network. Int J Infect Dis 2020;92:S15–25.
Woldeyohannes D, Assefa T, Aman R, et al. Predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia. PLoS One 2019;14:e0224025.
Alffenaar JWC, Akkerman OW, Kim HY, et al. Precision and personalized medicine and anti-tb treatment: is tdm feasible for programmatic use? Int J Infect Dis 2020;92:S5–9.
Sanchez-Padilla E, Marquer C, Kalon S, et al. Reasons for defaulting from drug-resistant tuberculosis treatment in armenia: a quantitative and qualitative study. Int J Tuberc Lung Dis 2014;18:160–7.
Chem ED, Van Hout MC, Hope V. Treatment outcomes and antiretroviral uptake in multidrug-resistant tuberculosis and HIV co-infected patients in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2019;19:723.
Verdecchia M, Keus K, Blankley S, et al. Model of care and risk factors for poor outcomes in patients on multi-drug resistant tuberculosis treatment at two facilities in Eswatini (formerly Swaziland), 2011-2013. PLoS One 2018;13:e0205601.
Huangfu P, Ugarte-Gil C, Golub J, et al. The effects of diabetes on tuberculosis treatment outcomes: an updated systematic review and meta-analysis. Int J Tuberc Lung Dis 2019;23:783-96.
Choi H, Lee M, Chen RY, et al. Predictors of pulmonary tuberculosis treatment outcomes in South Korea: a prospective cohort study, 2005-2012. BMC Infect Dis 2014;14:360.
Parmar MM, Sachdeva KS, Dewan PK, et al. Unacceptable treatment outcomes and associated factors among India’s initial cohorts of multidrug-resistant tuberculosis (MDR-TB) patients under the revised national TB control programme (2007–2011): evidence leading to policy enhancement. PLoS One 2018;13:e0193903.
Htun YM, Khaing TMM, Aung NM, et al. Delay in treatment initiation and treatment outcomes among adult patients with multidrug-resistant tuberculosis at Yangon regional tuberculosis centre, Myanmar: a retrospective study. PLoS One 2018;13: e0209932.
Phuong NTM, Nhung NV, Hoa NB, et al. Management and treatment outcomes of patients enrolled in mdr-tb treatment in viet nam. Public Heal Action 2016;6:25-31.
Alegria-Flores K, Weiner BJ, Wiesen CA, et al. Innovative approach to the design and evaluation of treatment adherence interventions for drug-resistant TB. Int J Tuberc Lung Dis 2017;21:1160-1.
Bastard M, Sanchez-Padilla E, Hewison C, et al. Effects of treatment interruption patterns on treatment success among patients with multidrug-resistant tuberculosis in Armenia and Abkhazia. J Infect Dis 2015;211:1607–15.
Bastard M, Sanchez-Padilla E, Du Cros P, et al. Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: multicenter cohort study. PLoS One 2018;13: e0193491.
Ministry of Health of the Republic of Armenia. National tuberculosis strategy 2016-20. Accessed on: 2020 Aug 5. Available from: http://www.irtek.am/views/act.aspx?aid=84463
WHO. Review of financial sustainability of tuberculosis activities in Armenia. Accessed on: 2020 Jul 1. Available from: https://www.euro.who.int/__data/assets/pdf_file/0006/376998/armenia-fin-sust-tb-eng.pdf
WHO. Rapid communication: key changes to the treatment of drug-resistant tuberculosis. 2019. Accessed on: 2020 Jul 1. Available from: https://www.who.int/tb/publications/2019/WHO_RapidCommunicationMDR_TB2019.pdf?ua=1
WHO. Introduction of bedaquiline for the treatment of multidrug-resistant tuberculosis at country level. Accessed on: 2020 Jul 1. Available from: https://www.who.int/tb/publications/2015/Bedaquiline_implementation_plan.pdf?ua=1
WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. 2016. Accessed on: 2020 Jul 1. Available from: https://apps.who.int/iris/bitstream/handle/10665/208825/9789241549684_eng.pdf;jsessionid=CFDC692E793B2858A95868810F57808A?sequence=1
Avaliani Z, Gozalov O, Kuchukhidze G, et al. What is behind programmatic treatment outcome definitions for tuberculosis? Eur Res J 2020;56 2001751.
International Labour Organization (ILO). Migration and development Armenia country study, 2009. Accessed on: 2020 Jun 29. Available from: http://www.un.am/up/library/Migr_Dev_Study_eng.pdf
Muñnoz-Torrico M, Luna JC, Migliori GB, et al. Comparison of bacteriological conversion and treatment outcomes among mdr-tb patients with and without diabetes in mexico: preliminary data. Rev Port Pneumol 2017;23:27-30.
Atif M, Bashir A, Ahmad N, et al. Predictors of unsuccessful interim treatment outcomes of multidrug resistant tuberculosis patients. BMC Infect Dis 2017;17:655.
Leveri TH, Lekule I, Mollel E, et al. Predictors of treatment outcomes among multidrug resistant tuberculosis patients in Tanzania. Tuberc Res Treat 2019;2019:3569018.
Makhmudova M, Maxsumova Z, Rajabzoda A, et al. Risk factors for unfavourable treatment outcomes among rifampicin-resistant tuberculosis patients in Tajikistan. Int J Tuberc Lung Dis 2019;23:331-6.
Tola HH, Shojaeizadeh D, Garmaroudi G, et al. Psychological distress and its effect on tuberculosis treatment outcomes in Ethiopia. Glob Health Action 2015;8:29019.
Merid MW, Gezie LD, Kassa GM, et al. Incidence and predictors of major adverse drug events among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara regional state public hospitals; Ethiopia: a retrospective cohort study. BMC Infect Dis 2019;19:286.
Zhang Y, Wu S, Xia Y, et al. Adverse events associated with treatment of multidrug-resistant tuberculosis in china: an ambispective cohort study. Med Sci Monit 2017;23:2348-56.
Alene KA, Yi H, Viney K, et al. Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC Infect Dis 2017;17:573.
Migliori GB, Nardell E, Yedilbayev A, et al. Reducing tuberculosis transmission: a consensus document from the World Health Organization Regional Office for Europe. Eur Respir J 2019;53:1900391.
Khachadourian V, Truzyan N, Harutyunyan A, et al. People-centered tuberculosis care versus standard directly observed therapy: study protocol for a cluster randomized controlled trial. Trials 2015;16:281.
Ravenscroft L, Kettle S, Persian R, et al. Video-observed therapy and medication adherence for tuberculosis patients: randomised controlled trial in Moldova. Eur Respir J 2020;56:2000493.
Sinkou H, Hurevich H, Rusovich V, et al. Video-observed treatment for tuberculosis patients in Belarus: findings from the first programmatic experience. Eur Res J 2017;49: 1602049.
Wade VA, Karnon J, Eliott JA, et al. Home videophones improve direct observation in tuberculosis treatment: a mixed methods evaluation. PLoS One 2012;7:e50155.
Horter S, Stringer B, Reynolds L, et al. “Home is where the patient isâ€: a qualitative analysis of a patient-centred model of care for multi-drug resistant tuberculosis. BMC Health Serv Res 2014;14:81.
Mhimbira F, Hella J, Maroa T, et al. Home-based and facility-based directly observed therapy of tuberculosis treatment under programmatic conditions in urban Tanzania. PLoS One 2016;11:e0161171.
Bastard M, Guglielmetti L, Huerga H, et al. Bedaquiline and repurposed drugs for fluoroquinolone-resistant multidrug-resistant tuberculosis: how much better are they? Am J Res Care 2018;198:1228-31.
Hewison C, Bastard M, Khachatryan N, et al. Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia. Int J Tuberc Lung Dis 2018;22:766–72.
Mbuagbaw L, Guglielmetti L, Hewison C, et al. Outcomes of bedaquiline treatment in patients with multidrug-resistant tuberculosis. Emerg Infect Dis 2019;25:936–43.
Bonnet M, Bastard M, Du Cros P, et al. Identification of patients who could benefit from bedaquiline or delamanid: a multisite MDR-TB cohort study. Int J Tuberc Lung Dis 2016;20:177–86.
Skripconoka V, Danilovits M, Pehme L, et al. Delamanid improves outcomes and reduces mortality in multidrug-resistant tuberculosis. Eur Respir J 2013;41:1393–400.
Kuksa L, Barkane L, Hittel N, et al. Final treatment outcomes of multidrugand extensively drug-resistant tuberculosis patients in Latvia receiving delamanid-containing regimens. Eur Res J 2017;50.
List of essential medicines of ra [Internet]. Accessed on: 2020 Jul 1. Available from: http://digicollection.org/hss/documents/s17079e/s17079e.pdf
Truzyan N, Crape B, Grigoryan R, et al. Increased risk for multidrug-resistant tuberculosis in migratory workers, Armenia. Emerg Infect Dis 2015;21:474–6.
How to Cite
Khachatryan, Lilit, Ruzanna Grigoryan, Andrei Dadu, Ajay M.V. Kumar, Kristina Akopyan, Kostyantyn Dumchev, Hasmik Harutyunyan, and Alberto Matteelli. 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.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Daniel Brito, Igor Goykhman, Kevin Bryan Lo, Yaser Alhamshari, Jorge Luis Peñalver, Francisco Aguilar, Eduardo Quintero, Aditi Kalla, Evan Friend, Gregg S. Pressman, Aortic stenosis calcium scoring in a racially mixed sample , Monaldi Archives for Chest Disease: Vol. 90 No. 4 (2020)
- Cristiano van Zeller, Asad Anwar, Nordita Ramos-Bascon, Natalie Barnes, Brendan Madden, Pulmonary function, computerized tomography features and six-minute walk test at three months in severe COVID-19 patients treated with intravenous pulsed methylprednisolone: a preliminary report , Monaldi Archives for Chest Disease: Vol. 91 No. 4 (2021)
- Nicola Bernardi, Edoardo Sciatti, Edoardo Pancaldi, Fabio Alghisi, Andrea Drera, Raffaele Falco, Enrico Vizzardi, Coeliac and cardiovascular disease: a possible relationship between two apparently separate conditions , Monaldi Archives for Chest Disease: Vol. 93 No. 2 (2023)
- Davide Papi, Giulia Montigiani, Luca Bucciardini, How the work of respiratory physiotherapists changes the tracheostomy management and decannulation in a NICU department: an Italian experience , Monaldi Archives for Chest Disease: Vol. 93 No. 3 (2023)
- Francesca Gatta, Yama Haqzad, George Gradinariu, Pietro Giorgio Malvindi, Zubair Khalid, Rona L. Suelo-Calanao, Nader Moawad, Aladdin Bashir, Luke J. Rogers, Clinton Lloyd, Bao Nguyen, Karen Booth, Lu Wang, Nawwar Al-Attar, Neil McDowall, Stuart Watkins, Rana Sayeed, Saleh Baghdadi, Andrea D’Alessio, Maria Monteagudo-vela, Jasmina Djordjevic, Matej Goricar, Solveig Hoppe, Charlotte Bocking, Azar Hussain, Betsy Evans, Salman Arif, Christopher Malkin, Mark Field, Kully Sandhu, Amer Harky, Ahmed Torky, Mauin Uddin, Muhammad Abdulhakeem, Ayman Kenawy, John Massey, Neil Cartwright, Nathan Tyson, Niki Nicou, Kamran Baig, Mark Jones, Firas Aljanadi, Colum G. Owens, Tunde Oyebanji, Joseph Doyle, Mark S. Spence, Paul F. Brennan, Ganesh Manoharan, Taha Ramadan, Sunil Ohri, Mahmoud Loubani, Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis , Monaldi Archives for Chest Disease: Vol. 94 No. 1 (2024)
- Sophia K. Papathanasiou, Ilias E. Dimeas, Sotirios I. Sinis, Zoe Daniil, Konstantinos I. Gourgoulianis, Neck mass and bilateral pleural effusions in a 53-year-old female , Monaldi Archives for Chest Disease: Early Access
- Jacopo Cefalo, Carmine Salerni, Giulia Ferranti, Manuela Bimbatti, Laura Moneghini, Paolo Carlucci, Ottavia Viganò, Giulia Marchetti, Umberto Gianelli, Stefano Centanni, Giovanni Sotgiu, Michele Mondoni, Mediastinal lymphadenopathies and skin lesions in a 49-year-old Sinhalese man , Monaldi Archives for Chest Disease: Early Access
- Marco Ambrosetti, Advances in exercise rehabilitation for patients with Lower Extremity Peripheral Artery Disease , Monaldi Archives for Chest Disease: Vol. 86 No. 1-2 (2016): Cardiac series
- Naoto Ishimaru, Hisashi Ohnishi, Mao Fujii, Masako Yumura, Sho Yoshimura, Saori Kinami, Microscopic polyangiitis presented with biopsy-confirmed pleuritis , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- Nitesh Gupta, Sumita Agrawal, Pranav Ish, Suruchi Mishra, Rajni Gaind, Ganapathy Usha, Balvinder Singh, Manas Kamal Sen, *Safdarjung Hospital COVID 2019 working group, Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India , Monaldi Archives for Chest Disease: Vol. 90 No. 1 (2020)
<< < 88 89 90 91 92 93 94 95 96 97 > >>
You may also start an advanced similarity search for this article.
