https://doi.org/10.4081/monaldi.2021.1677

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

Vol. 91 No. 1 (2021)
Published: January 14, 2021
Default, case fatality, treatment failure, home-based treatment, directly observed treatment (DOT), family DOT
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Authors

Lilit Khachatryan
l.khachatryan@moh.am
https://orcid.org/0000-0001-9683-2001
Global Fund Projects Coordinating Team, Ministry of Health, Yerevan, Armenia.
Ruzanna Grigoryan
Tuberculosis Research and Prevention Center, Yerevan, Armenia.
Andrei Dadu
World Health Organization, Regional Office for Europe, Copenhagen, Denmark.
Ajay M.V. Kumar
https://orcid.org/0000-0003-1011-8531
International Union Against Tuberculosis and Lung Disease, Paris, France.
Kristina Akopyan
https://orcid.org/0000-0003-0177-1870
Tuberculosis Research and Prevention Center, Yerevan, Armenia.
Kostyantyn Dumchev
https://orcid.org/0000-0003-2862-4977
Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
Hasmik Harutyunyan
Global Fund Projects Coordinating Team, Ministry of Health, Yerevan, Armenia.
Alberto Matteelli
University of Brescia, WHO Collaborative Centre for TB/HIV and Tuberculosis Elimination, Brescia, Italy.

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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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

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.

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