Treatment interruption and directly observed treatment for patients with multidrug-resistant tuberculosis in China: a cross-sectional survey

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• 作者：Prof Xiaolin Wei ; PhD^a ; Jia Yin ; MD^a ; Guanyang Zou ; MD^b ; Zhitong Zhang ; MD^b ; Prof John Walley ; MD^c ; Prof Joseph Harwell ; PhD^a ; Haitao Li ; BA^d ; Prof Qiang Sun ; PhD^e ; Renzhong Li ; PhD^f ; Lixia Wang ; PhD^f ; Dr Xiulei Zhang ; MD^d ; ^{zhangxiulei0531@126.com" class="auth_mail" title="E-mail the corresponding author}
• 刊名：The Lancet
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：386
• 期：supp_S1
• 页码：S22
• 全文大小：54 K

文摘

China has nearly a fifth of all cases of multidrug-resistant tuberculosis and follows WHO's standardised 24 month regimens. The aim of this study was to assess treatment interruption in patients with multidrug-resistant tuberculosis and its association with the provision of directly observed treatment.

Methods

We reviewed clinical charts and administered a questionnaire survey to all patients with confirmed multidrug-resistant tuberculosis who had been treated for at least 6 months between Jan 1, 2009, and April 30, 2012, in Shandong province, China. This questionnaire was developed by a panel of experts but has yet to be validated. The primary outcome was treatment interruption and logistic regression was used to explore its associated factors. Treatment interruption was defined as missing a dose for at least 1 day for less than 8 consecutive weeks. Severe interruption was defined as missing doses for 2–8 consecutive weeks. Ethics approval was obtained from the Ethics Committees of the University of Leeds, Leeds, UK, and Shandong Provincial Chest Hospital, Jinan, China. Patient consent forms were collected at the beginning of the survey.

Findings

Of 110 patients, 75 (68%) interrupted treatment. 19 (17%) patients reported severe interruption, with a median duration of 30 days (IQR 15–50). Of the 110 patients, 26 (24%) received injections from family members, and 55 (50%) patients received directly observed treatment (7 [13%] from village doctors and 48 [87%] from family members). Patients who underwent directly observed treatment with a family member had less severe interruptions (odds ratio 0·25, 95% CI 0·05–0·98) than patients who were given directly observed treatment by a village doctor or who did not undergo treatment.

Interpretation

We found that directly observed treatment by family members was linked to fewer severe treatment interruptions, which indicates that family members should be properly trained to provide directly observed treatment to patients with multidrug-resistant tuberculosis and that more structured involvement of family members should be prospectively studied as a potentially effective service delivery approach for this disease.

Funding

The Communicable Disease and Health Service Delivery (Comdis-HSD) Research Consortium is funded by the Department of International Development of the UK Government (grant number HRPC09).