Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India.


Dina, N.; Banurekha, V.V.; Kannan, T.; Tripathy, J.P.; Harries, A.D.; Mohan, N.; Swaminathan, S.


Public Health Action; 2017; 7; 32-38.


Setting: India has one of the highest global rates of multidrug- resistant tuberculosis (MDR-TB), which is associated with poor treatment outcomes. A better understanding of the risk factors for unfavourable outcomes is needed.


Objectives: To describe 1) the demographic and clinical characteristics of MDR-TB patients registered in three states of India during 20092011, 2) treatment outcomes, and 3) factors associated with unfavourable outcomes.


Design: A retrospective cohort study involving a record review of registered MDR-TB patients.


Results: Of 788 patients, 68% were male, 70% were aged 1544 years, 90% had failed previous anti-tuberculosis treatment or were retreatment smear-positive, 60% had a body mass index < 18.5 kg/m 2 and 72% had additional resistance to streptomycin and/or ethambutol. The median time from sputum collection to the start of MDR-TB treatment was 128 days (IQR 103173). Unfavourable outcomes occurred in 40% of the patients, mostly from death or loss to follow-up. Factors significantly associated with unfavourable outcomes included male sex, age > 45 years, being underweight and infection with the human immunodeficiency virus. Adverse drug reactions were reported in 24% of patients, with gastrointestinal disturbance, psychiatric morbidity and ototoxicity the most common.


Conclusion: Long delays from sputum collection to treatment initiation using conventional methods, along with poor treatment outcomes, suggest the need to scale up rapid diagnostic tests and shorter regimens for MDR-TB.


Keywords: MDR-TB; treatment; outcomes; India; operational research

Back to List of publications / Home