Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study
Objectives: To address gaps in health services for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), a treatment cascade model was used to evaluate patient retention and attrition at each successive step required to achieve a successful treatment outcome. Methods: From 2015–2018, a four-s...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Journal of Infection and Public Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034123001673 |
| _version_ | 1797814396344336384 |
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| author | Bin Chen Xinyi Chen Yanli Ren Ying Peng Fei Wang Lin Zhou Biao Xu |
| author_facet | Bin Chen Xinyi Chen Yanli Ren Ying Peng Fei Wang Lin Zhou Biao Xu |
| author_sort | Bin Chen |
| collection | DOAJ |
| description | Objectives: To address gaps in health services for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), a treatment cascade model was used to evaluate patient retention and attrition at each successive step required to achieve a successful treatment outcome. Methods: From 2015–2018, a four-step treatment cascade model was established in patients with confirmed MDR/RR-TB in southeast China. Step 1: diagnosis of MDR/RR-TB, step 2: Initiation of treatment, step 3: still under treatment at 6 month and step 4: cure or completion of MDR/RR-TB treatment, with each successive step including a gap that shows attrition of patients between steps. The retention and attrition of each step were graphed. Multi-variate logistic regression was carried out to further identify potential factors associated with the attrition. Results: In the treatment cascade consisting of 1752 MDR/RR-TB patients, the overall patient attrition rate was 55.8% (978/1752), with 28.0% (491/1752), 19.9% (251/1261), and 23.4% (236/1010) of patients attrition in the first, second, and third gap. Factors associated with MDR/RR-TB patients not initiating treatment included age ≥60 years (OR:2.875), and time for diagnosis ≥30 days (OR: 2.653). Patients who were diagnosed with MDR/RR-TB through rapid molecular test (OR: 0.517) and non-migrant residents of Zhejiang Province (OR: 0.273) both exhibited a lower likelihood of attrition during the treatment initiation phase. Meanwhile, old age (OR: 2.190) and non-resident migrants to the province were factors associated with not completing ≥ 6 months of treatment. Old age (OR: 3.883), retreatment (OR: 1.440), and time to diagnosis ≥30 days (OR: 1.626) were factors contributing to poor treatment outcomes. Conclusion: Several programmatic gaps were identified in the MDR/RR-TB treatment cascade. Future policies should provide more comprehensive support for vulnerable populations to improve the care quality at each step. |
| first_indexed | 2024-03-13T08:07:06Z |
| format | Article |
| id | doaj.art-2fed09a3418c4b55b1ddca6f1c689ad5 |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-03-13T08:07:06Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj.art-2fed09a3418c4b55b1ddca6f1c689ad52023-06-01T04:35:26ZengElsevierJournal of Infection and Public Health1876-03412023-07-0116710731080Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort studyBin Chen0Xinyi Chen1Yanli Ren2Ying Peng3Fei Wang4Lin Zhou5Biao Xu6School of Public Health, Fudan University, Shanghai 200433, People’s Republic of China; Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People’s Republic of ChinaDepartment of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People’s Republic of ChinaSchool of Public Health, Hangzhou Normal University, Hangzhou 311121, People’s Republic of ChinaDepartment of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People’s Republic of ChinaDepartment of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People’s Republic of ChinaDepartment of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People’s Republic of ChinaSchool of Public Health, Fudan University, Shanghai 200433, People’s Republic of China; Key Laboratory of Health Technology Assessment, National Health Commission of the People’s Republic of China, Fudan University, Shanghai 200433, People’s Republic of China; Corresponding author at: School of Public Health, Fudan University, Shanghai 200433, People’s Republic of China.Objectives: To address gaps in health services for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), a treatment cascade model was used to evaluate patient retention and attrition at each successive step required to achieve a successful treatment outcome. Methods: From 2015–2018, a four-step treatment cascade model was established in patients with confirmed MDR/RR-TB in southeast China. Step 1: diagnosis of MDR/RR-TB, step 2: Initiation of treatment, step 3: still under treatment at 6 month and step 4: cure or completion of MDR/RR-TB treatment, with each successive step including a gap that shows attrition of patients between steps. The retention and attrition of each step were graphed. Multi-variate logistic regression was carried out to further identify potential factors associated with the attrition. Results: In the treatment cascade consisting of 1752 MDR/RR-TB patients, the overall patient attrition rate was 55.8% (978/1752), with 28.0% (491/1752), 19.9% (251/1261), and 23.4% (236/1010) of patients attrition in the first, second, and third gap. Factors associated with MDR/RR-TB patients not initiating treatment included age ≥60 years (OR:2.875), and time for diagnosis ≥30 days (OR: 2.653). Patients who were diagnosed with MDR/RR-TB through rapid molecular test (OR: 0.517) and non-migrant residents of Zhejiang Province (OR: 0.273) both exhibited a lower likelihood of attrition during the treatment initiation phase. Meanwhile, old age (OR: 2.190) and non-resident migrants to the province were factors associated with not completing ≥ 6 months of treatment. Old age (OR: 3.883), retreatment (OR: 1.440), and time to diagnosis ≥30 days (OR: 1.626) were factors contributing to poor treatment outcomes. Conclusion: Several programmatic gaps were identified in the MDR/RR-TB treatment cascade. Future policies should provide more comprehensive support for vulnerable populations to improve the care quality at each step.http://www.sciencedirect.com/science/article/pii/S1876034123001673Multidrug-resistant tuberculosisRifampicin-resistant tuberculosisTreatment cascadeRetention in care |
| spellingShingle | Bin Chen Xinyi Chen Yanli Ren Ying Peng Fei Wang Lin Zhou Biao Xu Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study Journal of Infection and Public Health Multidrug-resistant tuberculosis Rifampicin-resistant tuberculosis Treatment cascade Retention in care |
| title | Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study |
| title_full | Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study |
| title_fullStr | Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study |
| title_full_unstemmed | Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study |
| title_short | Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study |
| title_sort | treatment cascade for patients with multidrug or rifampicin resistant tuberculosis and associated factors with patient attrition in southeastern china a retrospective cohort study |
| topic | Multidrug-resistant tuberculosis Rifampicin-resistant tuberculosis Treatment cascade Retention in care |
| url | http://www.sciencedirect.com/science/article/pii/S1876034123001673 |
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