Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods
Background This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) before and after the implementation of public–private mix (PPM). Factors affecting treatment success were also investigated. Methods Data from culture-confirmed pulmonary MDR-TB patients...
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| Format: | Article |
| Language: | English |
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The Korean Academy of Tuberculosis and Respiratory Diseases
2021-01-01
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| Series: | Tuberculosis and Respiratory Diseases |
| Subjects: | |
| Online Access: | http://www.e-trd.org/upload/pdf/trd-2020-0093.pdf |
| _version_ | 1818339411036733440 |
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| author | Yewon Kang Eun-Jung Jo Jung Seop Eom Mi-Hyun Kim Kwangha Lee Ki Uk Kim Hye-Kyung Park Min Ki Lee Jeongha Mok |
| author_facet | Yewon Kang Eun-Jung Jo Jung Seop Eom Mi-Hyun Kim Kwangha Lee Ki Uk Kim Hye-Kyung Park Min Ki Lee Jeongha Mok |
| author_sort | Yewon Kang |
| collection | DOAJ |
| description | Background This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) before and after the implementation of public–private mix (PPM). Factors affecting treatment success were also investigated. Methods Data from culture-confirmed pulmonary MDR-TB patients who commenced MDR-TB treatment at Pusan National University Hospital between January 2003 and December 2017 were retrospectively reviewed. Patients were divided into two groups in terms of PPM status: pre-PPM period, patients who commenced MDR-TB treatment between 2003 and 2010; and post-PPM period, patients treated between 2011 and 2017. Results A total of 176 patients were included (64 and 112 in the pre- and post-PPM periods, respectively). 36.9% of the patients were resistant to a fluoroquinolone or a second-line injectable drug, or both. The overall treatment success rate was 72.7%. The success rate of post-PPM patients was higher than that of pre-PPM patients (79.5% vs. 60.9%, p=0.008). Also, loss to follow-up was lower in the post-PPM period (5.4% vs. 15.6%, p=0.023). In multivariate regression analysis, age ≥65 years, body mass index ≤18.5 kg/m2, previous TB treatment, bilateral lung involvement, and extensively drug-resistant (XDR)- or pre-XDR-TB were associated with poorer treatment outcomes. However, the use of bedaquiline or delamanid for ≥1 month increased the treatment success. Conclusion The treatment success rate in MDR-TB patients was higher in the post-PPM period than in the pre-PPM period, particularly because of the low rate of loss to follow-up. To ensure comprehensive patient-centered PPM in South Korea, investment and other support must be adequate. |
| first_indexed | 2024-12-13T15:26:34Z |
| format | Article |
| id | doaj.art-b3ba9d6ee987408ca238da9988c10cce |
| institution | Directory Open Access Journal |
| issn | 1738-3536 2005-6184 |
| language | English |
| last_indexed | 2024-12-13T15:26:34Z |
| publishDate | 2021-01-01 |
| publisher | The Korean Academy of Tuberculosis and Respiratory Diseases |
| record_format | Article |
| series | Tuberculosis and Respiratory Diseases |
| spelling | doaj.art-b3ba9d6ee987408ca238da9988c10cce2022-12-21T23:40:20ZengThe Korean Academy of Tuberculosis and Respiratory DiseasesTuberculosis and Respiratory Diseases1738-35362005-61842021-01-01841748310.4046/trd.2020.00933280Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix PeriodsYewon Kang0Eun-Jung Jo1Jung Seop Eom2Mi-Hyun Kim3Kwangha Lee4Ki Uk Kim5Hye-Kyung Park6Min Ki Lee7Jeongha Mok8 Department of Internal Medicine, VHS Medical Center, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of KoreaBackground This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) before and after the implementation of public–private mix (PPM). Factors affecting treatment success were also investigated. Methods Data from culture-confirmed pulmonary MDR-TB patients who commenced MDR-TB treatment at Pusan National University Hospital between January 2003 and December 2017 were retrospectively reviewed. Patients were divided into two groups in terms of PPM status: pre-PPM period, patients who commenced MDR-TB treatment between 2003 and 2010; and post-PPM period, patients treated between 2011 and 2017. Results A total of 176 patients were included (64 and 112 in the pre- and post-PPM periods, respectively). 36.9% of the patients were resistant to a fluoroquinolone or a second-line injectable drug, or both. The overall treatment success rate was 72.7%. The success rate of post-PPM patients was higher than that of pre-PPM patients (79.5% vs. 60.9%, p=0.008). Also, loss to follow-up was lower in the post-PPM period (5.4% vs. 15.6%, p=0.023). In multivariate regression analysis, age ≥65 years, body mass index ≤18.5 kg/m2, previous TB treatment, bilateral lung involvement, and extensively drug-resistant (XDR)- or pre-XDR-TB were associated with poorer treatment outcomes. However, the use of bedaquiline or delamanid for ≥1 month increased the treatment success. Conclusion The treatment success rate in MDR-TB patients was higher in the post-PPM period than in the pre-PPM period, particularly because of the low rate of loss to follow-up. To ensure comprehensive patient-centered PPM in South Korea, investment and other support must be adequate.http://www.e-trd.org/upload/pdf/trd-2020-0093.pdfmultidrug-resistant tuberculosisppmpublic–private mixsouth koreatreatment outcome |
| spellingShingle | Yewon Kang Eun-Jung Jo Jung Seop Eom Mi-Hyun Kim Kwangha Lee Ki Uk Kim Hye-Kyung Park Min Ki Lee Jeongha Mok Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods Tuberculosis and Respiratory Diseases multidrug-resistant tuberculosis ppm public–private mix south korea treatment outcome |
| title | Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods |
| title_full | Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods |
| title_fullStr | Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods |
| title_full_unstemmed | Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods |
| title_short | Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods |
| title_sort | treatment outcomes of patients with multidrug resistant tuberculosis comparison of pre and post public private mix periods |
| topic | multidrug-resistant tuberculosis ppm public–private mix south korea treatment outcome |
| url | http://www.e-trd.org/upload/pdf/trd-2020-0093.pdf |
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