Diagnostic and treatment delays of multidrug‐resistant tuberculosis before initiating treatment: a cross‐sectional study. Issue 11 (26th July 2015)

• Record Type: Journal Article
• Authors: Zhang, Xiulei; Yin, Jia; Li, Haitao; Li, Shuguang; Walley, John; Zou, Guanyang; Zhang, Zhitong; Wei, Xiaolin
• Is Part Of: Tropical medicine & international health. Volume 20:Issue 11(2015:Nov.)
• Page Start: 1431
• Page End: 1437
• Publication Date: 2015-07-26
• Subjects: Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12566
• Languages: English
• ISSNs: 1360-2276

Abstract

<abstract abstract-type="main" id="tmi12566-abs-0001"> <title>Abstract</title> <sec id="tmi12566-sec-1001" sec-type="section"> <title>Objective</title> <p>Shandong Province has implemented the standardised treatment of multidrug‐resistant tuberculosis (MDR‐TB) supported by the Global Fund. The study aimed to understand the managements and delays of patients with MDR‐TB before initiating their treatments.</p> </sec> <sec id="tmi12566-sec-1002" sec-type="section"> <title>Methods</title> <p>All patients with MDR‐TB who had completed intensive phase treatment from January 2010 to May 2012 were interviewed using a structured questionnaire. Delays and treatments were analysed. Diagnosis delay is defined as the period between having sputum smear results and drug susceptibility test (DST) results. Treatment delay was defined as starting MDR‐TB treatment more than 2 days after receiving the diagnosis of MDR‐TB. Total delay is the sum of diagnosis delay and treatment delay.</p> </sec> <sec id="tmi12566-sec-1003" sec-type="section"> <title>Results</title> <p>In total, 110 patients with MDR‐TB participated in the study. Median delay for diagnosis was 102 days. Over 80% of patients had a diagnosis delay longer than 90 days. MDR‐TB treatments commenced after a median of 9 days after DST results, and over 37% of the patients with MDR‐TB experienced treatment delays. Chronic cases or patients with indifferent attitude had significantly longer treatment delay than other groups (<italic>P </italic>=<italic> </italic>0.03 and 0.03, respectively). During their delays, of 44 patients with retreatment failures, 12 (27.3%) were treated through adding single second line drugs (SLDs) to first‐line regimens, and 25 (56.8%) were treated with first‐line drugs. A high proportion of initial treatment failure/relapsed/returned cases (37%) and new cases (43%) were administered with SLDs.</p> </sec> <sec id="tmi12566-sec-1004" sec-type="section"> <title>Conclusions</title> <p>Most of the patients with MDR‐TB experienced prolonged diagnosis delay, which was the most important factor contributing to the total delay. Misuse of SLDs during the days was common, so necessary training should be given to prevent irrational prescription of medications.</p> </sec> </abstract>