Diagnostic and treatment delays of multidrug-resistant tuberculosis before initiating treatment: a cross-sectional study.

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Diagnostic and treatment delays of multidrug-resistant tuberculosis before initiating treatment: a cross-sectional study.

Trop Med Int Health. 2015 Jul 14;

Authors: Zhang X, Yin J, Li H, Li S, Walley J, Zou G, Zhang Z, Wei X

Abstract
OBJECTIVE: Shandong Province has implemented the standardized treatment of multi-drug resistant tuberculosis (MDR-TB) supported by the Global Fund. The study aimed to understand the managements and delays of MDR-TB patients before initiating their treatments.
METHODS: All MDR-TB patients who had completed intensive phase treatment from January 2010 to May 2012 were interviewed using a structured questionnaire. Delays and treatments were analyzed. 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.
RESULTS: In total, 110 MDR-TB patients 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 MDR-TB patients experienced treatment delays. Chronic cases or patients with indifferent attitude had significantly longer treatment delay than other groups (p=0.03, and 0.03, respectively). During their delays, of 44 patients with retreatment failures, 12 (27.3%) were treated through adding single SLD drugs 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.
CONCLUSIONS: Most of the MDR-TB patients 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. This article is protected by copyright. All rights reserved.

PMID: 26171742 [PubMed - as supplied by publisher]