Abstract

Background and aimsMulti drug or rifampicin resistant tuberculosis (MDR/RR-TB) is a major burden to TB prevention and eradication globally. Since 2016, WHO guidelines have included options for treating MDR/RR-TB with a standard regimen of 9 to 11 months duration (the ’shorter regimen’) rather than an individual regimen of at least 20 months. This regimen has been introduced in Indonesia since September 2017. Therefore, we aimed to determine the success rate and factors associated with the treatment outcome of shorter injectable based regimen in West Java province, Indonesia.MethodsThis was a retrospective cohort study of MDR/RR-TB patients aged over 18 years old who received the shorter injectable based regimen between September 2017 and December 2020. We defined successful outcomes as the combined proportion of patients who were cured or had complete treatment. While, unsuccessful outcomes were defined as the combined proportion of patients who died from any causes, failure, and loss to follow-up (LTFU).ResultsA total of 315 patients were included in this study. The success rate was 64.5%. Multivariate analysis showed male gender (aRR = 1.18, 95% CI 1.04 to 1.34) increased the chance of successful outcome, while malnutrition (aRR = 0.78, 95% CI 0.68 to 0.89), history of previous TB treatment (aRR = 0.80%CI 0.68 to 0.94), and time of culture conversion >2 months (aRR = 0.72 (95% CI 0.59 to 0.87) decreased the chance of successful outcome.ConclusionHistory of previous TB treatment, time of culture conversion >2 months, and malnutrition were independent factors that decrease the chance for success rate, while male gender increase the likelihood for success rate of patients treated by the shorter injectable based regimen.

Highlights

  • Multidrug-resistant tuberculosis (MDR/RR-TB), defined as Mycobacterium tuberculosis infection with resistance to rifampicin or both isoniazid and rifampicin, has become a significant problem on TB eradication globally [1]

  • Multivariate analysis showed male gender increased the chance of successful outcome, while malnutrition, history of previous TB treatment, and time of culture conversion >2 months

  • According to the National TB Programme (NTP) guideline, presumptive TB cases who were tested by Xpert MTB/RIF assay and had rifampicin-resistant result were classified as MDR/RR-TB patients

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Summary

Introduction

Multidrug-resistant tuberculosis (MDR/RR-TB), defined as Mycobacterium tuberculosis infection with resistance to rifampicin or both isoniazid and rifampicin, has become a significant problem on TB eradication globally [1]. High burden TB is determined based on three indicators: TB, TB / HIV (Human Immunodeficiency Virus), and MDR-TB. The thirty countries with the highest TB burden account for nearly 86% of new TB cases globally, and eight of these contributed two-thirds of the total, with Indonesia ranks third after India and China [1]. Since 2016, WHO guidelines have included options for treating MDR/RR-TB with a standard regimen of 9 to 11 months duration (the ’shorter regimen’) rather than an individual regimen of at least 20 months. This regimen has been introduced in Indonesia since September 2017. We aimed to determine the success rate and factors associated with the treatment outcome of shorter injectable based regimen in West Java province, Indonesia.

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