Abstract
Treatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4–2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.
Highlights
Treatment adherence is a key component of successful tuberculosis (TB) control programmes and it is an emphases of international and national TB control guidelines[1,2]
Multidrug resistant tuberculosis (MDR-TB) treatment considerably save the life of millions[9,10,11] and reduce transmission of the resistance strains, significant proportion of patients are interrupting the treatment during the follow up period[4,12,13,14,15,16,17]
We included a total of 407 multidrug resistant tuberculosis (MDR-TB) patients to this study (Fig. 1)
Summary
Treatment adherence is a key component of successful tuberculosis (TB) control programmes and it is an emphases of international and national TB control guidelines[1,2]. TB treatment interruption can occur for short period, which is called intermittent interruption or for greater than two consecutive months that refers to lost to follow up[1,4] Both intermittent treatment interruption and lost to follow up are the most challenges of TB control programme due to their high risk to severe illness, death, disease transmission, poor treatment outcome and occurrence of drug resistance[5]. All of these health related consequences of treatment interruption have economic impact in terms of cost and loss of income for patients and their families and cost to the health system[6,7,8]. Determining the magnitude of intermittent treatment interruption and its effect on final treatment outcome in MDR-TB patients are essential to achieve targeted treatment success and prevent XDR and TDR tuberculosis
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