Pre-diagnosis and pre-treatment attritions among presumptive MDR/RR-TB patients in Chonburi province, Thailand, 2015-2017

Abstract

The low detection rate of multidrug-resistant tuberculosis (MDR-TB) is one of the major obstacles to TB control in Thailand. Thus, this study aimed to assess pre-diagnosis and pre-treatment attrition rates among patients suspected of having MDR-TB, identify factors related to pre-diagnosis attrition, and determine the turnaround times (TAT) of diagnosis and treatment pathway. A retrospective cohort analysis was conducted using a record review. Among 972 presumptive MDR-TB patients, only 354 (36.4%) underwent drug-susceptibility testing (DST). Multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) was found in 32 patients, consisting of 26 (81.2%) males and 6 (18.8%) females. Pre-diagnosis and pre-treatment attrition rates were 63.58 % and 28.1%, respectively. Furthermore, the median (interquartile range [IQR]) turnaround time for MDR-TB testing was seven days (IQR 0-62 days), and the median time to the start of MDR-TB treatment was 20 days (IQR 2-38 days). Meanwhile, the factors associated with pre-diagnosis attrition were migrants, presumptive TB cases presenting at secondary-level hospitals, TB patients identified from hospitals outside the Ministry of Public Health, and extrapulmonary TB cases. The results of this research demonstrated that only one-third of patients at risk of MDR-TB underwent DST. Therefore, it is essential for healthcare workers at all levels to be educated and trained to identify patients that are eligible for DST. In addition, other interventions such as the decentralization of laboratory services and MDR-TB treatment to secondary-care district hospitals are also urgently needed.