Abstract
ABSTRACTOBJECTIVE to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB).METHODS Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated.RESULTS Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure.CONCLUSIONS The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.
Highlights
Multidrug-resistant tuberculosis (MDR-TB) is considered a global public health problem and a major threat to the control and elimination of tuberculosis (TB) in the world
Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death
According to the latest report by the World Health Organization (WHO), 54% of cases started treatment for MDR-TB in 2014, 54% have successfully completed it, 15% have lost to follow-up, 8% had some kind of failure, and 16% died
Summary
Multidrug-resistant tuberculosis (MDR-TB) is considered a global public health problem and a major threat to the control and elimination of tuberculosis (TB) in the world. According to the latest report by the World Health Organization (WHO), 54% of cases started treatment for MDR-TB in 2014, 54% have successfully completed it (cure or complete treatment), 15% have lost to follow-up, 8% had some kind of failure, and 16% died. Comparing the outcomes of new cases or recurrences of TB in which the bacillus is sensitive to first-line drugs, there was an 83% cure, indicating that increasing success rates in MDR-TB treatment is one of the major global challenges for disease control[1]. Treatment regimens are still based on fragile scientific evidence, and drugs used do not always undergo randomized controlled trials, which results in a high frequency of treatment failures[2]
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