Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013-2018.

Khasan Safaev,Anthony D Harries,Jamshid Gadoev,Sharofiddin Yuldashev,Oleksandr Korotych,Kostyantyn Dumchev,Irina Liverko,Nargiza Parpieva

doi:10.3390/ijerph18094663

Abstract

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

Highlights

Drug-resistant tuberculosis (DR-TB) has become a major public health concern in many countries
The prevalence of multidrug-resistant TB (MDR-TB) and XDR-TB as a proportion of the number of TB cases has remained stable over the past several years [1], in the World Health Organization’s (WHO) European Region, and especially in the countries of the former Soviet Union including Uzbekistan, it has been increasing [2]
The diagnosis of MDR-TB has improved with the advent and scale-up of the automated molecular diagnostic assay Xpert MTB/RIF, which enables a rapid diagnosis of both TB and rifampicin resistance within two hours [3]

Summary

Introduction

Drug-resistant tuberculosis (DR-TB) has become a major public health concern in many countries. Multidrug-resistant TB (MDR-TB—resistance to isoniazid and rifampicin) and extensively drug-resistant TB (XDR-TB—MDR-TB with added resistance to fluoroquinolones and second-line injectable drugs) are the most concerning types of drug-resistant TB because of difficulties with diagnosis and effective treatment [1]. The prevalence of MDR-TB and XDR-TB as a proportion of the number of TB cases has remained stable over the past several years [1], in the World Health Organization’s (WHO) European Region, and especially in the countries of the former Soviet Union including Uzbekistan, it has been increasing [2]. The diagnosis of MDR-TB has improved with the advent and scale-up of the automated molecular diagnostic assay Xpert MTB/RIF, which enables a rapid diagnosis of both TB and rifampicin resistance within two hours [3].

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Conclusion