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Eur Respir J. 2016 Oct;48(4):1160-1170. doi: 10.1183/13993003.00462-2016. Epub 2016 Sep 1.

Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method.

Author information

1
Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA carole_mitnick@hms.harvard.edu.
2
Dept of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Dept of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway.
3
Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA.
4
Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
5
Socios en Salud Sucursal, Lima, Peru.
6
Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA.
7
Dept of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
8
WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy.
9
Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
10
Médecins Sans Frontières, Cape Town, South Africa.
11
WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy Public Health Consulting Group, Lugano, Switzerland.
12
Tartu University Hospital, Lung Clinic, Tartu, Estonia.
13
Global TB Programme, World Health Organization, Geneva, Switzerland.
14
Partners in Health Russia, Moscow, Russia.
15
Makati Medical Center, Manila, Philippines.
16
Tuberculosis Control, San Francisco Department of Public Health, San Francisco, CA, USA.
17
US Centers for Disease Control and Prevention, Atlanta, GA, USA.
18
State Agency for Tuberculosis and Lung Diseases (TPSVA), Riga, Latvia.
19
Montreal Chest Institute, McGill University, Montreal, QC, Canada.
20
Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
21
Tomsk TB and Pulmonary Medical Center, Tomsk Oblast, Russia.
22
Dept of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
23
Tropical Disease Foundation, Philippine Institute of Tuberculosis, Makati City, Philippines.
24
Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Dept of Medicine, University of Cape Town, Cape Town, South Africa.
25
Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA Socios en Salud Sucursal, Lima, Peru.
26
South African Medical Research Council, Tuberculosis Research Platform, Pretoria, South Africa.
27
Institute of Tropical Medicine, Antwerp, Belgium.
28
National Institute for Heath Development, Tallinn, Estonia.

Abstract

Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection.We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference.Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34-0.42) for all patients and 0.33 (0.25-0.42) for HIV-co-infected patients.Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests.

PMID:
27587552
PMCID:
PMC5045442
DOI:
10.1183/13993003.00462-2016
[Indexed for MEDLINE]
Free PMC Article

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