Treatment outcomes from community-based drug resistant tuberculosis treatment programs: a systematic review and meta-analysis

BMC Infectious Diseases

James C Johnston³  Victoria J Cook³  Wenjia Chen¹  Pamela Weiss² 

[1] Collaboration for Outcomes Research and Evaluation, University of British Columbia, 2405 Wesbrook Mall, Vancouver, Canada;School of Humanitarian Studies, Royal Roads University, 2005 Sooke Rd, Victoria, British Columbia;The British Columbia Center for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z4R4, Canada

关键词: Community based;    Treatment;    Multidrug-resistant;    Tuberculosis;   

Others  :  1127520
DOI  :  10.1186/1471-2334-14-333

 received in 2013-09-04, accepted in 2014-05-28,  发布年份 2014

【 摘 要 】

Background

There is increasing evidence that community-based treatment of drug resistant tuberculosis (DRTB) is a feasible and cost-effective alternative to centralized, hospital-based care. Although several large programs have reported favourable outcomes from community-based treatment, to date there has been no systematic assessment of community-based DRTB treatment program outcomes. The objective of this study was to synthesize available evidence on treatment outcomes from community based multi-drug resistant (MDRTB) and extensively drug resistant tuberculosis (XDRTB) treatment programs.

Methods

We performed a systematic review and meta-analysis of the published literature to examine treatment outcomes from community-based MDRTB and XDRTB treatment programs. Studies reporting outcomes from programs using community-based treatment strategies and reporting outcomes consistent with WHO guidelines were included for analysis. Treatment outcomes, including treatment success, default, failure, and death were pooled for analysis. Meta-regression was performed to examine for associations between treatment outcomes and program or patient factors.

Results

Overall 10 studies reporting outcomes on 1288 DRTB patients were included for analysis. Of this population, 65% [95% CI 59-71%] of patients had a successful outcome, 15% [95% CI 12-19%] defaulted, 13% [95% CI 9-18%] died, and 6% [95% CI 3-11%] failed treatment for a total of 35% [95% CI 29-41%] with unsuccessful treatment outcome. Meta-regression failed to identify any factors associated with treatment success, including study year, age of participants, HIV prevalence, XDRTB prevalence, treatment regimen, directly observed therapy (DOT) location or DOT provider.

Conclusions

Outcomes of community-based MDRTB and XDRTB treatment outcomes appear similar to overall treatment outcomes published in three systematic reviews on MDRTB therapy. Work is needed to delineate program characteristics associated with improved treatment outcomes.

【 授权许可】

   
2014 Weiss et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Gandhi NR, Nunn P, Dheda K, Schaaf HS, Zignol M, van Soolingen D, Jensen P, Bayona J: Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. Lancet 2010, 375(9728):1830-1843.
• [2]World Health Organization: Global Tuberculosis Report. Geneva: WHO; 2012.
• [3]Jacobson KR, Tierney DB, Jeon CY, Mitnick CD, Murray MB: Treatment outcomes among patients with extensively drug-resistant tuberculosis: systematic review and meta-analysis. Clin Infect Dis 2010, 51(1):6-14.
• [4]World Health Organization: Global Plan to Stop TB 2011–2015. Geneva: WHO; 2011.
• [5]Laserson KF, Thorpe LE, Leimane V, Weyer K, Mitnick CD, Riekstina V, Zarovska E, Rich ML, Fraser HS, Alarcon E, Cegielski JP, Grzemska M, Gupta R, Espinal M: Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2005, 9(6):640-645.
• [6]WHO: Guidelines for Programmatic Management of Drug-Resistant Tuberculosis (2011 Update). Geneva: WHO; 2011.
• [7]Burgos M, Gonzalez LC, Paz EA, Gournis E, Kawamura LM, Schecter G, Hopewell PC, Daley CL: Treatment of multidrug-resistant tuberculosis in San Francisco: an outpatient-based approach. Clin Infect Dis 2005, 40(7):968-975.
• [8]Seung KJ, Omatayo DB, Keshavjee S, Furin JJ, Farmer PE, Satti H: Early outcomes of MDR-TB treatment in a high HIV-prevalence setting in Southern Africa. PLoS One 2009, 4(9):e7186.
• [9]Adatu F, Odeke R, Mugenyi M, Gargioni G, McCray E, Schneider E, Maher D: Implementation of the DOTS strategy for tuberculosis control in rural Kiboga District, Uganda, offering patients the option of treatment supervision in the community, 1998–1999. Int J Tuberc Lung Dis 2003, 7(9 Suppl 1):S63-71.
• [10]Okello D, Floyd K, Adatu F, Odeke R, Gargioni G: Cost and cost-effectiveness of community-based care for tuberculosis patients in rural Uganda. Int J Tuberc Lung Dis 2003, 7(9 Suppl 1):S72-79.
• [11]Wandwalo E, Kapalata N, Egwaga S, Morkve O: Effectiveness of community-based directly observed treatment for tuberculosis in an urban setting in Tanzania: a randomised controlled trial. Int J Tuberc Lung Dis 2004, 8(10):1248-1254.
• [12]Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM: Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One 2009, 4(9):e6914.
• [13]Orenstein EW, Basu S, Shah NS, Andrews JR, Friedland GH, Moll AP, Gandhi NR, Galvani AP: Treatment outcomes among patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis 2009, 9(3):153-161.
• [14]World Health Organization: Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis Emergency Update 2008. Geneva: WHO; 2008.
• [15]Cox D: Analysis of Binary Data. London: Methuen; 1970.
• [16]Singla R, Sarin R, Khalid UK, Mathuria K, Singla N, Jaiswal A, Puri MM, Visalakshi P, Behera D: Seven-year DOTS-Plus pilot experience in India: results, constraints and issues. Int J Tuberc Lung Dis 2009, 13(8):976-981.
• [17]Joseph P, Desai VB, Mohan NS, Fredrick JS, Ramachandran R, Raman B, Wares F, Thomas A: Outcome of standardized treatment for patients with MDR-TB from Tamil Nadu, India. Indian J Med Res 2011, 133:529-534.
• [18]Thomas A, Ramachandran R, Rehaman F, Jaggarajamma K, Santha T, Selvakumar N, Krishnan N, Mohan NS, Sundaram V, Wares F, Narayanan PR: Management of multi drug resistance tuberculosis in the field: Tuberculosis Research Centre experience. Indian J Tuberc 2007, 54(3):117-124.
• [19]Drobac PC, Mukherjee JS, Joseph JK, Mitnick C, Furin JJ, del Castillo H, Shin SS, Becerra MC: Community-based therapy for children with multidrug-resistant tuberculosis. Pediatrics 2006, 117(6):2022-2029.
• [20]Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Fawzi MC, Kapiga S, Neuberg D, Maguire JH, Kim JY, Farmer P: Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 2003, 348(2):119-128.
• [21]Mitnick CD, Shin SS, Seung KJ, Rich ML, Atwood SS, Furin JJ, Fitzmaurice GM, Alcantara Viru FA, Appleton SC, Bayona JN, Bonilla CA, Chalco K, Choi S, Franke MF, Fraser HS, Guerra D, Hurtado RM, Jazayeri D, Joseph K, Llaro K, Mestanza L, Mukherjee JS, Munoz M, Palacios E, Sanchez E, Sloutsky A, Becerra MC: Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med 2008, 359(6):563-574.
• [22]Malla P, Kanitz EE, Akhtar M, Falzon D, Feldmann K, Gunneberg C, Jha SS, Maharjan B, Prasai MK, Shrestha B, Verma SC, Zignol M: Ambulatory-based standardized therapy for multi-drug resistant tuberculosis: experience from Nepal, 2005–2006. PLoS One 2009, 4(12):e8313.
• [23]Tupasi TE, Gupta R, Quelapio MI, Orillaza RB, Mira NR, Mangubat NV, Belen V, Arnisto N, Macalintal L, Arabit M, Lagahid JY, Espinal M, Floyd K: Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: a cohort study in the Philippines. PLoS Med 2006, 3(9):e352.
• [24]Oyieng’o DP, Gardner P, Kisang A, Diero G, Sitienei L, Carter JJ: Community-based treatment of multidrug-resistant tuberculosis: early experience and results from Western Kenya. Public Health Action 2012, 2(2):38-42.
• [25]Satti H, McLaughlin MM, Omotayo DB, Keshavjee S, Becerra MC, Mukherjee JS, Seung KJ: Outcomes of comprehensive care for children empirically treated for multidrug-resistant tuberculosis in a setting of high HIV prevalence. PLoS One 2012, 7(5):e37114.
• [26]Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, Bayona JN, Becerra MC, Benedetti A, Burgos M, Centis R, Chan ED, Chiang CY, Coh H, D’Ambrosio L, DeRiemer K, Dung NH, Enarson D, Falzon D, Flanagan K, Flood J, Garcia-Garcia ML, Gandhi N, Granich RM, Hollm-Delgado MG, Holtz TH, Iseman MD, Jarlsberg LG, Keshavjee S, Kim HR, Koh WJ, et al.: Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients. PLoS Med 2012, 9(8):e1001300.
• [27]Kangovi S, Mukherjee J, Bohmer R, Fitzmaurice G: A classification and meta-analysis of community-based directly observed therapy programs for tuberculosis treatment in developing countries. J Community Health 2009, 34(6):506-513.
• [28]Bassili A, Fitzpatrick C, Qadeer E, Fatima R, Floyd K, Jaramillo E: A systematic review of the effectiveness of hospital- and ambulatory-based management of multidrug-resistant tuberculosis. AmJTrop Med Hyg 2013, 89(2):271-280.
• [29]Kim HJ, Hong YP, Kim SJ, Lew WJ, Lee EG: Ambulatory treatment of multidrug-resistant pulmonary tuberculosis patients at a chest clinic. Int J Tuberc Lung Dis 2001, 5(12):1129-1136.
• [30]Narita M, Alonso P, Lauzardo M, Hollender ES, Pitchenik AE, Ashkin D: Treatment experience of multidrug-resistant tuberculosis in Florida, 1994–1997. Chest 2001, 120(2):343-348.
• [31]Heller T, Lessells RJ, Wallrauch CG, Barnighausen T, Cooke GS, Mhlongo L, Master I, Newell ML: Community-based treatment for multidrug-resistant tuberculosis in rural KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis 2010, 14(4):420-426.
• [32]Fitzpatrick C, Floyd K: A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis. PharmacoEconomics 2012, 30(1):63-80.
• [33]Meyer-Rath G, Schnippel K, Long L, MacLeod W, Sanne I, Stevens W, Pillay S, Pillay Y, Rosen S: The impact and cost of scaling up GeneXpert MTB/RIF in South Africa. PLoS One 2012, 7(5):e36966.
• [34]Cox H, Ford N: Decentralisation of multidrug-resistant-tuberculosis care and management. Lancet Infect Dis 2013, 13(8):644-646.