The multi-drug resistant tuberculosis diagnosis and treatment cascade in Bangladesh
This was a retrospective cohort study involving record review
Abstract
Objectives
To determine, in areas supported by Bangladesh Rural Advancement Committee (BRAC):
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the pre-diagnosis and pre-treatment attrition among presumptive and confirmed Multi-Drug Resistant Tuberculosis (MDR-TB) patients
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factors associated with attrition.
Methods
This was a retrospective cohort study involving record review. Presumptive MDR-TB patients from peripheral microscopy centres serving 60% of the total population of Bangladesh were included in the study. Attrition and turnaround time for MDR-TB diagnosis by Xpert MTB/RIF and treatment initiation were calculated between July 2012 and June 2014.
Results
Of 836 presumptive MDR-TB patients referred from 398 peripheral microscopy centres, 161 MDR-TB patients were diagnosed. The number of diagnosed MDR-TB patients was less than country estimates of MDR-TB patients (2000 cases) during the study period. Among those referred, pre-diagnosis and pre-treatment attrition was 17% and 21% respectively. Median turnaround time for MDR-TB testing, result receipt and treatment initiation was four, zero and five days respectively. Farmers (RR=2.3, p=0.01) and daily wage laborers (RR=2.1, p=0.04) had twice the risk of having pre-diagnosis attrition. Poor record-keeping and unreliable upkeep of presumptive MDR-TB patient databases were identified as challenges at the peripheral microscopy centres.
Conclusion
There was a low proportion of pre-diagnosis and pre-treatment attrition in patients with presumptive and confirmed MDR-TB under programmatic conditions. However, the recording and reporting system did not detect all presumptive MDR-TB patients, highlighting the need to improve the system in order to prevent morbidity, mortality and transmission of MDR-TB in the community.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
Citation
Hossain ST, Isaakidis P, Sagili KD, Islam S, Islam MA, Shewade HD, et al. (2015) The Multi-Drug Resistant Tuberculosis Diagnosis and Treatment Cascade in Bangladesh. PLoS ONE 10(6): doi:10.1371/journal.pone.0129155
Links
The multi-drug resistant tuberculosis diagnosis and treatment cascade in Bangladesh