Impact of integrated psycho-socio-economic support on treatment outcome in drug resistant tuberculosis - A retrospective cohort study.

OBJECTIVE

To assess the impact of providing integrated psycho-socio-economic support to drug resistant tuberculosis (DRTB) patients on the treatment outcome under programmatic conditions.

STUDY DESIGN

Retrospective cohort study.

SETTING

An urban district TB centre in India under the Revised National Tuberculosis Control Programme.

PARTICIPANTS

A cohort of 123 patients who started DRTB treatment between June 2010 and May 2013.

METHODS

Patients started on treatment for DRTB between June 2010 and May 2013 who were provided with the integrated support package for at least 3 months formed the supported group while the other patients of the cohort formed the non-supported group. The treatment outcomes and sputum culture conversion rates were compared between the two groups.

RESULTS

The supported group consisted of 60 patients and the non-supported group of 63 patients. The treatment success rate was found to be significantly higher in the supported group (65% vs 46.03%; p=0.0349). Support duration was significantly associated with lower incidence of death [HR 0.876, 95% CI 0.811-0.947; p=0.0009] and loss to follow up [OR: 0.752, 95% CI 0.597-0.873; p=0.0023]. The treatment failure rate was higher in the supported group (16.66% vs 4.76%) with 60% of the failures in the supported group occurring after 24 months of compliant treatment. There was no significant association found between support duration and treatment failure or sputum culture conversion.

CONCLUSION

Integrated support seems to significantly increase the treatment success rate and improve survival and treatment adherence of DRTB patients. However, early diagnosis and effective pharmacotherapy are crucial for reducing treatment failures.