Global Fund Projects Coordinating Team, Ministry of Health, Yerevan.
Tuberculosis Research and Prevention Center, Yerevan.
Monaldi Arch Chest Dis. 2021 Jan 14;91(1). doi: 10.4081/monaldi.2021.1677.
Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) is recognized as a major public health concern globally. In Armenia, the proportion of RR/MDR-TB is increasing among all people affected with TB. We conducted a nationwide cohort study involving analysis of programmatic data to investigate the rates of and factors associated with unfavourable treatment outcomes among patients with RR/MDR-TB registered by the national TB programme from 2014 to 2017 in Armenia. We used Cox regression to identify factors associated with the outcome. Among 451 RR/MDR-TB patients, 80% were men and median age was 46 years. Of them, 53 (11.8%) had Extensively Drug-Resistant Tuberculosis (XDR-TB) and 132 (29.3%) had pre-XDR-TB. Almost half (224, 49.7%) of the patients had unfavourable treatment outcome, which included 26.8% Loss To Follow-Up (LTFU), 13.3% failures and 9.5% deaths. In multivariable analysis, people with pre-XDR-TB [adjusted Hazard Ratio [aHR] 3.13, 95% confidence intervals [CI] 2.16-4.55] and XDR-TB (aHR 4.08, 95% CI 2.45-6.79) had a higher risk of unfavourable outcomes. Patients receiving home-based treatment (71/451, 15.7%) and treatment with new drugs (172/451, 38.1%) had significantly lower risk (aHR 0.45, 95% CI 0.28-0.72 and aHR 0.26, 95% CI 0.18-0.39) of unfavourable treatment outcome. The proportion of MDR-TB patients reaching favourable treatment outcome in Armenia was substantially lower than the recommended level (75%). The most common treatment outcome was LTFU indicating the need for further assessment of underlying determinants. Home-based treatment looks promising and future studies are required to see if expanding it to all RR/MDR-TB patients is feasible and cost-effective.
利福平耐药/耐多药结核病（RR/MDR-TB）在全球范围内被认为是一个主要的公共卫生关注点。在亚美尼亚，所有结核病患者中 RR/MDR-TB 的比例正在增加。我们进行了一项全国性队列研究，对 2014 年至 2017 年期间国家结核病规划登记的 RR/MDR-TB 患者的治疗结局率和相关因素进行了分析。我们使用 Cox 回归来确定与结局相关的因素。在 451 名 RR/MDR-TB 患者中，80%为男性，中位年龄为 46 岁。其中，53 名（11.8%）患有广泛耐药结核病（XDR-TB），132 名（29.3%）患有耐多药前结核病（pre-XDR-TB）。近一半（224 名，49.7%）的患者治疗结局不佳，包括 26.8%的失访（LTFU）、13.3%的失败和 9.5%的死亡。在多变量分析中，患有耐多药前结核病（调整后的危险比[aHR] 3.13，95%置信区间[CI] 2.16-4.55）和 XDR-TB（aHR 4.08，95%CI 2.45-6.79）的患者不良结局的风险更高。接受家庭治疗（451 名患者中的 71 名，15.7%）和使用新药治疗（451 名患者中的 172 名，38.1%）的患者的风险显著降低（aHR 0.45，95%CI 0.28-0.72 和 aHR 0.26，95%CI 0.18-0.39）。亚美尼亚达到有利治疗结局的 MDR-TB 患者比例远低于建议水平（75%）。最常见的治疗结局是 LTFU，这表明需要进一步评估潜在决定因素。家庭治疗看起来很有前景，需要进一步研究是否可以将其扩展到所有 RR/MDR-TB 患者，并确定其是否可行且具有成本效益。
