Low rates of recurrence after successful treatment of multidrug-resistant tuberculosis in Tomsk, Russia
OBJECTIVES: To report rates of recurrence following successful treatment of MDR-TB in a program providing individualized treatment regimens designed according to the current global standard of care.
DESIGN: A retrospective cohort study of 408 adults successfully treated for pulmonary MDR-TB from 10 September 2000 to 1 November 2004, and followed for up to 6 years post-treatment. We used Poisson regression with generalized estimating equations to assess whether recurrence rates changed significantly with time.
RESULTS: We analyzed 399 (97.5%) patients with at least one follow-up visit (15 850 person-months of observation [PMO]). Baseline resistance to second-line drugs was common (65.2%); 398 patients (99.7%) were human immunodeficiency virus (HIV) negative. In the first year of post-treatment follow-up, there were six episodes of recurrence (1.4/1000 PMO, 95%CI 0.5–3.0). After the first post-treatment year, there were 21 episodes of recurrence (1.8/1000 PMO, 95%CI 1.1–2.8). The rate did not change significantly with time.
CONCLUSION: Individualized regimens designed according to the current global standard of care achieved low rates of MDR-TB recurrence among non-HIV-infected persons treated in a programmatic setting.
Keywords: anti-tuberculosis medications; cohort study; drug-resistant tuberculosis; programmatic setting
Document Type: Research Article
Affiliations: 1: Partners In Health Russia, Moscow, Russian Federation 2: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA 3: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Partners In Health, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA 4: Tomsk Penitentiary Services, Ministry of Justice, Tomsk, Russian Federation 5: Tomsk Oblast Tuberculosis Services, Tomsk, Russian Federation 6: Partners In Health, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA 7: Partners In Health, Boston, Massachusetts, USA 8: Novosibirsk Tuberculosis Research Institute, Novosibirsk, Russian Federation 9: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA; Partners In Health, Boston, Massachusetts, USA
Publication date: 01 April 2015
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