High-risk screening and detection of multidrug-resistant tuberculosis in two prefectures of China: a drug susceptibility surveillance-based secondary data analysis

Abstract

Background: In China, less than one-fifth of multidrug-resistant tuberculosis (MDR-TB) cases are detected. MDR-TB screening is conducted amongst the following five high-risk groups of TB patients: chronic cases, close contacts of MDR-TB patients, patients with treatment failure, relapsed and returned patients, and smear-positive patients at the end of the third month of initial treatment. Objective: To estimate the possibility of detecting MDR-TB cases if only the high-risk screening strategy is applied in China. Methods: A secondary analysis was applied to the surveillance-based longitudinal data of all sputum smear-positive TB patients in Prefecture E and Prefecture W of China from 2013 to 2015. The population attributable risk (PAR) was estimated using odds ratios for five risk factors/predictors and exposure proportions amongst all MDR-TB cases. Results: A total of 3513 TB patients (2807 from Prefecture E and 706 from Prefecture W) were included. Males accounted for 77.91% (2737/3513) of the patients. The average age was 52.5 ± 20.0 years old. Overall, 40.34% (71/176) of MDR-TB patients were from the five high-risk groups during the three-year study period. The detected proportion of MDR-TB cases using the high-risk screening strategy was significantly higher in Prefecture E than in Prefecture W. The PAR% for all five risk factors/predictors was 43.4% (95% CI: 24.6–61.7%), 49.9% (95% CI: 31.3–67.0%), and 30.3% (95% CI: 12.9–50.1%) in Prefecture E and 36.6% (95% CI: 10.4–64.5%), 13.3% (95% CI: −1.7–39.7%), and −82.5% (95% CI: −117.5–−11.2%) in Prefecture W in 2013, 2014, and 2015, respectively. The PAR% for the five specific risk factors/predictors ranged from 0.4% (95% CI: −0.2–4.8%) to 21.0% (95% CI: 13.1–30.0%) in these two prefectures. Conclusion: In general, a high-risk screening strategy would miss more than half of the MDR-TB patients because they do not belong to the five high-risk groups.

Access to quality diagnosis and rational treatment for tuberculosis: real-world evidence from China–Gates Tuberculosis Control Project Phase III

“…More patients who were not belong to the five high-risk groups, including chronic TB cases, close contacts of MDR-TB patients, patients with treatment failure, relapsed and returned patients, and smear-positive patients at the end of the third month of initial treatment, had access to the drug susceptibility tests in project areas. Yang et al reported that the screening among high-risk groups of drug-resistant TB would miss the detection of more than half of the MDR-TB patients, while the application of RMT and expanding the targets of drug resistance screening improved the detection rate of RR-TB patients [ 28 ].…”

Treatment quality and outcome for multidrug-resistant tuberculosis patients in four regions of China: a cohort study

“…As the WHO reported in 2018, the MDR-TB detection rate was only 22.8% in China coupled with a treatment coverage of 13.6% [ 2 ]. Poor accessibility to drug susceptibility testing (DST) especially in rural areas [ 7 ], long waiting time for conventional DST results [ 8 ] and incomplete high-risk screening strategy for MDR-TB [ 9 ] might explain the low detection rate of MDR-TB in China; while delayed DST, unaffordable treatment cost, drug-induced adverse effects and fragile supply chain of second-line drugs could be the main reasons for the low treatment coverage [ 5 , 10 , 11 ].…”

Treatment quality and outcome for multidrug-resistant tuberculosis patients in four regions of China: a cohort study

“…As the WHO reported in 2018, the MDR-TB detection rate was only 22.8% in China coupled with a treatment coverage of 13.6% [2]. Poor accessibility to drug susceptibility testing (DST) especially in rural areas [7], long waiting time for conventional DST results [8] and incomplete highrisk screening strategy for MDR-TB [9] might explain the low detection rate of MDR-TB in China; while delayed DST, unaffordable treatment cost, drug-induced adverse effects and fragile supply chain of second-line drugs could be the main reasons for the low treatment coverage [5,10,11].…”