Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods

Abstract

Background This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) before and after the implementation of public–private mix (PPM). Factors affecting treatment success were also investigated. Methods Data from culture-confirmed pulmonary MDR-TB patients who commenced MDR-TB treatment at Pusan National University Hospital between January 2003 and December 2017 were retrospectively reviewed. Patients were divided into two groups in terms of PPM status: pre-PPM period, patients who commenced MDR-TB treatment between 2003 and 2010; and post-PPM period, patients treated between 2011 and 2017. Results A total of 176 patients were included (64 and 112 in the pre- and post-PPM periods, respectively). 36.9% of the patients were resistant to a fluoroquinolone or a second-line injectable drug, or both. The overall treatment success rate was 72.7%. The success rate of post-PPM patients was higher than that of pre-PPM patients (79.5% vs. 60.9%, p=0.008). Also, loss to follow-up was lower in the post-PPM period (5.4% vs. 15.6%, p=0.023). In multivariate regression analysis, age ≥65 years, body mass index ≤18.5 kg/m 2 , previous TB treatment, bilateral lung involvement, and extensively drug-resistant (XDR)- or pre-XDR-TB were associated with poorer treatment outcomes. However, the use of bedaquiline or delamanid for ≥1 month increased the treatment success. Conclusion The treatment success rate in MDR-TB patients was higher in the post-PPM period than in the pre-PPM period, particularly because of the low rate of loss to follow-up. To ensure comprehensive patient-centered PPM in South Korea, investment and other support must be adequate.

Explorative Analysis of Treatment Outcomes of Levofloxacin- and Moxifloxacin-Based Regimens and Outcome Predictors in Ethiopian MDR-TB Patients: A Prospective Observational Cohort Study

“…The overall treatment outcome observed in the present study (65%) was relatively lower than a recent national study report (75.7%). 51 Moreover, other studies also indicated a relatively higher treatment success rates in various settings: 82.4% (Taiwan), 52 75.8% (Pakistan), 53 72.7% (Korea), 54 75.7% (Tanzania). 55 However, it is higher than that reported by WHO (57%) in 2017, 56 a meta-analysis (61%) 57 and an Indonesian national (48%) as well as provincial (36%) study.…”

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Concern to Bedaquiline: Authors’ Reply

“…We thank Oki Nugraha Putra and colleagues [ 1 ] for their comments on our article reporting the impact of public-private mix on the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) [ 2 ]. Multivariate analysis showed that the use of bedaquiline or delamanid for ≥1 month increased the treatment success rate of patients with MDR-TB.…”

Importance of Public-Private Mix Collaboration in Tuberculosis Control: It Is Also Valuable in Patients with Multidrug-Resistant Tuberculosis

“…In this issue of the journal, Kang et al [ 7 ] evaluated the impact of the PPM collaboration on MDR-TB control by comparing the treatment outcomes in patients with MDR-TB before and after the implementation of the PPM collaboration. Of 176 patients with pulmonary MDR-TB, 128 patients (72.7%) were successfully treated; the treatment success rate was significantly higher in the post-PPM period than in the pre-PPM period.…”

“…The PPM collaboration could play an important role in controlling these problems through close monitoring of patients with TB by monitoring treatment compliance and adverse drug reactions and providing education and counselling. The study by Kang et al [ 7 ] shows the positive results of the PPM collaboration in treatment of patients with MDR-TB, indicating the importance of the PPM collaboration covering all hospitals treating patients with TB and providing comprehensive support to patients with TB.…”

“…Bedaquiline and delamanid are the most promising novel drugs for the treatment of MDR-TB as they have shown high efficacy and tolerability [ 11 ]. In the study by Kang et al [ 7 ], the use of these two drugs was a positive predictive factor for successful treatment outcomes. Therefore, proper use of these two new drugs in combination with the PPM collaboration could improve treatment outcomes in patients with MDR-TB.…”