Table 4.
Treatment Outcomes of Patients With Multidrug-Resistant Tuberculosis According to Patient and Program Characteristics
| Characteristic | Patients With Known Treatment Outcomesa (n = 973) |
Patients With Known Outcomes Compared With Patients Lost to Follow-upb (n = 1205) |
|||||
|---|---|---|---|---|---|---|---|
| Successful Outcome, No. (%) | Poor Outcome, No. (%) | P Value | Risk Ratio (95% CI) for Treatment Success | Known Outcome, No. (%) | Lost to Follow-up, No. (%) | P Value | |
| Patient characteristic | |||||||
| Sex | |||||||
| Female | 272 (74.7) | 92 (25.3) | .77 | 364 (83.9) | 70 (16.1) | .04 | |
| Male | 450 (73.9) | 159 (26.1) | 0.99 (.92–1.06) | 609 (79.0) | 162 (21.0) | ||
| Quartile of age, y | |||||||
| 18–28 | 181 (74.2) | 63 (25.8) | .61c | Reference | 244 (75.8) | 78 (24.2) | .02c |
| 29–36 | 168 (72.4) | 64 (27.6) | .66 | 0.98 (.88–1.09) | 232 (83.8) | 45 (16.3) | .02 |
| 37–45 | 158 (74.2) | 55 (25.8) | .99 | 1.00 (.90–1.11) | 213 (79.2) | 56 (20.8) | .33 |
| 46–79 | 215 (75.7) | 69 (24.3) | .68 | 1.02 (.93–1.12) | 284 (84.3) | 53 (15.7) | .006 |
| Educational level | |||||||
| Less than secondary | 156 (70.9) | 64 (29.1) | .31 | 0.95 (.86–1.05) | 220 (80.3) | 54 (19.7) | .91 |
| Secondary | 323 (74.6) | 110 (25.4) | .007c | Reference | 433 (80.6) | 104 (19.4) | .97c |
| More than secondary | 214 (81.4) | 49 (18.6) | .04 | 1.09 (1.01–1.18) | 263 (80.4) | 64 (19.6) | .94 |
| Employment | |||||||
| Unemployed | 240 (67.0) | 118 (33.0) | <.001 | 0.83 (.77–.91) | 358 (78.7) | 97 (21.3) | .20 |
| Employed | 367 (80.3) | 90 (19.7) | <.001c | Reference | 457 (81.9) | 101 (18.1) | .24c |
| Not in workforced | 115 (73.7) | 41 (26.3) | .08 | 0.92 (.83–1.02) | 156 (83.9) | 30 (16.1) | .54 |
| Homelessness | |||||||
| Yes | 18 (85.7) | 3 (14.3) | .22 | 1.16 (.97–1.39) | 21 (75.0) | 7 (25.0) | .44 |
| No | 704 (74.0) | 248 (26.1) | 952 (80.9) | 225 (19.1) | |||
| History of incarceration | |||||||
| Yes | 32 (65.3) | 17 (34.7) | .054 | 0.84 (.68–1.03) | 49 (62.8) | 29 (37.2) | <.001 |
| No | 617 (77.7) | 177 (22.3) | <.001c | Reference | 794 (82.5) | 169 (17.6) | <.001c |
| Unknown | 73 (56.2) | 57 (43.9) | <.001 | 0.72 (.62–.84) | 130 (79.3) | 34 (20.7) | .33 |
| Smoking | |||||||
| Yes | 145 (68.7) | 66 (31.3) | .041 | 0.91 (.82–1.002) | 211 (78.7) | 57 (21.3) | .34 |
| No | 577 (75.8) | 184 (24.2) | 762 (81.3) | 175 (18.7) | |||
| Alcohol abuse | |||||||
| Yes | 96 (68.6) | 44 (31.4) | .03 | 0.88 (.79–.99) | 140 (78.2) | 39 (21.8) | .31 |
| No | 613 (77.2) | 181 (22.8) | <.001c | Reference | 794 (81.4) | 181 (18.6) | .44c |
| Unknown | 13 (33.3) | 26 (66.7) | <.001 | 0.43 (.28–.68) | 39 (76.5) | 12 (23.5) | .38 |
| Illicit drug use | |||||||
| Yes | 6 (50.0) | 6 (50.0) | .04 | 0.65 (.37–1.14) | 12 (70.6) | 5 (29.4) | .28 |
| No | 635 (77.4) | 185 (22.6) | <.001c | Reference | 820 (81.0) | 192 (19.0) | .54c |
| Unknown | 81 (57.5) | 60 (42.6) | <.001 | 0.74 (.64–.86) | 141 (80.1) | 35 (19.9) | .78 |
| HIV infection | |||||||
| Yes | 67 (49.3) | 69 (50.7) | <.001 | 0.68 (.56–.81) | 136 (85.5) | 23 (14.5) | .10 |
| No | 340 (73.1) | 125 (26.9) | <.001c | Reference | 465 (79.8) | 118 (20.2) | .25c |
| Unknown | 315 (84.7) | 57 (15.3) | <.001 | 1.16 (1.08–1.23) | 372 (80.4) | 91 (19.7) | .81 |
| Any comorbid condition other than HIV infection | |||||||
| Yes | 188 (73.2) | 69 (26.9) | .65 | 0.98 (.90–1.06) | 257 (79.8) | 65 (20.2) | .62 |
| No | 534 (74.6) | 182 (25.4) | 716 (81.1) | 167 (18.9) | |||
| Diabetes mellitus | |||||||
| Yes | 107 (81.1) | 25 (18.9) | .054 | 1.11 (1.01–1.22) | 132 (81.5) | 30 (18.5) | .80 |
| No | 615 (73.1) | 226 (26.9) | 841 (80.6) | 202 (19.4) | |||
| No. of previous tuberculosis episodes | |||||||
| 0 | 37 (80.4) | 9 (19.6) | .34c | Reference | 46 (67.7) | 22 (32.4) | .09c |
| 1 | 248 (70.5) | 104 (29.6) | .16 | 0.88 (.75–1.02) | 352 (82.4) | 75 (17.6) | .004 |
| 2 | 228 (76.3) | 71 (23.8) | .53 | 0.95 (.81–1.11) | 299 (78.5) | 82 (21.5) | .051 |
| ≥3 | 209 (75.7) | 67 (24.3) | .49 | 0.94 (.81–1.10) | 276 (83.9) | 53 (16.1) | .002 |
| Previous treatment history | |||||||
| None | 111 (82.8) | 23 (17.2) | .002c | Reference | 134 (79.8) | 34 (20.2) | .51 |
| First-line drugs | 525 (74.1) | 184 (26.0) | .03 | 0.89 (.82–.98) | 709 (81.7) | 159 (18.3) | .56 |
| SLDs | 86 (66.2) | 44 (33.9) | .002 | 0.80 (.69–.93) | 130 (76.9) | 39 (23.1) | .53 |
| Results of sputum microscopy for acid-fast bacilli | |||||||
| Positive | 605 (73.0) | 224 (27.0) | .04 | 0.90 (.82–.98) | 829 (80.2) | 205 (19.8) | .22 |
| Negative | 117 (81.3) | 27 (18.8) | 144 (84.2) | 27 (15.8) | |||
| Unilateral or bilateral disease on chest radiograph | |||||||
| Bilateral | 567 (71.6) | 225 (28.4) | <.001 | 0.83 (.78–.90) | 792 (81.2) | 183 (18.8) | .38 |
| Unilateral | 155 (85.6) | 26 (14.4) | 181 (78.7) | 49 (21.3) | |||
| Extent of cavitary disease on chest radiograph | |||||||
| None | 285 (78.3) | 79 (21.7) | <.001c | Reference | 368 (80.9) | 87 (19.1) | .67c |
| Unilateral | 290 (77.5) | 84 (22.5) | .80 | 0.99 (.92–1.06) | 378 (81.5) | 86 (18.5) | |
| Bilateral | 137 (61.4) | 86 (38.6) | <.001 | 0.79 (.70–.88) | 227 (79.4) | 59 (20.6) | |
| Any extrapulmonary tuberculosis disease | |||||||
| Yes | 34 (72.3) | 13 (27.7) | .76 | 0.97 (.81–1.16) | 47 (83.9) | 9 (16.1) | .54 |
| No | 688 (74.3) | 238 (25.7) | 926 (80.6) | 223 (19.4) | |||
| Body mass index category | |||||||
| Underweight (<18.5 kg/m2) | 248 (64.9) | 134 (35.1) | <.001 | 0.81 (.75–.89) | 382 (82.7) | 80 (17.3) | .25c |
| Normal (18.5–25.0 kg/m2) | 412 (79.5) | 106 (20.5) | <.001c | Reference | 518 (79.5) | 134 (20.6) | |
| Overweight (>25.0. kg/m2) | 62 (84.9) | 11 (15.1) | .28 | 1.06 (.96–1.19) | 73 (80.2) | 18 (19.8) | |
| Program characteristics | |||||||
| Countrye | |||||||
| A | (93.7) | (6.2) | <.001c | (66.67) | (33.33) | <.001c | |
| B | (78.9) | (21.1) | (80.68) | (19.32) | |||
| C | (80.2) | (19.8) | (71.59) | (28.41) | |||
| D | (87.1) | (12.9) | (82.34) | (17.66) | |||
| E | (71.4) | (28.6) | (85.56) | (14.44) | |||
| F | (49.4) | (50.6) | (83.51) | (16.49) | |||
| G | (64.6) | (35.4) | (63.16) | (36.84) | |||
| H | (90.0) | (10.0) | (100.00) | (0.00) | |||
| I | (82.2) | (17.8) | (95.74) | (4.26) | |||
| GLC approval | |||||||
| Yes | 503 (82.9) | 104 (17.1) | <.001 | 1.39 (1.27–1.52) | 607 (79.6) | 156 (20.5) | .17 |
| Nof | 219 (59.8) | 147 (40.2) | 366 (82.8) | 76 (17.2) | |||
| Directly observed treatment | |||||||
| Full (100%) | 537 (78.2) | 150 (21.8) | .005 | 1.28 (1.03–1.61) | 689 (81.4) | 157 (18.6) | .02c |
| Partial | 153 (65.7) | 80 (34.3) | .51 | 1.08 (.85–1.37) | 233 (83.2) | 47 (16.8) | |
| None | 31 (60.8) | 20 (39.2) | <.001c | Reference | 51 (64.6) | 28 (35.4) | |
| No. of SLDs tested in local laboratory | |||||||
| 0–2 | 288 (65.7) | 150 (34.2) | <.001c | Reference | 438 (82.3) | 94 (17.7) | .11c |
| 3 | 281 (79.1) | 74 (20.8) | <.001 | 1.20 (1.10–1.31) | 355 (80.7) | 85 (19.3) | |
| 4–7 | 153 (85.0) | 27 (15.0) | <.001 | 1.29 (1.18–1.42) | 180 (77.2) | 53 (22.7) | |
| No. of SLIs tested in local laboratory | |||||||
| 0 | 160 (69.9) | 69 (30.1) | .47c | Reference | 229 (81.2) | 53 (18.8) | .17c |
| 1 | 384 (76.8) | 116 (23.2) | .046 | 1.10 (1.00–1.21) | 500 (82.5) | 106 (17.5) | |
| 2–3 | 178 (72.9) | 66 (27.0) | .46 | 1.04 (.93–1.17) | 244 (77.0) | 73 (23.0) | |
| No. of SLIs tested in local laboratory | |||||||
| 0 | 160 (69.9) | 69 (30.1) | .87 | 744 (80.6) | 179 (19.4) | .82 | |
| 1–3 | 562 (75.5) | 182 (24.5) | 1.08 (.98–1.19) | 229 (81.2) | 53 (18.8) | ||
| No. of FQs tested in local laboratory | |||||||
| 0–1 | 430 (67.9) | 203 (32.1) | <.001 | 633 (80.9) | 149 (19.0) | .80 | |
| 2–4 | 292 (85.9) | 48 (14.1) | 1.26 (1.18–1.35) | 340 (80.4) | 83 (19.6) | ||
| Pyrazinamide tested in local laboratory | |||||||
| No | 267 (63.1) | 156 (36.9) | <.001 | 423 (85.8) | 79 (14.2) | <.001 | |
| Yes | 455 (82.7) | 95 (17.3) | 1.31 (1.21–1.42) | 550 (77.2) | 162 (22.7) | ||
| In hospital at time of enrollment | |||||||
| Yes | 282 (61.3) | 178 (38.7) | <.001 | 0.71 (.66–.78) | 460 (82.3) | 99 (17.7) | .21 |
| No | 440 (85.8) | 73 (14.2) | 513 (79.4) | 133 (20.6) | |||
| No. of hospitalizations | |||||||
| 0 | 330 (90.2) | 36 (9.8) | <.001c | Reference | 366 (76.1) | 115 (23.9) | <.001c |
| 1 | 306 (66.8) | 152 (33.2) | <.001 | 0.74 (.69– .80) | 458 (82.4) | 98 (17.6) | |
| 2 | 86 (57.7) | 63 (42.3) | <.001 | 0.64 (.56–.74) | 149 (88.7) | 19 (11.3) | |
| Surgery during treatment | |||||||
| Yes | 38 (84.4) | 7 (15.6) | .11 | 1.15 (1.00–1.30) | 45 (90.0) | 5 (10.0) | .09 |
| No | 684 (73.7) | 244 (26.3) | 928 (80.3) | 227 (19.6) | |||
Abbreviations: CI, confidence interval; FQs, fluoroquinolone; GLC, Green Light Committee; HIV, human immunodeficiency virus; SLDs, second-line drugs; SLIs, second-line injectable drugs.
a Based on standard World Health Organization (WHO) treatment outcome definitions for multidrug-resistant tuberculosis, known treatment outcomes include cure, treatment completion, treatment failure, and death.
b Lost to follow-up was previously referred to as default in standard WHO tuberculosis outcome terminology. That category in this table does not include 25 patients who transferred to another treatment unit before completing treatment and 14 who were continuing treatment when follow-up ended in 2010 and whose outcome could not be predicted. Risk ratios (and 95% CIs) are not presented for known outcomes versus lost to follow-up because most of the covariates were not statistically significant; point estimates of the risk ratios can be calculated from the proportions in each cell.
c For nominal and ordinal variables, the overall P value is listed next to the reference cell. For nominal variables, the P value is based on the χ2 test for general association. For ordinal variables, the P value is based on the Mantel–Haenszel extension of the χ2 test for trend. P values for each individual level of nominal and ordinal variables compared with the reference level are listed on the line for that level.
d Not in workforce owing to being retired, disabled, full-time students, or homemakers.
e Countries asked not to be identified by name; therefore, only percentages are presented, because their identities could be determined from the enrollment numbers.
f Countries E–I did not apply to the GLC (they were not disapproved).