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Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis: Comparison of Pre- and Post-Public–Private Mix Periods
Eun-Jung Jo (Department of Internal Medicine, Pusan National University Hospital, Busan)
Jung Seop Eom (Department of Internal Medicine, Pusan National University Hospital, Busan)
Mi-Hyun Kim (Department of Internal Medicine, Pusan National University Hospital, Busan)
Kwangha Lee (Department of Internal Medicine, Pusan National University Hospital, Busan)
Ki Uk Kim (Department of Internal Medicine, Pusan National University Hospital, Busan)
Hye-Kyung Park (Department of Internal Medicine, Pusan National University Hospital, Busan)
Min Ki Lee (Department of Internal Medicine, Pusan National University Hospital, Busan)
Jeongha Mok (Pusan National University)
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Abstract
Background: This study compared the treatment outcomes of patients with multidrug-resistant tuberculosis (MDRTB) 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/m2 , 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.
- keywords
- Multidrug-Resistant Tuberculosis, PPM, Public–Private Mix, South Korea, Treatment Outcome
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