Date Published: January 23, 2017
Publisher: Public Library of Science
Author(s): Zuhui Xu, Tao Xiao, Yanhong Li, Kunyun Yang, Yi Tang, Liqiong Bai, Lei Gao.
In 2015, only 49% of notified multi-drug resistant tuberculosis (MDR-TB) patients in China were estimated to have initiated treatment, compared with 90% of those worldwide. A case-control study was conducted to identify the reasons for non-enrollment in treatment among MDR-TB patients in Hunan province, China. All detected MDR-TB patients registered in designated MDR-TB hospitals in Hunan province from 2011 to 2014 were included and followed until June 2015 to determine their treatment status. Approximately 33.8% (482/1425) of patients were not enrolled in standardized treatment. Factors associated with lower enrollment rate were: age greater than 60 years, living in rural area, unemployed or occupation unreported. Of those who were not enrolled in MDR-TB treatment, the primary reasons for non-enrollment included economic hardship (23.0%), out-migration for work (18.0%), concerns about work and studies (13.7%), and the belief that they were cured after undergoing drug-sensitive TB treatment (12.4%). Therefore, comprehensive strategies targeting priority populations, especially those enhancing treatment affordability and availability, need to be implemented to improve MDR-TB control.
Multi-drug resistant tuberculosis (MDR-TB) is one of the greatest challenges to controlling tuberculosis worldwide . China has a serious epidemic of drug-resistant tuberculosis . According to the 2015 Global Tuberculosis Report , only 49% of notified MDR-TB cases in China were enrolled in MDR-TB treatment. In Hunan Province, free treatment has been provided to MDR-TB patients since the second half of 2011 with funding from the New Rural Cooperative Medical System (NRCMS) and the Global Fund Tuberculosis Program. However, the rate of enrollment among notified cases remains low. Accordingly, this study followed all identified and notified MDR-TB patients in Hunan Province for approximately four years to identify the reasons for non-enrollment in MDR-TB treatment.
MDR-TB is characterized by long treatment duration, a high cost of treatment, low cure rates and high mortality rates [5, 6] and is an important infectious source. The level of MDR-TB transmission is directly correlated with the prevalence of primary MDR-TB. Early detection and timely and appropriate treatment are vital to the control of MDR-TB . In this study, 38.2% of diagnosed patients were not enrolled inappropriate treatment; this rate is much higher than the average global rate of 10% but lower than the overall rate of 51% in China . Thus, enrollment in treatment should be prioritized to address the rate of untreated cases as well as the challenges associated with MDR-TB. This study showed that elderly patients (over 60 years old); rural patients; those who were unemployed or had an unreported occupation had lower enrollment rates than their respective counterparts (P<0.05, OR >1).
Elderly patients, rural patients, unemployed or occupation unreported patients were more likely to decline treatment than their respective counterparts. The leading cause of non-enrollment in MDR-TB treatment was economic hardship; however, out-migrating for work and worrying about work and studies were also cited as important barriers to enrollment. Therefore, comprehensive strategies targeting priority populations, especially those enhancing treatment affordability and availability, need to be implemented to improve MDR-TB control.