Abstract:

Objective To evaluate the effect of the management strategies for multidrug-resistant tuberculosis (MDR-TB) in Guangzhou, to provide the basis for the prevention and treatment of tuberculosis. Methods A total of 2417 high-risk patients of MDR-TB screened in Guangzhou Chest Hospital from July 1, 2014 to December 31, 2019 were selected. Their demographic characteristics and clinical data were collected; 671 cases were diagnosed of MDR-TB, and of them, 352 had treatment outcomes until December 31, 2019. The treatment plan of patients registered in Guangzhou were determined by the expert group, hospitalized in designated departments and followed-up in multidrug-resistant clinics, while the other patients chose hospitals and doctors freely. The medical costs of 162 patients from January to May, 2018 were collected. The treatment and outcome of the subjects, as well as the factors affecting the outcome of treatment, and the financial burden of medical care were analyzed. Results Of the 671 MDR-TB patients, 303 were registered in Guangzhou and the detection rate was 21.37% (303/1418), which was significantly lower than that of non-local registered patients (36.84% (368/999); χ²=69.93, P<0.01). Among the 352 patients with treatment outcomes, 200 patients (56.82%) were successfully treated, and 152 (43.18%) had adverse outcomes. Single factor analysis showed that the rate of successful treatment of patients registered in Guangzhou was significantly higher than that of non-local registered patients (69.23% (108/156) vs. 46.94% (92/196), χ²=17.59, P<0.01). The ratios of adverse outcomes in patients aged 41-60 years and ≥61 years were both significantly higher than that in successfully treated patients (52.00% (78/150) vs. 48.00% (72/150), 56.82% (25/44) vs. 43.18% (19/44), χ²=18.45, P<0.01). The rate of successful treatment in patients treated since and after January 1, 2016 was significantly higher than that in patients treated before January 1, 2016 (61.71% (166/269) vs. 40.96% (34/83), χ²=11.13, P<0.01). According to the multivariate regression analysis, the risk factors for adverse outcomes were non-local registration (OR(95%CI)=4.01(2.37-6.79)), aged >40 years (41-60 years old: OR(95%CI)=4.08(1.05-15.96); ≥61 years old: OR(95%CI)=6.51(1.48-28.60)). Treatment started after January 1, 2016 was a protective factor (OR(95%CI)=0.30(0.17-0.52)). The total economic burden of patients registered in Guangzhou was significantly lower that of non-local registered patients (M(Q₁,Q₃), RMB 24674 (17466, 49920) yuan vs. RMB 100215 (63858, 133720) yuan, Z=-7.80, P<0.01). Conclusion The management strategy of MDR-TB in Guangzhou could increase the rate of successful treatment in patients registered in Guangzhou, and reduce the financial burden. The management strategy of MDR-TB patients by the expert group, hospitalized and followed-up in designated departments, and reduction of medical costs should be promoted.

Key words: Tuberculosis,pulmonary, Drug resistance,multiple, Case management, Games,experimental, Evaluation studies