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Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2020.0093    [Accepted]
Published online October 28, 2020.
Treatment outcomes of patients with multidrug-resistant tuberculosis: Comparison of pre- and post-public–private mix periods
Yewon Kang, 1, Eun-Jung Jo, 2, Jung Seop Eom, 2,3, Mi-Hyun Kim, 2,3, Kwangha Lee, 2,3, Ki Uk Kim, 2,3, Hye-Kyung Park, 2,3, Min Ki Lee, 2,3, Jeongha Mok, M.D.2,3,4
1Department of Internal Medicine, VHS Medical Center, Busan, Republic of Korea
2Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
3Pusan National University School of Medicine, Busan, Republic of Korea
4Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
Correspondence:  Jeongha Mok, Tel: 82-51-240-7889, Fax: 82-51-254-3127, 
Email: mokgamokga@gmail.com
Received: 8 August 2020   • Revised: 29 September 2020   • Accepted: 28 October 2020
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/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.
Key Words: MDR-TB, PPM, Public-private mix, South Korea, Treatment outcome


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