Speaking the same language: treatment outcome definitions for multidrug-resistant tuberculosis.
METHODS
Globally it is estimated that 273000 new cases of multidrug-resistant tuberculosis (MDR-TB, resistance to isoniazid and rifampicin) occurred in 2000. To address MDR-TB management in the context of the DOTS strategy, the World Health Organization and partners have been promoting an expanded treatment strategy called DOTS-Plus. However, standard definitions for MDR-TB patient registration and treatment outcomes do not exist.


OBJECTIVE
To propose a standardized set of case registration groups and treatment outcome definitions for MDR-TB and procedures for conducting cohort analyses under the DOTS-Plus strategy.


METHODS
Using published definitions for drug-susceptible TB as a guide, a 2-year-long series of meetings, conferences, and correspondence was undertaken to review published literature and country-specific program experience, and to develop international agreement.


RESULTS
Definitions were designed for MDR-TB patient categorization, smear and culture conversion, and treatment outcomes (cure, treatment completion, death, default, failure, transfer out). Standards for conducting outcome analyses were developed to ensure comparability between programs.


CONCLUSIONS
Optimal management strategies for MDR-TB have not been evaluated in controlled clinical trials. Standardized definitions and cohort analyses will facilitate assessment and comparison of program performance. These data will contribute to the evidence base to inform decision makers on approaches to MDR-TB control.
Laserson
K F
KF
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. kel4@cdc.gov
Thorpe
L E
LE
Leimane
V
V
Weyer
K
K
Mitnick
C D
CD
Riekstina
V
V
Zarovska
E
E
Rich
M L
ML
Fraser
H S F
HS
Alarcón
E
E
Cegielski
J P
JP
Grzemska
M
M
Gupta
R
R
Espinal
M
M
D015331:Cohort Studies; D023801:Directly Observed Therapy; D014943:Global Health; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012042:Registries / Q000592:standards*; D009626:Terminology as Topic; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*