Concordance of programmatic and laboratory-based multidrug-resistant tuberculosis treatment outcomes in Peru.
BACKGROUND
Confirmation of cure for multidrug-resistant tuberculosis (MDR-TB) patients requires laboratory tests for Mycobacterium tuberculosis growth on culture media. Outcome decisions dictate patient management, and inaccuracies place patients at an increased risk of morbidity  and mortality, and may contribute to continued transmission of MDR-TB.


OBJECTIVE
To examine concordance between programmatic and laboratory-based MDR-TB treatment outcomes.


METHODS
The study population included 1658 MDR-TB patients in Peru treated between 1996 and 2002 with both program  and laboratory-based outcomes. Laboratory-based outcomes were assigned according to international standards requiring at least five consecutive negative cultures in the last 12 months of treatment to confirm cure.


RESULTS
Compared to the global culture-defined standard classification,  only 1.1% of treatment successes, but 54.3% of failures, were misclassified programmatically. Overall, 10.4% of patients identified by a clinician as having a successful treatment outcome still had cultures positive for MDR-TB.


CONCLUSIONS
Most patients with successful treatment outcomes  by strict culture definitions were also classified by clinicians as having successful outcomes. However, many culture-confirmed failures were missed. In light of delays and incomplete access to culture in MDR-TB programs, efforts should be made to improve the accuracy of programmatically determined  treatment outcomes.
Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
E R
ER
Alexy
L J
LJ
Podewils
C D
CD
Mitnick
M C
MC
Becerra
K F
KF
Laserson
C
C
Bonilla
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D010568:Peru; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
D000995:Antitubercular Agents