title: Experiences in anti-tuberculosis treatment in patients with multiple previous treatments and its impact on drug resistant tuberculosis epidemics.
abstract: BACKGROUND
  Tuberculosis (TB) patients with a history of multiple anti-TB treatments are the 'neglected' group to the free anti-TB treatment policy in China.
  
  
  OBJECTIVE
  To understand the experiences of TB patients with multiple previous treatments with regard to bacteriological diagnosis and treatment regimens, especially for second-line anti-TB drugs, and how this might influence the risks of multidrug and extensively drug-resistant TB (M/XDR-TB).
  
  
  METHODS
  A cross-sectional study was conducted in 10 county/district TB clinics in five provinces of China. The study participants were TB patients that had at least two previous treatment episodes that lasted longer than 1 month each. Face-to-face interviews and drug susceptibility testing (DST) were conducted with the consenting participants.
  
  
  RESULTS
  A total of 328 TB patients were recruited. The proportion of multidrug-resistant tuberculosis (MDR-TB) was 58.2% in the 287 DST-confirmed patients. Forty-two percent of the patients did not complete their first treatment course. About 23.8% of the participants had a history of taking second-line drugs, and more than 77.8% of them were treated in county TB dispensaries where only sputum microscopy was applied. Multivariate analysis found that the use of second-line drugs was significantly associated with frequency of previous treatments (p<0.01), but not with drug resistance profiles of patients.
  
  
  CONCLUSIONS
  Patients with multiple previous treatments are at extremely high risk of MDR-TB in China. The unregulated use of second-line drugs bring about the threat of XDR-TB epidemic. DST-guided treatment and strict regulations of anti-TB treatment should be assured for the high-risk TB patients for the prevention and control of M/XDR-TB.
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China; bxu@shmu.edu.cn.
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China; The Department of Tuberculosis Prevention and Control, Ministry of Health, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
authors.forename: Weibing
authors.initials: W
authors.lastname: Wang
authors.affiliation: School of Public Health, Centre for Global Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Diwan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D058872:Epidemics; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D015995:Prevalence; D012042:Registries
chemical_list: D000995:Antitubercular Agents
keywords: China; drug resistance; second-line anti-tuberculosis drugs; treatment history; tuberculosis