title: Treatment interruption and directly observed treatment of multidrug-resistant tuberculosis patients in China.
abstract: BACKGROUND
  China has nearly one fifth of global multidrug-resistant tuberculosis (MDR-TB) cases, and follows the 24-month World Health Organization (WHO) standardised regimens.
  
  
  OBJECTIVE
  To assess treatment interruption among MDR-TB patients and its association with the provision of directly observed treatment (DOT).
  
  
  METHODS
  We reviewed clinical charts and conducted a questionnaire survey among all confirmed MDR-TB patients who had been treated for at least 6 months from 1 January 2009 to 30 April 2012 in Shandong Province. Treatment interruption was defined as missing a dose for at least 1 day but for <8 consecutive weeks; the subset 'severe interruption' was defined as missing doses for 2-8 consecutive weeks.
  
  
  RESULTS
  Of 110 patients, 75 (68%) interrupted treatment; 19 (17%) reported severe interruption, with a median duration of 30 days. Of the 110 patients, 26 (24%) received injections from family members and 55 (50%) received DOT, 7 (13%) from village doctors and 48 (87%) from family members. Patients who underwent DOT with a family member had less severe interruptions (OR 0.25, 95%CI 0.05-0.98) than those who were given DOT by a village doctor or who did not undergo DOT.
  
  
  CONCLUSIONS
  Family members may act as treatment supporters for MDR-TB patients to reduce treatment interruptions, but require orientation on their role.
authors: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
authors: X-L
authors: XL
authors: Wei
authors: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
authors: J
authors: J
authors: Yin
authors: Nuffield Centre for International Health and Development, University of Leeds China Office, Shenzhen, China.
authors: G-Y
authors: GY
authors: Zou
authors: Nuffield Centre for International Health and Development, University of Leeds China Office, Shenzhen, China.
authors: Z-T
authors: ZT
authors: Zhang
authors: Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK.
authors: J
authors: J
authors: Walley
authors: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
authors: J
authors: J
authors: Harwell
authors: Center for TB Control, Shandong Provincial Chest Hospital, Jinan, China.
authors: H-T
authors: HT
authors: Li
authors: Center for Health Management and Policy, Shandong University, Jinan, China.
authors: Q
authors: Q
authors: Sun
authors: National Centre for TB Control and Prevention, China Centre for Disease Control, Beijing, China.
authors: R-Z
authors: RZ
authors: Li
authors: National Centre for TB Control and Prevention, China Centre for Disease Control, Beijing, China.
authors: L-X
authors: LX
authors: Wang
authors: Center for TB Control, Shandong Provincial Chest Hospital, Jinan, China.
authors: X-L
authors: XL
authors: Zhang
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002681:China; D023801:Directly Observed Therapy / Q000379:methods*; D019468:Disease Management; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014944:World Health Organization; D016903:Drug Monitoring
chemical_list: D000995:Antitubercular Agents