Epidemiological correlates and treatment outcomes of MULTIDRUG-RESISTANT Tuberculosis in Delhi, India: A record-based operational research study

Background: Multidrug-resistant tuberculosis (MDR-TB) referring to tuberculosis that is resistant to both rifampicin and isoniazid is a major challenge against meeting TB elimination targets. We conducted this operational research study with the objective of describing MDR-TB treatment outcome trends, epidemiological correlates and resistance patterns. We also evaluated the adequacy of treatment records for informing policy and practice related to disease control. Methods and materials: A retrospective record-based study was conducted in three major drug resistance TB treatment centers of Delhi, India. Data was extracted from the existing program records including patient treatment cards and laboratory registers. Period of enrolment was 2009–2014, and outcomes until December 2016. We analysed the data using SPSS Version 16. Results: A total of 2958 MDR-TB cases were identified from the treatment cards of which 1749 (59.1%) were males. The mean (±SD) age was 30.56 (±13.5) years. Favorable treatment outcomes were reported in 1371 (46.3%) cases with a declining trend registered during the period of observation. On binomial logistic treatment analysis, cases with age ≥35 years, male sex and undernourishment (BMI < 18.5) at the time of treatment initiation had a significantly increased likelihood of adverse MDR-TB treatment outcome (P < 0.001). Favorable treatment outcomes were maximum in MDR-TB (56.9%) compared to pre XDR-TB (26.3%) and XDR-TB (12.5%) cases. Smear positive cases on retreatment and those lost to follow-up comprised a total of 1164 (44.8%) of the total recorded drug resistant TB cases. Conclusion: We found an increasing burden of MDR-TB cases especially in the young, and male population which is highly mobile, promoting further infection transmission, while threatening the possibility of attaining the TB elimination targets. However, a major limitation of the study was the limited generalizability of the evidence due to the large volume of missing data especially relating to drug adherence, drug side effects, BMI and SES, reflecting the need for improved recording of these variables in clinical records. Finally, strengthening service delivery to ensure early anti-tubercular treatment initiation, preventing attrition, monitoring of adherence and support for treatment completion in drug sensitive TB cases can significantly reduce the emergence of drug-resistant TB.