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Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar.

Community-based MDR-TB care project improves treatment initiation in patients diagnosed with MDR-TB in Myanmar.
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Wai PP, Shewade HD, Kyaw NTT, Thein S, Si Thu A, Kyaw KWY, Aye NN, Phyo AM, Maung HMW, Soe KT, Aung ST,


Wai PP, Shewade HD, Kyaw NTT, Thein S, Si Thu A, Kyaw KWY, Aye NN, Phyo AM, Maung HMW, Soe KT, Aung ST, (click to view)

Wai PP, Shewade HD, Kyaw NTT, Thein S, Si Thu A, Kyaw KWY, Aye NN, Phyo AM, Maung HMW, Soe KT, Aung ST,

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PloS one 2018 03 2913(3) e0194087 doi 10.1371/journal.pone.0194087

Abstract
BACKGROUND
The Union in collaboration with national TB programme (NTP) started the community-based MDR-TB care (CBMDR-TBC) project in 33 townships of upper Myanmar to improve treatment initiation and treatment adherence. Patients with MDR-TB diagnosed/registered under NTP received support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each township had a project nurse exclusively for MDR-TB and 30 USD per month (max. for 4 months) were provided to the patient as a pre-treatment support.

OBJECTIVES
To assess whether CBMDR-TBC project’s support improved treatment initiation.

METHODS
In this cohort study (involving record review) of all diagnosed MDR-TB between January 2015 and June 2016 in project townships, CBMDR-TBC status was categorized as "receiving support" if date of project initiation in patient’s township was before the date of diagnosis and "not receiving support", if otherwise. Cox proportional hazards regression (censored on 31 Dec 2016) was done to identify predictors of treatment initiation.

RESULTS
Of 456 patients, 57% initiated treatment: 64% and 56% among patients "receiving support (n = 208)" and "not receiving support (n = 228)" respectively (CBMDR-TBC status was not known in 20 (4%) patients due to missing diagnosis dates). Among those initiated on treatment (n = 261), median (IQR) time to initiate treatment was 38 (20, 76) days: 31 (18, 50) among patients "receiving support" and 50 (26,101) among patients "not receiving support". After adjusting other potential confounders (age, sex, region, HIV, past history of TB treatment), patients "receiving support" had 80% higher chance of initiating treatment [aHR (0.95 CI): 1.8 (1.3, 2.3)] when compared to patients "not receiving support". In addition, age 15-54 years, previous history of TB and being HIV negative were independent predictors of treatment initiation.

CONCLUSION
Receiving support under CBMDR-TBC project improved treatment initiation: it not only improved the proportion initiated but also reduced time to treatment initiation. We also recommend improved tracking of all diagnosed patients as early as possible.

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