Author | Journal | Year | Exposure | Outcome | Comments |
---|---|---|---|---|---|
Goble [38] | NEJM | 1993 | Duration of disease | Failure: continually positive sputum cultures after at least three months of therapy | Duration of disease very long |
1-3 yrs | 12/44 | ||||
4-8 yrs | 18/44 OR 1.8 (0.6-5.4) | ||||
≥9 yrs | 17/46 OR 1.6 (0.5-5.0) | ||||
Chan [37] | AJRCCM | 2004 | Each additional year delay before first visit to site | Initial favourable response: ≥3 negative sputum cultures over ≥3 months OR 0.93 (0.87-0.995) p=0.03 | Median pre-therapy disease duration = 4.2 years; analysis takes no account of time to MDR therapy, just time to first visit |
Bonilla [66] | PLoS ONE | 2008 | Â | Treatment success | Paper mainly about individualisation of regimens with DST and availability of 2nd line DST within 31 days; no data on lead-in time from diagnosis and exclusions from primary analyses limit interpretation |
MDR DST available within ≤31 days | 264/334 (79.0%) | ||||
MDR DST available after > 31 days | 108/160 (67.5%) | ||||
XDR DST available within ≤31 days | 11/14 (78.6%) | ||||
XDR DST available after > 31 days | 7/23 (30.4%) | ||||
Dheda [31] | Lancet | 2010 | Treatment outcome | Delay to treatment | Compared delay to treatment in groups of survivors and non-survivors and culture converters and non-converters. Delay to treatment = time from sputum acquisition to start of treatment |
Survival | 78 days [53–107] | ||||
Death | 57 days [36–67] p=0·001 | ||||
Culture conversion | 91 days [61–116] | ||||
Non-conversion | 59 days [43–86] p=0·001 | ||||
Heller [45] | IJTLD | 2010 | Â | Median days (95%CI) treatment delay | Before vs. after comparison following change from traditional hospital based management (TM) to community based (CM). In multivariate analysis time to smear conversion was longer for TM group than for CM group (aHR=1.78, p=0.062), as was time to culture conversion (aHR=1.82, p=0.026) |
Traditional (n=46) | 106.5 (88.6-151.1) | ||||
Community (n=48) | 84 (78.7-93.3) p=0.002 | ||||
 | Median days (95%CI) to smear conversion | ||||
Traditional (n=48) | 91 (72.2-119.8) | ||||
Community (n=32) | 59 (34.9-83.1) p=0.055 | ||||
 | Median days (95%CI) to culture conversion | ||||
Traditional (n=53) | 119 (106.1-131.9) | ||||
Community (n=39) | 85 (68.0-102.0) p=0.002 | ||||
 | Active and on treatment at 6 months | ||||
Traditional | 91.2% | ||||
Community | 84.8% p=0.4 | ||||
Seddon [64] | CID | 2012 | Treatment delay (not defined) | Not associated with: [1] failure to culture convert by month 2 (26/74, p=0.25) [2] unfavourable treatment outcome (15/103, p=0.36) [3] death (8/103, p=0.18) | Median delay 91 days (IQR 51–166) Data in table 4 – analysis not clear |
Van der Walt [13] | ERJ (Conference abstract) | 2012 | Â | Time to treatment | Shorter time to treatment in inpatients but no differences in time to smear or culture conversion |
Inpatients | 76 days | ||||
Community | 64 days p<0.01 | ||||
 | Sputum conversion | ||||
Inpatients | 54% | ||||
Community | 52% | ||||
 | Time to conversion (median with IQR) | ||||
Inpatients | 105 (64.5-164) | ||||
Community | 121 (61.0-206.5) | ||||
Loveday [46] | IJTLD | 2012 | Â | Median (IQR) treatment delay in days | Decentralised vs. centralised hospital care. Shorter delay to treatment but worse treatment outcomes for decentralised care, but many other differences in care beyond treatment initiation delay. |
Decentralised | 72 (56–99) | ||||
Centralised | 93 (71–120) p<0.001 | ||||
 | Unsuccessful treatment outcomes | ||||
Decentralised | 96/419 (23%) | ||||
Centralised | 37/441 (8%) | ||||
Cox [63] | IJTLD | 2014 | Â | Median (IQR) treatment delay in days | MDR programme implemented. But changes other than treatment initiation delay e.g. change to include moxifloxacin |
Before (2005) | 58 (25–91) (n=39) | ||||
During (2010) | 31 (18–45) (n=183) | ||||
 | Treatment success | ||||
Before (2005–7) | 85/206 (41%) | ||||
During (2010) | 86/164 (52%) | ||||
Mpagama [48] | PLoS ONE | 2013 | Median (range) time from MDR diagnosis to treatment | Outcome | No difference in time from MDR diagnosis to treatment initiation between intensive phase completers and deaths. |
272 (26–888) | Completion of intensive phase n=54 | ||||
255 (193–317) | Died n=4 p=0.8 | ||||
Chan [50] | PLoS ONE | 2013 | Delay | Treatment success in 3 models Multiple logistic analysis | Change to programme management in Taiwan |
>120 days | 133/194 (69%) | ||||
≤120 days | 328/457 (72%) | ||||
>120 vs.≤120 | OR 1.2 (0.8-1.7), p=0.4 Adjusted HRs 0.8 (0.6-0.9), p=0.012 0.8 (0.6-1.0), p=0.018 | ||||
Delay in 390 patients with second line drug susceptibility testing | Â | ||||
>120 days | 74/117 (63%) | ||||
≤120 days | 170/273 (62%) | ||||
>120 vs. ≤120 | OR 1.0 (0.6-1.5), p=0.9 aOR 0.6 (0.4-0.9), p=0.01 | ||||
Helbling [61] | Swiss Med Wkly | 2014 | Time to treatment | Treatment success 39/51 (76.5%) Time to treatment initiation not associated with treatment success in logistic regression model (no data shown) | Median time to initiation was 5.5 weeks but 10 initiated MDR treatment immediately |
Kipiani [68] | CID | 2014 | Line probe assay implementation | Delay to MDR treatment | Before vs. after analysis of line probe assay implementation. Groups differed in many ways – post implementation group had more HCV co-infection, more initial inpatient treatment, more likely to receive kanamycin instead of capreomycin, higher rates on prior MDR treatment, resistant to more drugs. |
Pre-implementation | 83.9 (56–106) | ||||
Post-implementation | 18.2 (11–24) p<0.01 (Unclear if overall or just for subset who received first line drugs) | ||||
 | 12 wk culture conversion | ||||
Pre-implementation | 5/68 (7%) | ||||
Post-implementation | 25/51 (49%) | ||||
 | 24 week culture conversion | ||||
Pre-implementation | 43/68 (63%) | ||||
Post-implementation | 44/51 (86%) p=0.01 | ||||
 | 24 week smear conversion | ||||
Pre-implementation | 77% | ||||
Post-implementation | 90% p=0.05 | ||||
Li [51] | Lancet Global Health | 2015 | Programme implementation | Median [IQR] time to treatment | Time to treatment only reported for 32% and 71% of pre- and post-intervention patients |
Before | 139 [69–207] | ||||
After | 14 [10–21] | ||||
 | Still on treatment at 6 months | ||||
Before | 8% (2/26) | ||||
After | 80% (137/172) | ||||
Loveday [11] | IJTLD | 2015 | Â | Median (IQR) treatment delay in days | Includes all of Loveday 2012 data plus data for 7 additional months |
Decentralised | 72 (54–97) (n=724) | ||||
Decentralised | 72 (54–97) (n=724) | ||||
Centralised | 92 (69–120) (n=811) p<0.001 | ||||
 | Treatment success | ||||
Decentralised | 427/736 (58%) | ||||
Centralised | 439/813 (54%) p=0.18 | ||||
 | Death | ||||
Decentralised | 133/736 (18.1%) | ||||
Centralised | 113/813 (13.9%) p=0.21 | ||||
Otero [22] | TMIH | 2015 | Treatment outcomes | Median (IQR) time in days to MDR-TB treatment | Should be noted that the duration of treatment prior to switching was undetermined. |
For patients starting on MDR regimen: | Â | ||||
Success | 26 (18–41) | ||||
Not success | 25 (18–30) p=0.6 | ||||
For patients switching to MDR regimen: | Â | ||||
Success | 11.5 (2–35) | ||||
Not success | 22 (2–48) p=0.1 |