Screening outcomes from patients with suspected multidrug-resistant tuberculosis: lessons learned in the Philippines.

Abstract

SETTING: The high prevalence of multidrug-resistant tuberculosis (MDR-TB) in the Philippines is a challenge for the National TB Programme.OBJECTIVE: To assess patterns of drug resistance and screening outcomes among MDR-TB suspects evaluated from 2003 to 2008 at DOTS-Plus clinics in the Philippines.METHODS: Descriptive study of 4897 consecutive patients with suspected MDR-TB.RESULTS: The median time from the first visit until a diagnosis of drug-resistant TB was 132 days (IQR 110-166 days). Among patients screened for MDR-TB, the most frequent resistance pattern among those previously treated in DOTS facilities was resistance to isoniazid (INH) and rifampicin (RMP). Resistance to INH+RMP plus fluoroquinolones was the most common pattern among those who had failed Category II treatment and patients treated by non-DOTS facilities. Among patients with MDR-TB, 57% ultimately received appropriate treatment with second-line drugs. The remaining 43% were lost to follow-up (25%), died (14%) or refused treatment (4%).CONCLUSION: Resistance to INH+RMP is the most frequent resistance pattern among patients referred from DOTS clinics in the Philippines for suspected MDR-TB. Initial use of standard regimens based on national survey data and quick uptake of new rapid molecular resistance tests may be useful to reduce diagnostic delays and expedite treatment for drug-resistant TB.