PLoS ONE (Jan 2019)

Impact of universal drug susceptibility testing and effective management of multidrug-resistant tuberculosis in Taiwan.

  • Pin-Hui Lee,
  • Pei-Chun Chan,
  • Yen-Ting Peng,
  • Po-Wei Chu,
  • Mei-Hua Wu,
  • Ruwen Jou,
  • Ming-Chih Yu,
  • Chou-Jui Lin,
  • Yi-Wen Huang,
  • Shun-Tien Chien,
  • Jen-Jyh Lee,
  • Chen-Yuan Chiang

DOI
https://doi.org/10.1371/journal.pone.0214792
Journal volume & issue
Vol. 14, no. 4
p. e0214792

Abstract

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BACKGROUND:The treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients in the 1990s in Taiwan was not satisfactory. To strengthen programmatic management of drug-resistant tuberculosis (PMDT), Taiwan MDR-TB Consortium (TMTC) was established in 2007. We assess the performance and epidemiologic impact of TMTC. METHODOLOGY/PRINCIPLE FINDINGS:We analyzed the trends of proportion of TB cases with drug susceptibility testing, enrollment of MDR-TB patients into TMTC and outcomes of treatment of all MDR-TB patients in Taiwan from 2007-2016. We computed the trends of both incidence and prevalence of MDR-TB from 2007-2016. We assessed the trends of MDR-TB among both new and recurrent TB cases. The proportion of TB cases with drug susceptibility testing results increased from 24.2% in 2007 to 97.9% in 2016. Of the 1,452 MDR-TB patients who were eligible for TMTC care, 1,197 (82.4%) were enrolled in TMTC, in whom 82.9% had treatment success. MDR-TB incidence was 9.0 cases per million in 2007, which declined to 4.6 cases per million in 2016 (p<0.0001). MDR-TB prevalence decreased from 19.4 cases per million in 2007 to 8.4 cases per million in 2016 (p<0.0001). The proportion of MDR-TB among new TB cases decreased from 1.4% in 2010 to 1.0% in 2016 (p = 0.039); and that among recurrent TB cases from 9.0% in 2010 to 1.8% in 2016 (p<0.0001). CONCLUSIONS:We concluded that effective PMDT have had a significant impact on the epidemic of drug-resistant TB in Taiwan.