ABSTRACT
OBJECTIVE
to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB).
METHODS
Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated.
RESULTS
Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure.
CONCLUSIONS
The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.
Tuberculosis, Multidrug-Resistant, complications; Tuberculosis, Multidrug-Resistant, mortality; Risk Factors; Treatment Adherence and Compliance
Number of previous MDR-TB treatments: (1) first treatment, (2) more than one treatment for MDR-TB; Use of illicit drugs: (1) patient does not use illicit drugs, (2) patient makes use of illicit drugs.
Number of previous MDR-TB treatments: - (1): first treatment; (2) more than one treatment for MDR-TB; Form of discovery of the case: (1) diagnosis by outpatient demand and active search of the cases; (2) diagnosis in emergency service and during hospitalization. Use of illicit drugs: (1) patient does not use illicit drugs; (2) patient makes use of illicit drugs. Smoking: (1) non-smoker patient; (2) smoker. Type of Treatment: (1) supervised treatment; (2) self-administered treatment.