Treatment of multidrug-resistant tuberculosis in Uzbekistan from 2012 to 2018: does practice follow policy?

Compliance with treatment guidelines is crucial for effective and successful treatment of multidrug-resistant tuberculosis (MDR-TB). Thus, we assessed if MDR-TB treatment practices in Uzbekistan from 2012-18 were compliant with the national treatment guidelines in terms of 1) prescription of initial standard treatment regimens, 2) correct weight-based drug and 3) correct documentation of treatment changes (prolongation of intensive phase and regimen changes during both phases of treatment). Data of 1481 adult MDR TB patients were analyzed. Overall, 25% of patients were treated using the standardized regimens in compliance with the national guidelines: there was an increasing trend from 2% in 2012 to 44% in 2018 (Figure). Compliance to recommended weight-based drug dosages was observed in 85% of the patients during intensive phase and 84% in continuation phase – ranged between 71% and 91% over the years. The prolongation of the intensive phase was done in 42% of patients. The treatment was changed in 44% of patients during the intensive phase and 34% during the continuation phase. The documentation of treatment changes was suboptimal during the initial years (42-75%), however it improved significantly during later years (86-100%). Future research should explore reasons for non-compliance so that quality of patient care can be improved.

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