P56
Multidrug-resistant Tuberculosis (MDR-TB) in the Ternopil Region, Ukraine – a cohort study on registry data from 2017-2018 from the regional TB dispensary in Ternopil (Ukraine)
I Friesen(1) L Hryshchuk(2) H Saturska(2) J Fehr(3) T Ulrichs(4)
1:Labor Berlin, Charité und Vivantes GmbH, Berlin, Germany; 2:I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine; 3:Hasso Plattner Institute for Digital Engineering, Berlin, Germany; 4:Akkon-Hochschule für Humanwissenschaften, Berlin Germany
Drug resistance is a major obstacle to treat Tuberculosis (TB) and reduce mortality rates. Ukraine is among the top 30 countries with the highest incidence of multidrug resistance TB (MDR-TB) and with one of the lowest treatment-success rates of 51% in 2017. It is crucial to understand factors that impact treatment outcomes in Ukraine to improve treatment regimen and reduce mortality rates from TB-infection.
We analyzed registry data from the regional TB dispensary in Ternopil, Ukraine between January 2017 and December 2018 and assessed which factors were associated with successful vs. unfavorable treatment outcomes, using multivariate logistic regressions and hazard ratio estimation. The cohort comprised 192 patients above 18 years of which 186 (96.9%) had bacteriologically-confirmed TB, 104 (54.2%) MDR-TB, 36 (19.4%) had XDR-TB, and 46 (24.3%) had resistance to rifampicin. The proportion of unfavorable outcomes was 19.1% among MDR-TB, 61.1% among XDR-TB, and 35.1% among RR-TB.
XDR-TB was 3.44 (95%CI [1.25;10.07]) times more likely to result in an unfavorable vs. a successful treatment outcome. Other factors that were independently associated with unfavorable treatment outcomes according to adjusted Hazard Ratios (aHR) were: Being male (aHR 3.53, 95%CI [1.57;7.94]), disease relapse (aHR 1.87, 95%CI [1.04;3.33], HIV/TB coinfection (aHR 3.03; 95%CI [1.18-7.66]) and non-ambulatory treatment care (aHR 3.87; 95%CI [1.21-12.44]).
Our results indicate risk groups for unfavorable treatment outcomes from the Ternopil region and suggest that outpatient treatment might positively impact treatment success. Further analyses on the effectiveness of different treatment regimen are necessary to increase treatment success of drug-resistant TB in Ukraine.