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dc.contributor.authorYe Minn Htunen_US
dc.contributor.authorTin Mi Mi Khaingen_US
dc.contributor.authorNay Myo Aungen_US
dc.contributor.authorYin Yinen_US
dc.contributor.authorZaw Myinten_US
dc.contributor.authorSi Thu Aungen_US
dc.contributor.authorNgamphol Soonthornworasirien_US
dc.contributor.authorUdomsak Silachamroonen_US
dc.contributor.authorYuthichai Kasetjaroenen_US
dc.contributor.authorJaranit Kaewkungwalen_US
dc.contributor.otherMahidol Universityen_US
dc.contributor.otherDefence Services Medical Schoolen_US
dc.contributor.otherRegional Tuberculosis Centeren_US
dc.contributor.otherDefence Services Medical Academyen_US
dc.contributor.otherBureau of Tuberculosisen_US
dc.contributor.otherMinistry of Healthen_US
dc.identifier.citationPLoS ONE. Vol.13, No.12 (2018)en_US
dc.description.abstract© 2018 Htun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Myanmar faces a health security threat, with an increasing number of multidrug-resistant tuberculosis (MDR-TB) cases. Long delays in the initiation of treatment are a barrier to MDR-TB control. Objectives The main objectives of this study were (1) to identify the determinants of delay in treatment initiation after MDR-TB diagnosis, and (2) to explore the effects of treatment delay on disease infectivity, severity, treatment adherence, and treatment outcomes. Methods This retrospective study reviewed 330 MDR-TB treatment cards for patients enrolled for treatment at Yangon Regional Tuberculosis Centre, in 2014. Results Median treatment delay was 105 days, interquartile range (IQR) 106 (61–167) days; (51.5%) of patients experienced a long treatment delay ( 105 days). Regarding the determinants of treatment delay, this study identified important patient-healthcare system interaction factors. Significant risk factors of long treatment delay included female sex, age > 30 years, and prior contact with patients with MDR-TB. Patients with long treatment delays were significantly different from those with short delays, in terms of having high sputum smear grade, resistance to more than two main drugs (isoniazid and rifampicin), and long culture conversion time. In this study, delay in the initiation of treatment was associated with poor treatment outcome, but this was not statistically significant after adjusting for other risk factors. Median treatment-delay times were longer among patients with poor outcomes (144 days) than those with successful outcomes (102 days). Conclusions Post-diagnosis delays in the initiation of treatment among MDR-TB patients were significantly long. The study results showed that inadequate MDR-TB treatment initiation center, centralization of treatment initiation, limitation of human resources, were health-system factors delaying timely treatment initiation and implementation of an effective TB-control program. Our findings highlight the need for immediate interventions to reduce treatment delay and improve treatment outcomes, including scaling up diagnostic capacity with Xpert MTB/ RIF at township level, expansion of decentralized MDR-TB treatment initiation centers, ensuring a productive health workforce comprising trained health personnel, and providing health education and treatment-adherence counseling to patients and family members.en_US
dc.rightsMahidol Universityen_US
dc.subjectAgricultural and Biological Sciencesen_US
dc.subjectBiochemistry, Genetics and Molecular Biologyen_US
dc.titleDelay in treatment initiation and treatment outcomes among adult patients with multidrug-resistant tuberculosis at Yangon Regional Tuberculosis Centre, Myanmar: A retrospective studyen_US
Appears in Collections:Scopus 2018

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