Treatment interruption and directly observed treatment of multidrug-resistant tuberculosis patients in China

BACKGROUND: China has nearly one fifth of global multidrug-resistant tuberculosis (MDR-TB) cases, and follows the 24-month World Health Organization (WHO) standardised regimens. OBJECTIVE: To assess treatment interruption among MDR-TB patients and its association with the provision of directly observed treatment (DOT). METHODS: We reviewed clinical charts and conducted a questionnaire survey among all confirmed MDR-TB patients who had been treated for at least 6 months from 1 January 2009 to 30 April 2012 in Shandong Province. Treatment interruption was defined as missing a dose for at least 1 day but for <8 consecutive weeks; the subset 'severe interruption' was defined as missing doses for 2-8 consecutive weeks. RESULTS: Of 110 patients, 75 (68%) interrupted treatment; 19 (17%) reported severe interruption, with a median duration of 30 days. Of the 110 patients, 26 (24%) received injections from family members and 55 (50%) received DOT, 7 (13%) from village doctors and 48 (87%) from family members. Patients who underwent DOT with a family member had less severe interruptions (OR 0.25, 95%CI 0.05-0.98) than those who were given DOT by a village doctor or who did not undergo DOT. CONCLUSIONS: Family members may act as treatment supporters for MDR-TB patients to reduce treatment interruptions, but require orientation on their role.