Out-patient MDR-TB care in Moldova

Moldova is a high burden multidrug-resistant tuberculosis (MDR-TB) country (>1,600 cases a year, traditionally managed in hospitals, with long admissions, and risk of nosocomial transmission). Aim of the study is to evaluate the impact of an innovative MDR-TB management model combining rapid diagnostics with outpatient-based MDR-TB treatment (OP) and intensified patient support from 2012 to 2014. 43 cases were managed as in-patients (IP) as per standard approach and 38 started OP with a standardized MDR-TB regimen. No major differences were found between IP and OP risk factors and clinical characteristics (new cases: 53.5 vs 68.4%; 1 st - and 2 nd -line drug-resistance pattern: all MDR-TB with two extensively drug-resistant TB OP cases). The median time to MDR-TB treatment initiation after Xpert test results was 10 days for IP vs 6 for OP. Sputum smear conversion (IP vs OP) was as follows: 38.7 vs 71.4% at 2 weeks, 96.7vs 63.6 % at 2 months and 86.7vs 77.2 % at 5 months. The median time to smear conversion was 28 vs 42 days. Comparing IP vs OP, culture conversion was as follows: 59.0 vs 55.8 % at month 1 and 94.7 vs 77.4 % at month 5. The median time to culture conversion was 56 vs 56 days. Treatment outcomes (IP vs OP) were as follows: cured 11/43 (25.6%) vs 9/38 (24%): failed 0 vs 2; died 1 vs 1; lost to follow-up 3 vs 3; still on treatment 28 vs 23 (P=0.67). No treatment was interrupted or modified because of adverse events. The study results demonstrate that OP MDR-TB care is feasible providing results not inferior to IP in Moldova, reducing the risk of nosocomial transmission and stigma. It can be expanded in other countries of the Region. Funded via unrestricted grant to the Centre for Health Policy Studies (PAS) by Otsuka.