Reasons for Non-Enrollment in Treatment among Multi-Drug Resistant Tuberculosis Patients in Hunan Province, China

January Reasons for Non-Enrollment in Treatment among Multi-Drug Resistant Tuberculosis Patients in Hunan Province, China Zuhui Xu 0 1 Tao Xiao 0 1 Yanhong Li 0 1 Kunyun Yang 1 Yi Tang 0 1 Liqiong Bai 1 0 Department of tuberculosis control, Tuberculosis Control Institute of Hunan Province , Changsha city, Hunan province, China , 2 Department of MDR-TB internal medicine, Hunan Chest hospital , Changsha city, Hunan province, China , 3 Department of director's office, Tuberculosis Control Institute of Hunan Province , Changsha city, Hunan province , China 1 Editor: Lei Gao, Chinese Academy of Medical Sciences and Peking Union Medical College , CHINA In 2015, only 49% of notified multi-drug resistant tuberculosis (MDR-TB) patients in China were estimated to have initiated treatment, compared with 90% of those worldwide. A casecontrol study was conducted to identify the reasons for non-enrollment in treatment among MDR-TB patients in Hunan province, China. All detected MDR-TB patients registered in designated MDR-TB hospitals in Hunan province from 2011 to 2014 were included and followed until June 2015 to determine their treatment status. Approximately 33.8% (482/1425) of patients were not enrolled in standardized treatment. Factors associated with lower enrollment rate were: age greater than 60 years, living in rural area, unemployed or occupation unreported. Of those who were not enrolled in MDR-TB treatment, the primary reasons for non-enrollment included economic hardship (23.0%), out-migration for work (18.0%), concerns about work and studies (13.7%), and the belief that they were cured after undergoing drug-sensitive TB treatment (12.4%). Therefore, comprehensive strategies targeting priority populations, especially those enhancing treatment affordability and availability, need to be implemented to improve MDR-TB control. - Data Availability Statement: All relevant data are within the paper and its Supporting Information file. Funding: The study was funded by the Medical and Health Research Project of the Hunan Province Health Bureau (B2014-138) and the World Health Organization County Project (CHN/10/STB/ 005520). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Introduction Multi-drug resistant tuberculosis (MDR-TB) is one of the greatest challenges to controlling tuberculosis worldwide [1]. China has a serious epidemic of drug-resistant tuberculosis [ 2 ]. According to the 2015 Global Tuberculosis Report [1], only 49% of notified MDR-TB cases in China were enrolled in MDR-TB treatment. In Hunan Province, free treatment has been provided to MDR-TB patients since the second half of 2011 with funding from the New Rural Cooperative Medical System (NRCMS) and the Global Fund Tuberculosis Program. However, the rate of enrollment among notified cases remains low. Accordingly, this study followed all identified and notified MDR-TB patients in Hunan Province for approximately four years to identify the reasons for non-enrollment in MDR-TB treatment. Competing Interests: The authors have declared that no competing interests exist. Methods Study population All MDR-TB patients registered between 2011 and 2014 in designated MDR-TB specialist hospitals (the majority of whom were registered in one provincial tuberculosis hospital) were enrolled as the study population. The methods used for MDR-TB detection included phenotypic drug susceptibility testing (based on solid culture and liquid culture techniques) and molecular methods (line probe assay). Mycobacterium tuberculosis (MTB) strains that were found to be resistant to both isoniazid (INH) and rifampicin (RMP) using any of the aforementioned methods were considered MDR-TB. Data sources Four data sources from the designated MDR-TB hospitals were used to extract patient information: the ªDrug Susceptibility Testing (DST) Results Registry formº, which documents all DST results, including diagnoses of MDR-TB; the ªMDR-TB Case Registry formº, which includes data on the treatment enrollment of MDR-TB cases; the self-designed "MDR-TB Patient Tracing Registry form of Hunan Province", which includes information on the reasons for non-enrollment in treatment; and the Chinese Internet-based TB Management Information System, which includes data on patient sex, age, occupation, residence, and treatment history. For the analyses, age groups were categorized as 20, 21±40, 41±60 and 61 years. Each patient's current location was categorized as central, northern, southern, southwestern, western, other province and unknown based on their socioeconomic status within the province and the travel distance required for MDR-TB care. The four forms were linked by CDC staffs using patient ªpatient nameº, ªsexº, ªageº, and ªliving address ªto incorporate each patient's information (the researcher used de-identified data). Treatment history was classified according to the definitions provided by the n (...truncated)