Non-response to first-line anti-tuberculosis treatment in Sikkim, India: a risk-factor analysis study

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Sikkim, India, exhibits a high rate of treatment failure or regimen change for multidrug-resistant tuberculosis (MDR-TB) among patients on first-line anti-tuberculosis therapy.
• Understanding the factors contributing to non-response is crucial for improving tuberculosis treatment outcomes in the region.

Purpose of the Study:

• To identify patient-specific factors associated with non-response to first-line tuberculosis treatment in Sikkim.
• To investigate the reasons why patients require a shift to MDR-TB regimens.

Main Methods:

• A retrospective cohort study was conducted using data from the Revised National Tuberculosis Control Programme for patients registered in 2015.
• Data included 1508 patients undergoing first-line TB treatment.
• Additionally, 42 non-responding patients were interviewed to ascertain their current treatment status.

Main Results:

• Approximately 9% of the 1508 patients enrolled in the study were classified as non-responders.
• Factors significantly associated with non-response included residing in an urban setting (aOR 2.39), specific Indian ethnicities (tribal aOR 1.73, other Indian aOR 1.83) compared to Nepali origin, and patients undergoing retreatment (aOR 2.40).
• Among the interviewed non-responders, 67% had previously received treatment for drug-resistant TB.

Conclusions:

• One in eleven tuberculosis patients in Sikkim did not respond to initial first-line treatment.
• Further research into host-pathogen genetics and socio-behavioral factors is recommended to explain ethnic variations in treatment non-response.