COMPLIANCE OF INITIALLY PRESCRIBED ANTI-TUBERCULOSIS TREATMENT REGIMENS WITH COMPLETE DRUG SUSCEPTIBILITY TEST...

Georgia has countrywide access to the genotypic and phenotypic drug susceptibility testing (gDST and pDST), however identification of susceptibility to the different anti-Tuberculosis (TB) drugs in different time period, not in all cases gives us opportunity to simultaneously know susceptibility to the all anti-TB drugs and to build an appropriate treatment regimens based on complete individual DST profile in timely manner. Initial TB treatment regimen prescribed based on gDST results not in all cases may be compliant with complete DST profile, which may be detected based on pDST results within eight weeks only. It's important to know proportion of TB patients, who in period between gDST and pDST results are treated with regimens which is non-compliant with complete individual DST profile and how the use of these inappropriate treatment regimens may affect TB treatment outcome. The aim of the study was to assess compliance of anti-TB treatment regimens with complete DST profile in period between gDST and pDST results and its association with treatment outcomes among patients who initially was registered as drug sensitive TB (DS-TB) cases in Georgia. A retrospective cohort study was conducted among 8468 patients initially registered as DS-TB adult (18+) cases, from 2015 - 2020 cohorts, whose DST profiles and anti-TB treatment outcomes was known. Adjusted analysis of the study participants data [8468 (100%)] shows significant association of a successful TB treatment outcome with the "appropriate treatment regimen" (adjusted OR 3.3, 95% CI: (2.43-4.48), p<0.001), "female gender" (adjusted OR 1.69, 95% CI: 1.47 - 1.94, p<0.001) and with "new TB case" (adjusted OR 2.15, 95% CI: 1.91-2.42, p<0.001). From 184 patients, for whom between gDST and pDST results an inappropriate 2 month treatment was used, in 171 (93%) cases the resistance to the Isoniazid was detected (Rifampicin resistance in 52 (28%), Ethambutol resitance in 44 (24%) and Ofloxacin rsistance in 16 (9%) cases was detected). Based on study data discordance between Xpert MTB/RIF and culture tests were revealed. From all 7221 (85.3%) Xpert (MTB+) cases, only 5915 cases were culture positive too. All 400 (4.7%) patients with Xpert (MTB-) results were Culture positive. In 664 cases with Xpert (MTB+) results, Culture was negative. For successful outcomes, all efforts should be done to have the individual and complete DST profiles of all patients at initial stage of TB diagnosis. Otherwise, in case of delayed DST results anti-TB treatment for a certain period maybe inappropriate and can raise the risk of non-successful outcome.