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Open Access Multi- and extensively drug-resistant tuberculosis in Latvia: trends, characteristics and treatment outcomes

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Setting: Drug-resistant tuberculosis (TB) is an important public health problem in Latvia.

Objective: To document trends, characteristics and treatment outcomes of registered patients with multi-drug-resistant (MDR-) and extensively drug-resistant (XDR-) TB in Latvia from 2000 to 2010.

Design: A retrospective national cohort study.

Results: Of 1779 patients, 1646 (92%) had MDR- and 133 (8%) XDR-TB. Over 11 years, the proportion of XDR-TB among MDR-TB patients increased from 2% to 18%. Compared to MDR-TB patients, those with XDR-TB were significantly more likely to have failed MDR-TB treatment (OR 8.4, 95%CI 4.3–16.2), have human immunodeficiency virus infection (OR 3.2, 95%CI 1.8–5.7), be illegal drug users (OR 5.7, 95%CI 2.6–11.6) or have had contact with MDR-TB patients (OR 1.9, 95%CI 1.3–2.8). Cure rates for XDR-TB were 50%. Compared with MDR-TB patients, those with XDR-TB had a higher risk of treatment failure (29% vs. 8%, respectively, P < 0.001). Unfavourable treatment outcomes were significantly associated with being male; having smear-positive disease; pulmonary cavities; failure, default or relapse after previous MDR-TB treatment; and a history of incarceration.

Conclusion: More MDR-TB in Latvia is now also XDR-TB. This study identified several risk factors for XDR-TB and, for unfavourable treatment outcomes, highlighting the importance of early diagnosis and appropriate management of MDR-/XDR-TB.

Keywords: Europe; Latvia; SORT IT; XDR-TB; operational research

Document Type: Research Article

Affiliations: 1: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia, Riga Stradins University, Riga, Latvia 2: Riga East University Hospital TB and Lung Disease Centre, Riga, Latvia 3: Medical Department, Operational Center Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg 4: Tuberculosis and M/ XDR-TB Programme, Division of Communicable Diseases, Health Security & Environment, World Health Organization Regional Office for Europe, Copenhagen, Denmark 5: International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK

Publication date: 21 October 2014

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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