The California Multidrug-Resistant Tuberculosis Consult Service: a partnership of state and local programs

• Published in: Public health action Vol. 8; no. 1; pp. 7 - 13
• Main Authors: Shah, N. S., Westenhouse, J., Lowenthal, P., Schecter, G., True, L., Mase, S., Barry, P. M., Flood, J.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 21-03-2018
• Subjects: Consultation; Multidrug-Resistant; Original; Tuberculosis; tuberculosis; consultation; multidrug-resistant
• ISSN: 2220-8372; 2220-8372
• DOI: 10.5588/pha.17.0091

Background: The US Centers for Disease Control and Prevention recommend expert consultation for multi-drug-resistant tuberculosis (MDR-TB) cases. In 2002, the California MDR-TB Service was created to provide expert MDR-TB consultations. We describe the characteristics, treatment
outcomes and management of patients referred to the Service.Methods: Surveillance data were used for descriptive analysis of cases, with consultation during July 2002-December 2012. Clinical consultation data and modified World Health Organization indicators were used to assess
the care and management of cases, with consultation from January 2009 to December 2012.Results: Of 339 MDR-TB patients, 140 received a consultation. The proportion of patients receiving a consultation increased from 12% in 2002 to 63% in 2012. There were 24 pre-extensively drug-resistant
TB and 5 patients with extensively drug-resistant TB. The majority (n = 123, 88%) completed treatment, 5 (4%) died, 7 (5%) moved before treatment completion, 4 (3%) stopped treatment due to an adverse event and 1 (1%) had an unknown outcome. Indicator data showed that 86% underwent
rapid molecular drug susceptibility testing, 98% received at least four drugs to which they had known or presumed susceptibility, and 93% culture converted within 6 months.Conclusions: Consultations with the MDR-TB Service increased over time. Results highlight successful treatment
and indicator outcomes.