location: nan, 'Thailand 
year: 2021 source: HSRI 
title: Quality improvement of management of multidrug resistant tuberculosis (MDR-TB) using electronic MDR-TB registry 
abstract:Background: An electronic tuberculosis (TB) registry, accessible over the internet is useful to accumulate all TB-related patient data and apply best practice standards to produce accurate treatment decisions. The study aims to develop the electronic case-based MDR-TB registry that can be used to improve patient care by systematically monitoring the treatment response and drug adverse events following the design schedule. Methods: This is a pre-and post-intervention study, conducted at Makarak hospital, a district of Kanchanaburi province located in the west of Thailand. This hospital was selected based on a higher rate of MDR-TB reported over the past decade since 2002. The primary objective was to increase success rate of MDR-TB treatment after using eMDR-TB registry. Eligible patients were adult > 18 years, diagnosed with MDR-TB since October 2015. Electronic MDR-TB registry was developed in the cooperation with Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS) and Ministry of Public health in data management software. The sample size needed to determine the outcome was 112 patients or 56 patients in each group, comparing between those already completed or starting treatment before using eMDR-TB registry and those who were newly diagnosed after using eMDR-TB registry. Results: A total of 164 MDR-TB patients were diagnosed between October 2015 and June 2020: 148 cases who were already treated MDR-TB before using registry and 16 cases who were using assessment and monitoring with eMDR-TB registry. The median duration of treatment of those do not use (no registry) and use registry were 18.7 months and 6.6 months, respectively since the treatment of use registry group is still ongoing. The median age of all patients was 55 years and 58% of patients were male and 56% of patients had at least one comorbidity in which diabetes mellitus was the most common and also more common in use regisytry than no registry group. The proportion of smear and culture conversion within 6 month were 77% and 79.4%, respectively. Time to smear and culture conversion of all patients was 69 days and 77 days, respectively. The patient in use registry group had a significant shorter time to sputum conversion than no registry group (67 days vs. 81 days, p=0.029). Among 148 cases in no registry group who had the outcome at the end of treatment available, only 45% were cure or complete treatment, 28% died mostly within 6 months and 10% were lost to follow-up. A higher proportion of use registry group are still receiving treatment than no registry group (81% vs. 69%) and had a lower proportion of death within 6 months (12% vs. 22%). The treatment duration of survived and death patients were 610 days and 70 days, respectively. There were 70% of patients experienced hypokalemia, 37% had hypothyroidism, 31% had acute renal injury and 20% had abnormal audiometry. Laboratory parameters have been checked as planned for at least 80%. Hypokalemia and hypothyroidism had been observed more commonly in no registry group whereas hyperuricemia and abnormal audiometry were found more commonly in registry group. Factors associated with mortality were older age, low body weigth, HIV infection and stroke. Body mass index less than 18.5 kg/m was an independent factor of death from cox regression. Conclusion: A more comprehensive and holistic approach in management of MDR-TB particularly in the first few months or in patients with high risk of death are needed to reduce the mortality and possibly improve the patients’ adherence until the end of treatment.