Résumé :
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Multidrug-resistant tuberculosis (MDR-TB) is a growing threat to global TB control. Uzbekistan is one of the 15 high-burden MDR-TB countries in the World Health Organization (WHO) European Region. According to national policy, all patients should receive a 6-month intensive phase of treatment through hospitalized inpatient care. However, between January and December 2011, owing to physical reconstruction of the hospital for MDR-TB patients in Uzbekistan, all patients started and continued treatment on a fully ambulatory outpatient basis. A retrospective cohort study was therefore carried out to compare final treatment outcomes and reported adverse drug reactions among patients with MDRTB who completed the intensive phase of treatment through inpatient care (2010) with those who completed the intensive phase on an ambulatory basis (2011) in Tashkent, Uzbekistan. A total of 129 MDR-TB patients received hospitalized intensive-phase treatment and 82 received ambulatory intensive-phase treatment. There were no significant differences between the two groups with respect to sociodemographic characteristics, clinical features or comorbidities. Treatment outcomes were similar between the two groups, with a tendency to more favourable outcomes in those on ambulatory therapy (treatment success: 63%, ambulatory care; 53%, hospitalized care). Reported adverse reactions were significantly higher in those on hospitalized therapy (86%) compared with ambulatory therapy (55%), for reasons that are not clear, with most adverse outcomes reported in the third, fourth or fifth month for hospitalized patients and in the first month for ambulatory patients. In conclusion, the National TB Programme needs to reconsider its current policy for the model of inpatient MDR-TB care in favour of ambulatory treatment, in line with WHO recommendations.
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