References in the content below refer to the PBMEF Guide.
Definitions
Percentage of drug-resistant tuberculosis (DR-TB) (rifampicin-resistant [RR]/multidrug-resistant [MDR]- TB and extensively drug-resistant [XDR]-TB) cases successfully treated (cured or treatment completed) among all DR-TB cases enrolled on appropriate treatment during the reporting period.
Treatment outcomes are defined by the time period of enrollment on treatment; e.g., “2018 cases successfully treated” reflect those who were enrolled on treatment in 2018, even though treatment may have extended into 2020. For this reason, reports of treatment outcome data lag by two years.
Calculation: (Numerator/Denominator) x 100
Numerator
Denominator
Ref # |
RS-1
|
Tier Level |
Core Indicator
|
Category |
Cure
|
Type |
Core Outcome
|
Unit of Measure |
Percent of cases
|
Data Type |
Percentage
|
Disaggregations |
Age
Gender
Subnational
|
Reporting Level |
National
|
Reporting Frequency |
Annually
|
This indicator is reported by national TB program (NTP) official records. Quarterly report on TB treatment outcomes in the basic management unit and Combined annual outcomes report for basic TB and for MDR-TB/RR-TB.
This standard World Health Organization (WHO) indicator can also be calculated using the WHO database. The variable for the numerator is mdr_succ plus xdr_succ and the denominator is mdr_coh plus xdr_coh.
DR-TB treatment success measures a TB program’s ability to enroll DR-TB patients on appropriate treatment and retain patients throughout the entire course of DR-TB treatment. This final outcome is the most important measure of the effectiveness of the DR-TB program in terms of patient care.
Therefore, it is also a performance indicator for the NTP as a whole. Although improving in some countries, the treatment success rate reported in 2019 for DR-TB globally remains low at 57% for MDR-TB/RR-TB. However, the wider use of more effective, shorter, and “all oral” DR-TB treatment regimens, as well as more patient-centered models of care, are expected to improve treatment success rates. USAID’s National Action Plan seeks to ensure that 90% of TB patients are treated and cured to prevent development of DR-TB. Improvements in DR-TB treatment success can help to reduce the overall TB mortality rate. High treatment success coupled with high coverage of patients are both critical to having an impact on the DR-TB burden in a country.
Drug-resistant treatment success rate can be analyzed as a trend over time and compared to national and global DR-TB treatment success rate targets. A cascade can also be constructed to highlight gaps in care where some patients could be lost. (See Appendix 2 for a more detailed DR-TB pathway and cascade of care.) The gap between treatment initiation and treatment success can be further broken down to understand why patients were unsuccessful with treatment (e.g., death, treatment failure, moved to pre-XDR treatment, or unknown outcomes).