Rising prevalence of drug-resistant TB in Malaysia a cause for concern

Drug-resistant tuberculosis (DR-TB) is a growing global health issue, and Malaysia is not exempt from this threat. A study appearing in Medical Journal of Malaysia reveals alarming patterns in prevalence, characteristics, and treatment outcomes of DR-TB cases in Selangor and Kuala Lumpur.

The study documented a total of 430 cases of DR-TB over a 5-year period (2016-2020) and observed a significant increase in the prevalence rate from 0.27 to 1.79 per 100,000 individuals. The majority of those afflicted are middle-aged, with an average age of 41. A total of 70.7 percent were male and 79.3 percent of them were Malaysian. The largest ethnic group affected were Malays, making roughly 50.2 percent of the total study population. Socioeconomic factors were a determinant as more than half of the patients had only non-college level education and 34.9 percent of them were reported to be habitual smokers.

The DR-TB patients also had a high incidence of comorbidities. Diabetes was present in 23.5 percent, while 10.9 percent were HIV-positive. Nearly half of the cases were retreatment cases, and 83.9 percent had positive smear test results, indicative of high bacterial load. As for chest X-ray results, most DR-TB patients (54.4 percent) had minimal lesions, 41.2 percent showed moderate to far-advanced lesions and 4.4 percent had no lesions.

The most common types of DR-TB were multidrug-resistant tuberculosis (MDR-TB)/pre-extensively drug-resistant tuberculosis (XDR)/XDR-TB, followed by isoniazid-resistant tuberculosis (HR-TB) and rifampicin-resistant tuberculosis  (RR-TB). Patients already diagnosed as DR-TB were given DOT supervision by the healthcare system in about two-thirds (66.7 percent) of the cases. Family members of patients also played a pivotal role in assisting with supervision. There were few patients that did not receive supervision other than the two categories mentioned above.

As for treatment outcomes, 56.7 percent of cases achieved treatment success. However, 42.1 percent had negative outcomes, primarily due to loss to follow-up (49.7 percent) and death (42.6 percent). Treatment failure accounted for 7.7 percent of cases. A small percentage (1.2 percent) were still on treatment. These outcomes reflect the challenges in managing DR-TB, which include complex treatment regimens, extended durations, drug interactions and significant side effects.

Treatment outcomes for DR-TB cases (2016-2020_

Takeaways from the study

The authors noted the rise in DR-TB cases during the study period and highlighted the urgent need for improved public health interventions. Enhanced diagnostic capabilities, such as wider adoption of GeneXpert® technology, can improve early detection. Further, strategies to improve patient adherence, such as decentralized treatment services and community support initiatives, could reduce losses due to follow-up.

Additionally, it is crucial to conduct focused research to examine the interplay of social, economic, environmental, and healthcare determinants of DR-TB cases. There is also a need for implementation of appropriate programs to strengthen the capacity of healthcare workers in the management of DR-TB cases.