Association Between Prior Tuberculosis History and Treatment Outcomes in Drug-Resistant Tuberculosis Patients Receiving Bedaquiline-Based Therapy: Prospective Observational Study from Western India

Abstract

Introduction: Drug-resistant tuberculosis (DR-TB) poses a significant public health challenge in India. While treatment success in DR-TB cases remains limited, bedaquiline-based oral longer regimens have shown promising results in select studies. Objective: This study aimed to evaluate whether a patient’s prior TB status influences treatment outcomes under a bedaquiline-based regimen and to assess other previous TB-related variables affecting current DR-TB outcomes. Methods: A prospective observational study was conducted at a tertiary care center in Rajkot, Gujarat, between April 2023 and September 2024. Fifty DR-TB patients on bedaquiline-based oral longer regimens were selected using purposive sampling. Data on previous TB treatment, clinical and demographic variables were collected. Treatment outcomes were categorized as cured, treatment completed, defaulted, died, or failed. Statistical analysis using Chi-square and Cramer’s V was conducted to assess associations. Results: Of the 50 patients, 74% were underweight and from lower socioeconomic backgrounds, and 58% were female. Patients with a history of cured drug-sensitive TB (DSTB) demonstrated the highest favourable outcomes, with 70% showing success, and 55% achieving cure. In contrast, those with prior treatment failure or no TB history had poorer outcomes. However, the association between prior TB status and current DR-TB outcomes was not statistically significant (Chi-square = 20.99, p > 0.05; Cramer’s V = 0.3), indicating a weak correlation. Conclusion: Although cured DSTB history appears to improve outcomes, previous TB status alone does not significantly predict DR-TB treatment success. A comprehensive approach addressing adherence, resistance, comorbidities, nutrition, and social factors is crucial for better outcomes.