Countrywide audit of multidrug-resistant tuberculosis and treatment outcomes in Mongolia.

Setting: Eighteen treatment units for multidrug-resistant tuberculosis (MDR-TB) in Mongolia.

Objective: To determine the total number of MDR-TB cases detected, their resistance patterns, the proportion and characteristics of cases starting treatment, the delay between diagnosis and treatment initiation, and the relation between treatment outcomes and drug resistance.

Design: Retrospective cohort study using routine programme data.

Results: Of 268 MDR-TB cases detected, 168 (63%) were resistant to HRES, 59 (22%) to HRS, 34 (13%) to HR and 7 (3%) to HRE. Of the 268 MDR-TB patients, 139 (52%) started treatment: 69 (50%) were secondary and/or university students, 35 (25%) were unemployed, 24 (17%) were currently employed and 14 (8%) retired, disabled or status was unrecorded. The median time from MDR-TB diagnosis to treatment initiation was 137 days (IQR 43-218). The treatment success rate was 69%; 9% failed treatment, which may indicate extensively drug-resistant TB (XDR-TB) or pre-XDR-TB.

Conclusion: Close to seven in 10 patients in Mongolia had a successful treatment outcome, which is encouraging. Specific problems included the high proportion of students, about half of all diagnosed patients accessed treatment and there was an unacceptable delay of 4 months to treatment. These issues need to be addressed.