Attrition in the treatment cascade among elderly patients with multidrug-resistant TB

<sec><title>BACKGROUND</title>Elderly patients with multidrug-/rifampicin-resistant TB (MDR/RR-TB) face major difficulties in achieving favourable treatment outcomes. This study aimed to identify gaps, age differences in the MDR/RR-TB treatment cascade, and determinants of attrition in elderly patients in Zhejiang Province, China.</sec><sec><title>METHODS</title>A 7-year retrospective cohort study was conducted in diagnosed MDR/RR-TB patients during 2015-2021. The treatment cascade for MDR/RR-TB consists of diagnosis confirmation, treatment initiation, treatment continuation at Month 6, and treatment success, with three gaps between the successive steps due to patient attrition.</sec><sec><title>RESULTS</title>Of the 3,156 MDR/RR-TB patients, 804 were aged over 60. Compared to the younger group, elderly patients had significantly higher attrition (<i>P</i> < 0.001) in treatment initiation (22.5% vs. 15.1%), treatment continuation at Month 6 (12.8% vs. 3.9%), and treatment success (31.7% vs. 15.6%). Of the elderly patients, 46.1% achieved treatment success. The overall attrition in elderly patients had decreased longitudinally from 77.9% to 35.5% (<i>P</i> < 0.001). Older age, conventional drug susceptibility testing, and no health insurance were associated with not initiating treatment, while long travel distances and lack of regimen adjustment influenced treatment discontinuation.</sec><sec><title>CONCLUSION</title>Attrition of Chinese elderly patients in the MDR/RR-TB treatment cascade calls for targeted interventions, especially for treatment initiation and adherence.</sec>.