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Early Outcomes of MDR-TB Treatment in a High HIV-Prevalence Setting in Southern Africa

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  • Kwonjune J Seung
  • David B Omatayo
  • Salmaan Keshavjee
  • Jennifer J Furin
  • Paul E Farmer
  • Hind Satti

Abstract

Background: Little is known about treatment of multidrug-resistant tuberculosis (MDR-TB) in high HIV-prevalence settings such as sub-Saharan Africa. Methodology/Principal Findings: We did a retrospective analysis of early outcomes of the first cohort of patients registered in the Lesotho national MDR-TB program between July 21, 2007 and April 21, 2008. Seventy-six patients were included for analysis. Patient follow-up ended when an outcome was recorded, or on October 21, 2008 for those still on treatment. Fifty-six patients (74%) were infected with HIV; the median CD4 cell count was 184 cells/μl (range 5–824 cells/μl). By the end of the follow-up period, study patients had been followed for a median of 252 days (range 12–451 days). Twenty-two patients (29%) had died, and 52 patients (68%) were alive and in treatment. In patients who did not die, culture conversion was documented in 52/54 patients (96%). One patient had defaulted, and one patient had transferred out. Death occurred after a median of 66 days in treatment (range 12–374 days). Conclusions/Significance: In a region where clinicians and program managers are increasingly confronted by drug-resistant tuberculosis, this report provides sobering evidence of the difficulty of MDR-TB treatment in high HIV-prevalence settings. In Lesotho, an innovative community-based treatment model that involved social and nutritional support, twice-daily directly observed treatment and early empiric use of second-line TB drugs was successful in reducing mortality of MDR-TB patients. Further research is urgently needed to improve MDR-TB treatment outcomes in high HIV-prevalence settings.

Suggested Citation

  • Kwonjune J Seung & David B Omatayo & Salmaan Keshavjee & Jennifer J Furin & Paul E Farmer & Hind Satti, 2009. "Early Outcomes of MDR-TB Treatment in a High HIV-Prevalence Setting in Southern Africa," PLOS ONE, Public Library of Science, vol. 4(9), pages 1-7, September.
  • Handle: RePEc:plo:pone00:0007186
    DOI: 10.1371/journal.pone.0007186
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    References listed on IDEAS

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    1. Shin, Sonya & Furin, Jennifer & Bayona, Jaime & Mate, Kedar & Kim, Jim Yong & Farmer, Paul, 2004. "Community-based treatment of multidrug-resistant tuberculosis in Lima, Peru: 7 years of experience," Social Science & Medicine, Elsevier, vol. 59(7), pages 1529-1539, October.
    2. Thelma E Tupasi & Rajesh Gupta & Ma Imelda D Quelapio & Ruth B Orillaza & Nona Rachel Mira & Nellie V Mangubat & Virgil Belen & Nida Arnisto & Lualhati Macalintal & Michael Arabit & Jaime Y Lagahid & , 2006. "Feasibility and Cost-Effectiveness of Treating Multidrug-Resistant Tuberculosis: A Cohort Study in the Philippines," PLOS Medicine, Public Library of Science, vol. 3(9), pages 1-10, September.
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    1. Petros Isaakidis & Bhanumati Varghese & Homa Mansoor & Helen S Cox & Joanna Ladomirska & Peter Saranchuk & Esdras Da Silva & Samsuddin Khan & Roma Paryani & Zarir Udwadia & Giovanni Battista Migliori , 2012. "Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral and Second Line Anti-TB Treatment in Mumbai, India," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-7, July.

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