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Achieving high treatment success for multidrug-resistant TB in Africa: initiation and scale-up of MDR TB care in Ethiopia--an observational cohort study. | LitMetric

AI Article Synopsis

  • In Ethiopia, a community and hospital-based program using a standardized second-line drug regimen showed a treatment success rate of 78.6% for patients with multidrug-resistant TB (MDR TB) from 2009 to 2014, despite resource limitations and high rates of HIV coinfection.
  • Key factors influencing treatment outcomes included the patient's HIV status, body mass index (BMI), presence of cor pulmonale, and whether the MDR TB was confirmed.
  • The study highlights the importance of monitoring side effects, providing nutritional support, and fostering collaboration between NGOs and health ministries as effective strategies for improving TB treatment success in resource-poor settings.

Article Abstract

Background: In Africa, fewer than half of patients receiving therapy for multidrug-resistant TB (MDR TB) are successfully treated, with poor outcomes reported for HIV-coinfected patients.

Methods: A standardised second-line drug (SLD) regimen was used in a non-governmental organisation-Ministry of Health (NGO-MOH) collaborative community and hospital-based programme in Ethiopia that included intensive side effect monitoring, adherence strategies and nutritional supplementation. Clinical outcomes for patients with at least 24 months of follow-up were reviewed and predictors of treatment failure or death were evaluated by Cox proportional hazards models.

Results: From February 2009 to December 2014, 1044 patients were initiated on SLD. 612 patients with confirmed or presumed MDR TB had ≥ 24 months of follow-up, 551 (90.0%) were confirmed and 61 (10.0%) were suspected MDR TB cases. 603 (98.5%) had prior TB treatment, 133 (21.7%) were HIV coinfected and median body mass index (BMI) was 16.6. Composite treatment success was 78.6% with 396 (64.7%) cured, 85 (13.9%) who completed treatment, 10 (1.6%) who failed, 85 (13.9%) who died and 36 (5.9%) who were lost to follow-up. HIV coinfection (adjusted HR (AHR): 2.60, p<0.001), BMI (AHR 0.88/kg/m(2), p=0.006) and cor pulmonale (AHR 3.61, p=0.003) and confirmed MDR TB (AHR 0.50, p=0.026) were predictive of treatment failure or death.

Conclusions: We report from Ethiopia the highest MDR TB treatment success outcomes so far achieved in Africa, in a setting with severe resource constraints and patients with advanced disease. Intensive treatment of adverse effects, nutritional supplementation, adherence interventions and NGO-MOH collaboration were key strategies contributing to success. We argue these approaches should be routinely incorporated into programmes.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680185PMC
http://dx.doi.org/10.1136/thoraxjnl-2015-207374DOI Listing

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