Background: Multi-drug resistant – tuberculosis (MDR-TB) is an emerging public health concern in Uganda, with only just over 200 new cases notified by 2014. Prior to 2013, MDR-TB treatment in Uganda was only being provided at the national referral hospital and two private-not-for profit clinics. From 2013, MDR-TB treatment was scaled up to seven regional referral hospitals (RRH). We analyzed data on the first cohort of patients started on MDR-TB treatment at the seven RRH. Methods: This study was a retrospective descriptive analysis of data collected on a cohort of 69 patients started on MDR-TB treatment at 7 RRHs between 1st April 2013 and 30th June 2014. Results: Of the 69 patients, 21 (30.4%) were female and 39 (56.5%) were HIV-negative. Thirty (43.5%) were resistant to both isoniazid and rifampicin and 57 (82.6%) were category 1 or 2 failures. Median age at the start of MDR-TB treatment was 35 years (SD 13.5), mean time-to-treatment initiation was 96.1 days and out of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a mean CD4 count of 258. Within six months of treatment, 59 (86.0%) patients’ culture converted, of which 45 (65.2%) converted by the second month and 14 (20.3%) by the sixth month, one (1.5%) did not culture convert, three (4.4%) died and six (8.8%) were lost-to-follow up. Thirty-two (46.4%) patients experienced at least one severe drug adverse event, while 40 (67.8%) gained weight (mean 4.7 kilograms). Conclusions: Despite MDR-TB treatment initiation delays, most patients culture converted early, while few were lost to follow-up. These interim outcomes indicate a successful scale-up of MDR-TB treatment at RRH. Reasons for the high proportion of HIV-negative patients on MDR-TB treatment should be investigated.

Background: Multi-drug resistant – tuberculosis (MDR-TB) is an emerging public health concern in Uganda. Prior to 2013, MDR-TB treatment in Uganda was only provided at the national referral hospital and two private-not-for profit clinics. From 2013, it was scaled up to seven regional referral hospitals (RRH). The aim of this study was to measure interim (six months) treatment outcomes among the first cohort of patients started on MDR-TB treatment at the RRH in Uganda. Methods: This was a cross-sectional study in which a retrospective descriptive analysis of data on a cohort of 69 patients started on MDR-TB treatment at 7 RRH between 1st April 2013 and 30th June 2014 and had been on treatment for at least nine months was conducted. Results: Of the 69 patients, 21 (30.4%) were female, 39 (56.5%) HIV-negative, 30 (43.5%) resistant to both isoniazid and rifampicin and 57 (82.6%) category 1 or 2 drug susceptible TB treatment failures. Median age at start of treatment was 35 years (Interquartile range (IQR): 27-45), median time-to-treatment initiation was 27.5 (IQR:6-89) days and of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a median CD4 count of 206 cells/microliter of blood (IQR: 113-364.5). Within six months of treatment, 59 (86.0%) patients culture converted, of which 45 (65.2%) converted by the second month and the other 14 (20.3%) by the sixth month; one (1.5%) did not culture convert; three (4.4%) died; and six (8.8%) were lost-to-follow up. Fifty (76.8%) patients experienced at least one drug adverse event, while 40 (67.8%) gained weight. Mean weight gained was 4.7 (standard deviation:3.2) kilograms. Conclusions: Despite MDR-TB treatment initiation delays, most patients had favourable interim treatment outcomes with majority culture converting early and very few getting lost to follow-up. These encouraging interim outcomes indicate a successful scale-up of MDR-TB treatment to RRH.