Better programmatic outcome with the shorter regimen for the treatment of multidrug-resistant tuberculosis (MDR-TB) in Guinea: A retrospective cohort study

Abstract

Setting Since August 2016, after the Ebola outbreak, the Guinean National Tuberculosis Programme and Damien Foundation implemented the shorter treatment regimen (STR) for multidrug-resistant tuberculosis (MDR-TB) in the three MDR-TB sites of Conakry. Previously, the longer regimen was used to treat MDR-TB. Objectives In a post-Ebola context, with a weakened health system, we describe the MDR-TB treatment uptake, patients characteristics, treatment outcomes and estimate the effect of using the longer versus STR on having a programmatically adverse outcome. Design This is a retrospective cohort study in RR-TB patients treated with either the longer regimen or STR. Results In Conakry, in 2016 and 2017, 131 and 219 patients were diagnosed with rifampicin-resistant tuberculosis (RR-TB); and 108 and 163 started treatment, respectively. Of 271 patients who started treatment, 75 were treated with the longer regimen and 196 with the STR. Patients characteristics were similar regardless of the regimen except that the median age was higher among those treated with a longer regimen (30 years (IQR:24-38) versus 26 years (IQR:21-39) for the STR. Patients treated with a STR were more likely to obtain a programmatically favorable outcome (74.0% vs 58.7%, p = 0.01) as lost to follow up was

Treatment outcomes for multidrug- and rifampicin-resistant tuberculosis in Central and West Africa: a systematic review and meta-analysis

“…Kamara et al found a higher success rate of 80% vs. 54% among patients treated with the shorter regimen (9-11 months) compared to the longer (18-24 months) (see appendix 3 for treatment regimens) (Kamara et al, 2022). Similar results were reported by Hassane-Harouna et al who found a successful outcome in 74% with the shorter regimen vs. 59% with the longer regimen (Hassane-Harouna et al, 2020). They also found that a higher number of patients were LFTU if treated with the longer regimen.…”

“…Adverse effects have been known to affect the proportion of patients that are LTFU (Huerga et al, 2017). The study from Guinea (Hassane-Harouna et al, 2020), where DOT was not applied, also found a higher rate of LTFU among patients on the longer treatment regime (20% vs. 8.2%) in agreement with the proposition that shorter treatment regimens will have a positive effect on the treatment default rate due to fewer adverse effects and smaller burden of pills (Schwoebel et al, 2020, Trébucq et al, 2018. The largest study (n=845) had a low rate of LTFU of 4.5% in comparison to the other studies in light of the considerable cohort size (Schwoebel et al, 2020).…”

Treatment outcomes of patients with multidrug and extensively drug-resistant tuberculosis in Zhejiang, China

“…The higher proportion of XDR-TB patients may have contributed to the lower success rate in that study. Reports from other countries showed a success rate ranging from 38.6% to 74.0% [ 11 – 14 ].…”

Effectiveness and Safety of a Shorter Treatment Regimen in a Setting with a High Burden of Multidrug-Resistant Tuberculosis

“…Most of the STR studies conducted in Africa and Asia have shown impressive treatment success ranging between 80.2% and 95.5% [ 8 , 9 , 11 , 26 , 27 ]. Treatment effectiveness of STR was comparatively worse in Swaziland (70.8%) [ 10 ] and Guinea (74.0%) [ 28 ], but nevertheless much higher than treatment effectiveness of the longer regimen reported in their countries. In our study population treatment failure was the predominant reason of unfavorable treatment outcome, accounting for 17.9% of all patients.…”