Drug-Resistant Tuberculosis, KwaZulu-Natal, South Africa, 2001–2007

Wallengren, Kristina; Scano, Fabio; Nunn, Paul; Margot, Bruce; Buthelezi, Sandile; Williams, Brian; Pym, Alexander S.; Samuel, Elisabeth; Mirzayev, Fuad; Nkhoma, W; Mvusi, Lindiwe; Pillay, Yogan

doi:10.3201/eid1710.100952_article.htm

Cited by 4 publications

(8 citation statements)

References 43 publications

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“…The four rural decentralised MDR TB sites are geographically positioned throughout the Province with a strategic focus on areas with the highest incidence of MDR-TB(Figure I). 13 The populations of these four sites are amongst the most socio-economically challenged in the country with limited or no access to piped water. 14 …”

Section: Methodsmentioning

confidence: 99%

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Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa

Loveday

Wallengren²,

Voce

et al. 2012

int j tuberc lung dis

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Setting In KwaZulu-Natal, South Africa, a TB and HIV endemic setting, prolonged hospitalisation for the treatment of the growing number of MDR-TB patients is not possible or effective. Objective We compared early treatment outcomes in patients with MDR-TB, with and without HIV co infection, at a central, urban, referral hospital with four decentralised rural sites. Design This is an operational, prospective cohort study of patients between 1 July 2008 to 30 November 2009, where culture conversion, time-to-culture-conversion, survival and predictors of these outcomes were analysed. Results Of the 860 patients with MDR-TB, 419 were at the decentralised sites and 441 at the central hospital. Overall, 71% were HIV co-infected. In the 17 month study period, there was a higher proportion of culture conversion at the decentralised sites compared with the centralised hospital (54% vs. 24%; P<0.001; Odds Ratio 3.76, 95% CI 2.81 – 5.03). The median time to treatment initiation was significantly shorter at the decentralised sites compared with the centralised hospital (72 vs 93 days; p<0.001). There was no significant difference in survival following treatment initiation. Conclusion This study shows that early treatment outcomes suggest that decentralised care for MDR-TB patients is superior to that in a centralised setting.

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Section: Methodsmentioning

confidence: 99%

“…7 Consequently, of the 5165 MDR-TB patients treated between 1994 and 2004, 67% had unsuccessful treatment outcomes, of which 14% defaulted and 19% were not evaluated. 8 …”

Section: Introductionmentioning

confidence: 99%

Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa

Loveday

Wallengren²,

Voce

et al. 2012

int j tuberc lung dis

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“…1 KwaZulu-Natal Province has emerged as a global hotspot of the TB, drug-resistant TB, and HIV syndemic, with 76% of MDR-TB patients co-infected with HIV, and MDR-TB mortality rates of 71%. 3-5 Local management of MDR-TB was based on hospitalisation in a centralised specialised hospital for the initial six months of treatment, to facilitate daily injections and allow close monitoring of adverse events and adherence. Following discharge, and for the remaining period of treatment (18 months or longer), patients were expected to return for monthly out-patient visits, which for some patients entailed travelling 500kms to reach the hospital.…”

Section: Introductionmentioning

confidence: 99%

“…Following discharge, and for the remaining period of treatment (18 months or longer), patients were expected to return for monthly out-patient visits, which for some patients entailed travelling 500kms to reach the hospital. In this setting, the escalating burden of MDR-TB together with limited bed capacity resulted in long waiting lists, an average delay of 111 days for hospital admission and treatment initiation 3 and in 2007, only 32% of MDR-TB patients accessed treatment. 6 Furthermore, patients were discharged before the end of the injectable phase of treatment to facilities unfamiliar with MDR-TB treatment, resulting in poor treatment outcomes and high default rates.…”

Section: Introductionmentioning

confidence: 99%

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Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa

Loveday

Wallengren²,

Brust

et al. 2015

int j tuberc lung dis

103

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Setting KwaZulu-Natal, South Africa a predominantly rural province with high burdens of TB, MDR-TB and HIV infection. Objective To determine the most effective model of care by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. Design A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home, had easier access to care and home-based care was available from treatment initiation. Results Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (a total of 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, p=0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, p=0.22). In multivariate analysis MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR=1.43, p=0.01). However, there was heterogeneity in outcomes at the four community-based sites, with Site 1 demonstrating that home-based care was associated with increased treatment success of 72% compared with success of between 52 - 60% at the other three sites. Conclusion Community-based care for patients with MDR-TB was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.

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Evolving rifampicin and isoniazid mono-resistance in a high multidrug-resistant and extensively drug-resistant tuberculosis region: a retrospective data analysis

et al. 2019

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ObjectivesSouth Africa ranks among the highest drug-resistant tuberculosis (DR-TB) burdened countries in the world. This study assessed the changes in resistance levels in culture confirmed Mycobacterium tuberculosis (MTB) in the highest burdened province of South Africa during a period where major changes in diagnostic algorithm were implemented.SettingThis study was conducted at the central academic laboratory of the KwaZulu-Natal province of South Africa.ParticipantsWe analysed data for all MTB cultures performed in the KwaZulu-Natal province between 2011 and 2014. The data were collected from the laboratory information system.ResultsOut of 88 559 drug susceptibility results analysed, 18 352 (20.7%) were resistant to rifampicin (RIF) and 19 190 (21.7%) showed resistance to isoniazid (INH). The proportion of rifampicin resistant cases that were mono-resistant increased from 15.3% in 2011 to 21.4% in 2014 while INH mono-resistance (IMR) showed a range between 13.8% and 21.1%. The multidrug-resistant tuberculosis (MDR-TB) rates increased from 18.8% to 23.9% and the proportion of MDR-TB cases that had extensively drug-resistant tuberculosis remained between 10.2% and 11.1%. Most drug resistance was found in females between the ages of 15 and 44 years and the northern districts bordering high MDR-TB regions had the highest MDR-TB rates.ConclusionOur findings show increasing RIF mono-resistance (RMR) and a substantial amount of IMR. This highlights a need for an initial test that detects resistance to both these drugs so as to avoid using RIF monotherapy during continuous phase of treatment in patients with IMR. Furthermore, addition of INH will benefit patients with RMR. Although DR-TB is widespread, HIV and migration influence its distribution; therefore, TB control strategies should include interventions that target these aspects.

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Drug-Resistant Tuberculosis, KwaZulu-Natal, South Africa, 2001–2007

Abstract: 1 IOM planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Cited by 4 publications

References 43 publications

Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa

Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa

Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa

Evolving rifampicin and isoniazid mono-resistance in a high multidrug-resistant and extensively drug-resistant tuberculosis region: a retrospective data analysis

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