High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda

Abstract

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.