Re-Treatment Tuberculosis Cases Categorised as “Other”: Are They Properly Managed?

Abstract

BackgroundAlthough the World Health Organization (WHO) provides information on the number of TB patients categorised as “other”, there is limited information on treatment regimens or treatment outcomes for “other”. Such information is important, as inappropriate treatment can lead to patients remaining infectious and becoming a potential source of drug resistance. Therefore, using a cohort of TB patients from a large registration centre in Lilongwe, Malawi, our study determined the proportion of all TB re-treatment patients who were registered as “other”, and described their characteristics and treatment outcomes.MethodsThis retrospective observational study used routine program data to determine the proportion of all TB re-treatment patients who were registered as “other” and describe their characteristics and treatment outcomes between January 2006 and December 2008.Results1,384 (12%) of 11,663 TB cases were registered as re-treatment cases. Of these, 898 (65%) were categorised as “other”: 707 (79%) had sputum smear-negative pulmonary TB and 191 (21%) had extra pulmonary TB. Compared to the smear-positive relapse, re-treatment after default (RAD) and failure cases, smear-negative “other” cases were older than 34 years and less likely to have their HIV status ascertained. Among those with known HIV status, “other” TB cases were more likely to be HIV positive. Of TB patients categorised as “other”, 462 (51%) were managed on the first-line regimen with a treatment success rate of 63%.ConclusionA large proportion of re-treatment patients were categorised as “other”. Many of these patients were HIV-infected and over half were treated with a first-line regimen, contrary to national guidelines. Treatment success was low. More attention to recording, diagnosis and management of these patients is warranted as incorrect treatment regimen and poor outcomes could lead to the development of drug resistant forms of TB.

Characteristics and treatment outcomes of tuberculosis retreatment cases in three regional hospitals, Uganda

“…A similar fi nding was observed in Malawi, 9 where 38% of smear-negative 'other' TB cases received the Category II regimen and 51% received Category I. This fi nding indicates a lack of knowledge of or adherence to national guidelines that could be addressed by training clinicians.…”

“…5 Studies from India and Africa have shown that retreatment, failure and return after LTFU cases have poor treatment outcomes, with success rates of 50-60%. [6][7][8][9] Patient characteristics such as male sex, alcoholism and illiteracy, and health system factors such as long distances to TB clinics, lack of anti-tuberculosis drugs, inadequate health education and poor management of drug side effects are risk factors for return after LTFU or retreatment default. [10][11][12][13][14][15] Some studies have identifi ed characteristics of retreatment cases that infl uence…”

Clinical, Laboratory and Radiological Profile of Re-Treatment Tuberculosis

“…Above data is different from other studies in showing a female predominance like Hannock, Henry et al 8 at Malawi which shows 60% females in their study.…”

Characteristics of adults and children diagnosed with tuberculosis in Lilongwe, Malawi: findings from an integrated HIV/TB clinic

“…Relapse was higher among TB ⁄ ART (5.0%) than TB-only patients (3.2%) and TB ⁄ HIV patients (2.6%; P < 0.001). TB ⁄ ART patients had the highest proportion of 'other' patients (13%; P < 0.001), patients who are more likely to be mis-categorised re-treatment cases and HIV co-infected (Tweya et al 2011). EPTB was most common among TB ⁄ ART (26.9%) and less common among TB ⁄ HIV (20.7%) and TB-only (16.2%; P < 0.001).…”