Time to Drug-Resistant Tuberculosis Treatment in a Prospective South African Cohort

Water, Brittney van de; Bettger, Janet Prvu; Silva, Sílvia Agostinho da; Humphreys, Janice; Cunningham, Coleen K.; Farley, Jason E.

doi:10.1177/2333794x17744140

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…Additionally, we did not have laboratory data to further investigate CD4 count and HIV viral loads to understand how each of those play a role in TB treatment outcomes [ 49 ]. We also were unable to assess timing of treatment initiation for either TB or HIV—both of which can have significant impact on treatment outcomes [ 6 , 50 ]. Similarly, we do not know how many (if any) of the people living with HIV not on ART may have started ART during their TB treatment.…”

Section: Discussionmentioning

confidence: 99%

Association of HIV infection and antiretroviral therapy with the occurrence of an unfavorable TB treatment outcome in a rural district hospital in Eastern Cape, South Africa: A retrospective cohort study

et al. 2022

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Background Our objective was to assess differences in TB treatment outcomes between individuals who were HIV negative, HIV positive on anti-retroviral treatment (ART) and HIV positive not on ART, at TB treatment initiation at a rural district hospital in Eastern Cape, South Africa. Methods This was a retrospective cohort study of individuals diagnosed with TB between January 2017 and April 2020 at a district hospital. Adults 15 years and over with reported HIV status and treatment outcome were included (N = 711). A categorical outcome with three levels was considered: unfavorable, down referral, and success. We report descriptive statistics for the association between HIV and ART status and treatment outcome using Chi-square and Fisher’s exact tests. A multinomial baseline logit model was used to estimate odds ratios for treatment outcomes. Results Overall, 59% of included patients were HIV positive with 75% on ART. Eighty-eight patients 12% had an unfavorable outcome. Half of all patients were down referred with an additional 37% having a successful outcome. Individuals without HIV were more likely to be down referred (versus unfavorable) compared to individuals with untreated HIV (2.90 OR, 1.36, 6.17 95% CI). There was a greater likelihood for individuals without HIV having a successful TB treatment outcome compared to individuals with untreated HIV (4.98 OR, 2.07, 11.25 95% CI). Conclusion The majority of individuals had positive TB treatment outcomes (down referred or success). However, people without HIV had nearly five times greater odds of having successful outcomes than those with untreated HIV.

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Section: Discussionmentioning

confidence: 99%

Association of HIV infection and antiretroviral therapy with the occurrence of an unfavorable TB treatment outcome in a rural district hospital in Eastern Cape, South Africa: A retrospective cohort study

et al. 2022

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“…Geographical location of the DR-TB facility emerged as a major factor in DR-TB treatment initiation and timeliness in our study, similar to other studies in sub-Saharan Africa (SSA). [24–26] Patients in some regions were half as likely to be ever initiated on treatment as those in the SW region. Timeliness of treatment did not vary significantly except for two States (Lagos and Osun) where patients were up to 10 times less likely to be treated within 1 month.…”

Section: Discussionmentioning

confidence: 99%

Rates and timeliness of treatment initiation among drug-resistant tuberculosis patients in Nigeria- A retrospective cohort study

et al. 2019

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Background There were an estimated 580,000 new cases of multidrug/rifampicin resistant TB (DR-TB) in 2015, and only 20% were initiated on treatment. This study explored health system and patient factors associated with initiation and timeliness of treatment among DR-TB patients in Nigeria, ranked 4 th globally for estimated TB cases in 2015. Methods A retrospective cohort study using 2015 diagnosis and treatment data from the Nigerian TB program electronic records examined “treatment ever received” (yes/no) and “treatment within 30 days” (yes/no). We compared health system and patient characteristics using binomial logistic regression, while controlling for confounders. Results Of 996 patients diagnosed nationwide in 2015 (aged 0–87 years, median 34), 47.8% were never treated. Of those treated (n = 520), 51.2% were treated within the 30 days prescribed in the National treatment guideline. Healthcare facility locations were significantly associated with ever receiving treatment and timely treatment. Predictors of timely treatment at the national level also included level of care and patient treatment history. The South-West zone, where DR-TB programs started, showed overall better access to DR-TB healthcare. Conclusions Healthcare facility geographic locations were significantly associated with treatment initiation and timeliness. Significant regional differences in access to DR-TB care in Nigeria persist, reflecting uneven contexts for national DR-TB treatment rollout.

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“…A previous study on prison inmates in the Kyrgyz Republic reported median delays from diagnosis to starting treatment of 7 days and further delays in people with RR-TB [ 17 ]. In other settings, despite the introduction of Xpert MTB/Rif technology, median treatment delay ranged from 8 days in Ethiopia to 11 and 14 days in South Africa [ 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Time to Treatment and Risk Factors for Unsuccessful Treatment Outcomes among People Who Started Second-Line Treatment for Rifampicin-Resistant or Multi-Drug-Resistant Tuberculosis in the Kyrgyz Republic, 2021

Kyrbashov,

Kulzhabaeva,

Kadyrov

et al. 2023

TropicalMed

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The Kyrgyz Republic is a high-burden country for rifampicin resistant/multi-drug resistant tuberculosis (RR/MDR-TB). TB control efforts rely on early diagnosis and initiation of people on effective regimens. We studied the interval from diagnosis of RR-TB to starting treatment and risk factors for unsuccessful outcomes among people who started RR/MDR-TB treatment in 2021. We conducted a cohort study using country-wide programme data and used binomial regression to determine associations between unsuccessful outcomes and predictor variables. Of the 535 people included in the study, three-quarters were in the age category 18–59 years, and 68% had past history of TB. The median (IQR) time from onset of TB symptoms to diagnosis was 30 (11–62) days, 1 (0–4) days from diagnosis to starting treatment, and 35 (24–65) days from starting treatment to receipt of second-line drug susceptibility test (SL-DST) results. Overall, 136 (25%) had unsuccessful outcomes. Risk factors for unsuccessful outcomes were being homeless, fluroquinolone resistance, having unknown HIV status, past TB treatment, male gender and being unemployed. Treatment outcomes and the interval from diagnosis to starting treatment were commendable. Further reductions in unsuccessful outcomes by be achieved through ensuring timely diagnosis and access to SL-DSTs and by reducing the proportion of people who are lost to follow-up.

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Time to Drug-Resistant Tuberculosis Treatment in a Prospective South African Cohort

Cited by 8 publications

References 19 publications

Association of HIV infection and antiretroviral therapy with the occurrence of an unfavorable TB treatment outcome in a rural district hospital in Eastern Cape, South Africa: A retrospective cohort study

Association of HIV infection and antiretroviral therapy with the occurrence of an unfavorable TB treatment outcome in a rural district hospital in Eastern Cape, South Africa: A retrospective cohort study

Rates and timeliness of treatment initiation among drug-resistant tuberculosis patients in Nigeria- A retrospective cohort study

Time to Treatment and Risk Factors for Unsuccessful Treatment Outcomes among People Who Started Second-Line Treatment for Rifampicin-Resistant or Multi-Drug-Resistant Tuberculosis in the Kyrgyz Republic, 2021

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