SETTING: Public ambulatory centers in northern Lima, Peru. OBJECTIVE: To compare two retreatment strategies in Category I failures. DESIGN: Retrospective cohort study of Category I failures enrolled between February 1997 and October 2001. Strategy A was a nationwide approach, applying a Category II regimen; if that regimen failed, a standardized regimen including second-line drugs was used. Strategy B was a pilot protocol designed to diagnose and treat multidrug-resistant tuberculosis (MDR-TB); this strategy included drug susceptibility testing (DST) and eliminated the Category II regimen. RESULTS: Of 125 patients that Category I failed to cure, 73 entered Strategy A and 52 entered Strategy B. Almost 90% of those with DST results had MDR-TB. Strategy B was three times more likely than Strategy A to cure patients (79% vs. 38%, RR = 2.9, 95% CI 1.7-5.1) and five times more likely to cure patients than the Category II regimen alone (79% vs. 15%, RR 5.2, 95% CI 3.0-9.2). Strategy B also significantly reduced delays to MDR-TB diagnosis and to the initiation of MDR-TB therapy. CONCLUSIONS: Under program conditions, a retreatment strategy based on DST and eliminating the Category II regimen can improve clinical outcomes among Category I treatment failures found to have active, infectious MDR-TB.
SETTING: Public ambulatory centers in northern Lima, Peru. OBJECTIVE: To compare two retreatment strategies in Category I failures. DESIGN: Retrospective cohort study of Category I failures enrolled between February 1997 and October 2001. Strategy A was a nationwide approach, applying a Category II regimen; if that regimen failed, a standardized regimen including second-line drugs was used. Strategy B was a pilot protocol designed to diagnose and treat multidrug-resistant tuberculosis (MDR-TB); this strategy included drug susceptibility testing (DST) and eliminated the Category II regimen. RESULTS: Of 125 patients that Category I failed to cure, 73 entered Strategy A and 52 entered Strategy B. Almost 90% of those with DST results had MDR-TB. Strategy B was three times more likely than Strategy A to cure patients (79% vs. 38%, RR = 2.9, 95% CI 1.7-5.1) and five times more likely to cure patients than the Category II regimen alone (79% vs. 15%, RR 5.2, 95% CI 3.0-9.2). Strategy B also significantly reduced delays to MDR-TB diagnosis and to the initiation of MDR-TB therapy. CONCLUSIONS: Under program conditions, a retreatment strategy based on DST and eliminating the Category II regimen can improve clinical outcomes among Category I treatment failures found to have active, infectious MDR-TB.
Authors: Jennifer Furin; Medea Gegia; Carole Mitnick; Michael Rich; Sonya Shin; Mercedes Becerra; Peter Drobac; Paul Farmer; Rocio Hurtado; J Keith Joseph; Salmaan Keshavjee; Iagor Kalandadze Journal: Bull World Health Organ Date: 2011-11-24 Impact factor: 9.408
Authors: Carlos Acuña-Villaorduña; Irene Ayakaka; Scott Dryden-Peterson; Susan Nakubulwa; William Worodria; Nancy Reilly; Jennifer Hosford; Kevin P Fennelly; Alphonse Okwera; Edward C Jones-López Journal: Am J Trop Med Hyg Date: 2015-05-04 Impact factor: 2.345
Authors: Edward C Jones-López; Irene Ayakaka; Jonathan Levin; Nancy Reilly; Francis Mumbowa; Scott Dryden-Peterson; Grace Nyakoojo; Kevin Fennelly; Beth Temple; Susan Nakubulwa; Moses L Joloba; Alphonse Okwera; Kathleen D Eisenach; Ruth McNerney; Alison M Elliott; Jerrold J Ellner; Peter G Smith; Roy D Mugerwa Journal: PLoS Med Date: 2011-03-15 Impact factor: 11.069
Authors: Kwonjune J Seung; David B Omatayo; Salmaan Keshavjee; Jennifer J Furin; Paul E Farmer; Hind Satti Journal: PLoS One Date: 2009-09-25 Impact factor: 3.240
Authors: Michael G Whitfield; Heidi M Soeters; Robin M Warren; Talita York; Samantha L Sampson; Elizabeth M Streicher; Paul D van Helden; Annelies van Rie Journal: PLoS One Date: 2015-07-28 Impact factor: 3.240