H Cox1, J Hughes1, J Daniels1, V Azevedo2, C McDermid1, M Poolman3, A Boulle4, E Goemaere1, G van Cutsem1. 1. Médecins Sans Frontières, Khayelitsha, Cape Town, South Africa. 2. City of Cape Town Health Department, Khayelitsha, Cape Town, South Africa. 3. Western Cape Province Department of Health, Cape Town, South Africa South Africa. 4. Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
Abstract
SETTING: Khayelitsha, South Africa, a peri-urban township with high burdens of tuberculosis (TB), drug-resistant tuberculosis (DR-TB), and human immunodeficiency virus (HIV) infection. OBJECTIVE: To describe case detection and patient outcomes in a community-based DR-TB programme. DESIGN: DR-TB management was integrated into primary health care in Khayelitsha from 2007 onwards. Implementation was incremental, and included training and clinician support, counselling and home visits, tuberculous infection control, a local in-patient service, and routine monitoring. Patients received treatment rapidly through their local clinic, and were only hospitalised if clinically unwell. RESULTS: DR-TB case notification (any rifampicin resistance) increased from 28 per 100 000 population per year (2005-2007) to 55/100 000/year in 2009-2011 (72% HIV-infected). From 2008 to 2011, 754 patients received treatment (86% of those diagnosed). The median time between diagnostic sputum and treatment decreased over the years of implementation to 27 days in 2011 (P < 0.001). Treatment success was 52% in 2010, with 31% default, 13% death and 4% treatment failure. Two-year survival was 65%, with poorer survival in those with HIV (HR 2.0, 95%CI 1.4-2.8), second-line drug resistance (HR 3.3, 95%CI 2.2-4.8), and diagnosis in earlier programme years (HR 1.4, 95%CI 1.1-2.0). CONCLUSION: Community-based DR-TB management is feasible, and contributes to improved case detection, reduced treatment delay and improved survival. Treatment outcomes remain poor, highlighting the poor efficacy, tolerability and lengthy duration of current treatment.
SETTING: Khayelitsha, South Africa, a peri-urban township with high burdens of tuberculosis (TB), drug-resistant tuberculosis (DR-TB), and human immunodeficiency virus (HIV) infection. OBJECTIVE: To describe case detection and patient outcomes in a community-based DR-TB programme. DESIGN: DR-TB management was integrated into primary health care in Khayelitsha from 2007 onwards. Implementation was incremental, and included training and clinician support, counselling and home visits, tuberculous infection control, a local in-patient service, and routine monitoring. Patients received treatment rapidly through their local clinic, and were only hospitalised if clinically unwell. RESULTS: DR-TB case notification (any rifampicin resistance) increased from 28 per 100 000 population per year (2005-2007) to 55/100 000/year in 2009-2011 (72% HIV-infected). From 2008 to 2011, 754 patients received treatment (86% of those diagnosed). The median time between diagnostic sputum and treatment decreased over the years of implementation to 27 days in 2011 (P < 0.001). Treatment success was 52% in 2010, with 31% default, 13% death and 4% treatment failure. Two-year survival was 65%, with poorer survival in those with HIV (HR 2.0, 95%CI 1.4-2.8), second-line drug resistance (HR 3.3, 95%CI 2.2-4.8), and diagnosis in earlier programme years (HR 1.4, 95%CI 1.1-2.0). CONCLUSION: Community-based DR-TB management is feasible, and contributes to improved case detection, reduced treatment delay and improved survival. Treatment outcomes remain poor, highlighting the poor efficacy, tolerability and lengthy duration of current treatment.
Authors: M Loveday; K Wallengren; J Brust; J Roberts; A Voce; B Margot; J Ngozo; I Master; G Cassell; N Padayatchi Journal: Int J Tuberc Lung Dis Date: 2015-02 Impact factor: 2.373
Authors: E Sinanovic; L Ramma; A Vassall; V Azevedo; L Wilkinson; N Ndjeka; K McCarthy; G Churchyard; H Cox Journal: Int J Tuberc Lung Dis Date: 2015-02 Impact factor: 2.373
Authors: Helen S Cox; Johnny F Daniels; Odelia Muller; Mark P Nicol; Vivian Cox; Gilles van Cutsem; Sizulu Moyo; Virginia De Azevedo; Jennifer Hughes Journal: Open Forum Infect Dis Date: 2015-02-26 Impact factor: 3.835
Authors: Ako A Agbor; Jean Joel R Bigna; Serges Clotaire Billong; Mathurin Cyrille Tejiokem; Gabriel L Ekali; Claudia S Plottel; Jean Jacques N Noubiap; Hortence Abessolo; Roselyne Toby; Sinata Koulla-Shiro Journal: PLoS One Date: 2014-12-15 Impact factor: 3.240
Authors: Sizulu Moyo; Helen S Cox; Jennifer Hughes; Johnny Daniels; Leigh Synman; Virginia De Azevedo; Amir Shroufi; Vivian Cox; Gilles van Cutsem Journal: PLoS One Date: 2015-03-18 Impact factor: 3.240
Authors: Birahim Pierre Ndiaye; Friedrich Thienemann; Martin Ota; Bernard S Landry; Makhtar Camara; Siry Dièye; Tandakha Ndiaye Dieye; Hanif Esmail; Rene Goliath; Kris Huygen; Vanessa January; Ibrahima Ndiaye; Tolu Oni; Michael Raine; Marta Romano; Iman Satti; Sharon Sutton; Aminata Thiam; Katalin A Wilkinson; Souleymane Mboup; Robert J Wilkinson; Helen McShane Journal: Lancet Respir Med Date: 2015-02-26 Impact factor: 102.642