Kathryn Schnippel1, Kate Shearer2, Denise Evans2, Rebecca Berhanu3, S'celo Dlamini4, Norbert Ndjeka4. 1. Right to Care, 5(th) floor Outspan House, 1006 Lenchen Avenue North, Centurion 0157, South Africa. Electronic address: kschnipp@gmail.com. 2. Health Economics and Epidemiology Research Office, Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 3. Right to Care, 5(th) floor Outspan House, 1006 Lenchen Avenue North, Centurion 0157, South Africa; Health Economics and Epidemiology Research Office, Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 4. National TB Programme, South African National Department of Health, Pretoria, South Africa.
Abstract
BACKGROUND: The South African Electronic Drug-Resistant Tuberculosis Register (EDRweb) is the national database of registered drug-resistant tuberculosis (DR-TB) cases. METHODS: This study was a retrospective, de-identified secondary analysis of EDRweb patients initiating treatment for rifampicin-resistant TB (January 2009 to September 2011). The relative risks of death and treatment success were estimated using modified Poisson regression with robust error estimation. RESULTS: Seventeen thousand six hundred and ninety-seven cases of DR-TB were registered and met the inclusion criteria; 52.0% (n=9207) were male and the median age was 35 years (interquartile range 27-43 years). Of the 9419 cases with HIV infection (53.2%), 7157 (76.0%) were on antiretroviral therapy. Most had undergone previous TB treatment (76.5%, n=13531). Multidrug-resistant TB was the most common diagnosis, at 80.6% (n=14272). No treatment outcome was available for 6934 patients (39.2%). For patients with outcomes, 4227 (39.4%) were successfully treated, 2987 (27.8%) died, 2533 (23.7%) were lost to follow-up, and 996 (9.3%) failed. Second-line drug resistance was the strongest predictor of death during DR-TB treatment; extensively drug-resistant TB patients were more likely to have died during treatment (adjusted relative risk 2.63, 95% confidence interval 2.45-2.84). CONCLUSIONS: Testing for second-line drug resistance at initiation of DR-TB treatment can identify patients most at risk of treatment failure and death and most in need of individualized treatment.
BACKGROUND: The South African Electronic Drug-Resistant Tuberculosis Register (EDRweb) is the national database of registered drug-resistant tuberculosis (DR-TB) cases. METHODS: This study was a retrospective, de-identified secondary analysis of EDRweb patients initiating treatment for rifampicin-resistant TB (January 2009 to September 2011). The relative risks of death and treatment success were estimated using modified Poisson regression with robust error estimation. RESULTS: Seventeen thousand six hundred and ninety-seven cases of DR-TB were registered and met the inclusion criteria; 52.0% (n=9207) were male and the median age was 35 years (interquartile range 27-43 years). Of the 9419 cases with HIV infection (53.2%), 7157 (76.0%) were on antiretroviral therapy. Most had undergone previous TB treatment (76.5%, n=13531). Multidrug-resistant TB was the most common diagnosis, at 80.6% (n=14272). No treatment outcome was available for 6934 patients (39.2%). For patients with outcomes, 4227 (39.4%) were successfully treated, 2987 (27.8%) died, 2533 (23.7%) were lost to follow-up, and 996 (9.3%) failed. Second-line drug resistance was the strongest predictor of death during DR-TB treatment; extensively drug-resistant TBpatients were more likely to have died during treatment (adjusted relative risk 2.63, 95% confidence interval 2.45-2.84). CONCLUSIONS: Testing for second-line drug resistance at initiation of DR-TB treatment can identify patients most at risk of treatment failure and death and most in need of individualized treatment.
Authors: R Manesen; K A Mekler; T R Molobi; A A Tyiki; M J Madlavu; K Velen; S Charalambous; Y F van der Heijden Journal: Public Health Action Date: 2021-03-21
Authors: Rebecca C Harris; Louis Grandjean; Laura J Martin; Alexander J P Miller; Joseph-Egre N Nkang; Victoria Allen; Mishal S Khan; Katherine Fielding; David A J Moore Journal: BMC Infect Dis Date: 2016-05-04 Impact factor: 3.090