V Alarcón1, E Alarcón-Arrascue2, A Mendoza-Ticona3, G Obregón4, J Cornejo5, D Vargas6, J De Los Ríos7, D A J Moore8, E Heldal9. 1. Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, El Agustino, Peru. 2. International Union Against Tuberculosis and Lung Disease (The Union), Paris, France. 3. Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, El Agustino, Peru, Hospital de Emergencias Villa El Salvador, Ministerio de Salud, Villa El Salvador. 4. Instituto Nacional de Salud de Perú, Lima. 5. Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, El Agustino, Peru, Hospital Nacional Arzobispo Loayza, Ministerio de Salud. 6. Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, El Agustino, Peru, Hospital Nacional Hipólito Unanue, Ministerio de Salud, El Agustino. 7. Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud, El Agustino, Peru, Hospital María Auxiliadora, Ministerio de Salud, San Juan de Miraflores, Peru. 8. London School of Hygiene & Tropical Diseases, London, UK. 9. The Union, Oslo, Norway.
Abstract
BACKGROUND: In Peru, a treatment approach for extensively drug-resistant tuberculosis (XDR-TB) incorporating World Health Organization Group 5 drugs and patient-centred care has achieved 65% success. To extend this approach to pre-XDR-TB patients, we evaluated this population separately. OBJECTIVE: To assess programmatic management of pre-XDR-TB. METHOD: Retrospective study using the official national registry from 2011 to 2014. Cases were separately evaluated according to resistance to fluoroquinolones (FQs) (pre-XDR-F) or to second-line injectables (SLIs) (pre-XDR-I). RESULTS: Of 610 pre-XDR-TB patients, 120 (20%) had pre-XDR-F and 490 (80%) had pre-XDR-I. Pre-XDR-F cases were older (34 years vs. 28 years, P < 0.001) and a higher proportion had previously received two or more regimens (70% vs. 38%, P < 0.001). Among the 452 patients who started treatment in 2011-2013, treatment success was 43.3%, 26.5% were lost to follow-up, 12.1% died and 13.7% failed treatment. Success was higher in pre-XDR-I (48.5%) than pre-XDR-F (21.4%) patients. History of previous treatment (OR 2.23, 95%CI 1.52-3.38) and pre-XDR-F (OR 2.39, CI 1.18-4.83) were associated with unsuccessful outcomes. CONCLUSION: Programmatic management of pre-XDR-TB has not been successful, particularly in pre-XDR-F patients, with lower rates of success than those achieved in the same setting for XDR-TB. The strategy used for XDR-TB should be extended to pre-XDR-TB patients in Peru.
BACKGROUND: In Peru, a treatment approach for extensively drug-resistant tuberculosis (XDR-TB) incorporating World Health Organization Group 5 drugs and patient-centred care has achieved 65% success. To extend this approach to pre-XDR-TBpatients, we evaluated this population separately. OBJECTIVE: To assess programmatic management of pre-XDR-TB. METHOD: Retrospective study using the official national registry from 2011 to 2014. Cases were separately evaluated according to resistance to fluoroquinolones (FQs) (pre-XDR-F) or to second-line injectables (SLIs) (pre-XDR-I). RESULTS: Of 610 pre-XDR-TBpatients, 120 (20%) had pre-XDR-F and 490 (80%) had pre-XDR-I. Pre-XDR-F cases were older (34 years vs. 28 years, P < 0.001) and a higher proportion had previously received two or more regimens (70% vs. 38%, P < 0.001). Among the 452 patients who started treatment in 2011-2013, treatment success was 43.3%, 26.5% were lost to follow-up, 12.1% died and 13.7% failed treatment. Success was higher in pre-XDR-I (48.5%) than pre-XDR-F (21.4%) patients. History of previous treatment (OR 2.23, 95%CI 1.52-3.38) and pre-XDR-F (OR 2.39, CI 1.18-4.83) were associated with unsuccessful outcomes. CONCLUSION: Programmatic management of pre-XDR-TB has not been successful, particularly in pre-XDR-F patients, with lower rates of success than those achieved in the same setting for XDR-TB. The strategy used for XDR-TB should be extended to pre-XDR-TBpatients in Peru.
Authors: Mirtha Gabriela Soto Cabezas; César Vladimir Munayco Escate; Oscar Escalante Maldonado; Eddy Valencia Torres; Johans Arica Gutiérrez; Martin Javier Alfredo Yagui Moscoso Journal: Rev Panam Salud Publica Date: 2020-09-23
Authors: Le Hong Van; Phan Trieu Phu; Dao Nguyen Vinh; Vo Thanh Son; Nguyen Thi Hanh; Le Thanh Hoang Nhat; Nguyen Huu Lan; Truong Van Vinh; Nguyen Thi Mai Trang; Dang Thi Minh Ha; Guy E Thwaites; Nguyen Thuy Thuong Thuong Journal: BMC Infect Dis Date: 2020-02-22 Impact factor: 3.090