High treatment failure and default rates for patients with multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa, 2000–2003
OBJECTIVE: To describe treatment outcomes and determine risk factors associated with unfavorable outcomes among MDR-TB patients admitted to the provincial TB referral hospital in KwaZulu-Natal Province, South Africa.
DESIGN: Retrospective observational study of MDR-TB patients admitted from 2000 to 2003.
RESULTS: Of 1209 MDR-TB patients with documented treatment outcomes, 491 (41%) were cured, 35 (3%) completed treatment, 208 (17%) failed treatment, 223 (18%) died and 252 (21%) defaulted. Of the total number of patients with known human immunodeficiency virus (HIV) status, 52% were HIV-infected. Treatment failure, death and default each differed in their risk factors. Greater baseline resistance (aOR 2.3–3.0), prior TB (aOR 1.7), and diagnosis in 2001, 2002 or 2003 (aOR 1.9–2.3) were independent risk factors for treatment failure. HIV co-infection was a risk factor for death (aOR 5.6), and both HIV (aOR 2.0) and male sex (aOR 1.9) were risk factors for treatment default.
CONCLUSION: MDR-TB treatment outcomes in KwaZulu-Natal were substantially worse than those published from other MDR-TB cohorts. Interventions such as concurrent antiretroviral therapy and decentralized MDR-TB treatment should be considered to improve MDR-TB outcomes in this high HIV prevalence setting.
Document Type: Regular Paper
Affiliations: 1: Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA 2: Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine and Department of Epidemiology & Population Health, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA 3: Centre for the AIDS Programme of Research in South Africa, Durban, South Africa 4: King George V Hospital, Durban, South Africa
Publication date: 2010-04-01
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