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Free Content Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa

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Abstract:

SETTING: In KwaZulu-Natal, South Africa, a setting endemic for tuberculosis (TB) and the human immunodeficiency virus (HIV), prolonged hospitalisation for the treatment of the growing number of multidrug-resistant TB (MDR-TB) patients is neither possible nor effective.

OBJECTIVE: To compare early treatment outcomes in patients with MDR-TB with and without HIV co-infection at four decentralised rural sites with a central urban referral hospital.

DESIGN: This is an operational, prospective cohort study of patients between 1 July 2008 and 30 November 2009, where culture conversion, time to culture conversion, survival and predictors of these outcomes were analysed.

RESULTS: Of 860 patients with MDR-TB, 419 were at the decentralised sites and 441 at the central hospital. Overall, 71% were HIV co-infected. In the 17-month study period, there was a higher proportion of culture conversion at the decentralised sites compared with the centralised hospital (54% vs. 24%, P < 0.001, OR 3.76, 95%CI 2.81–5.03). The median time to treatment initiation was significantly shorter at the decentralised sites compared with the centralised hospital (72 vs. 93 days, P < 0.001). There was no significant difference in survival following treatment initiation.

CONCLUSION: In this study, early treatment outcomes suggest that decentralised care for MDR-TB patients is superior to that in a centralised setting.

Keywords: high burden of TB and HIV; operational research

Document Type: Research Article

DOI: https://doi.org/10.5588/ijtld.11.0401

Affiliations: 1: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa; and Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa 2: KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Durban, South Africa 3: Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa 4: KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa 5: Biostatics Unit, Medical Research Council, Durban, South Africa 6: Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA 7: University of Michigan School of Medicine, Ann Arbor, Michigan, USA; Harvard University School of Medicine, Boston, Massachusetts, USA 8: Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa

Publication date: 2012-02-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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