Outcomes from the first multidrug-resistant tuberculosis programme in Kenya
OBJECTIVE: To describe patients' treatment outcomes and adverse events.
DESIGN: A retrospective case note review of patients started on MDR-TB treatment at two Médecins Sans Frontières-supported sites and the national referral hospital of Kenya was undertaken. Sites operated an ambulatory model of care. Patients were treated for a minimum of 24 months with at least 4–5 drugs for the intensive phase of treatment, including an injectable agent.
RESULTS: Of 169 patients, 25.6% were human immunodeficiency virus (HIV) positive and 89.3% were culture-positive at baseline. Adverse events occurred in 67.4% of patients: 45.9% had nausea/vomiting, 43.9% electrolyte disturbance, 41.8% dyspepsia and 31.6% hypothyroidism. The median time to culture conversion was 2 months. Treatment outcomes were as follows: 76.6% success, 14.5% deaths, 8.3% lost to follow-up and 0.7% treatment failure. HIV-positive individuals (adjusted odds ratio [aOR] 3.51, 95% confidence interval [CI] 1.12–11.03) and women (aOR 2.73, 95%CI 1.01–7.39) had a higher risk of unfavourable outcomes, while the risk was lower in those with culture conversion at 6 months (aOR 0.11, 95%CI 0.04–0.32).
CONCLUSION: In Kenya, where an ambulatory model of care is used for MDR-TB treatment, treatment success was high, despite high rates of HIV. Almost half of the patients experienced electrolyte disturbance and one third had hypothyroidism; this supports the view that systematic regular biochemical monitoring is needed in Kenya.
Keywords: Africa; HIV; adverse events; culture conversion
Document Type: Research Article
Affiliations: 1: Epicentre, Paris, France 2: National Leprosy and Tuberculosis Control Programme, Nairobi 3: Médecins Sans Frontières, Nairobi, Kenya 4: Institute for Infection and Immunity, St George's University of London, London, UK 5: Kenya Medical Research Institute, Kisumu, Kenya 6: Médecins Sans Frontières, Paris, France
Publication date: 01 March 2017
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