Programmatic management of patients with pre-extensively drug-resistant tuberculosis in Peru, 2011–2014
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.
Keywords: Peru; culture conversion; pre-XDR-TB; treatment outcome
Document Type: Research Article
Affiliations: 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
Publication date: 01 October 2018
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