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Free Content Identifying early treatment failure on Category I therapy for pulmonary tuberculosis in Lima Ciudad, Peru

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SETTING: Ambulatory, public tuberculosis treatment facilities, central Lima, Peru.

OBJECTIVE: To identify risk factors for failure on directly observed Category I therapy.

DESIGN: Case-control study. All failures of Category I (2HREZ/4H2R2) therapy in 2000 (2.9% of smear-positive TB patients) were included as cases; two controls per case were matched on health center and approximate time of treatment initiation.

RESULTS: The study included 38 cases and 76 controls, all new smear-positive, pulmonary TB patients treated with Category I therapy in central Lima in 2000. Neither treatment irregularity nor incidence of adverse events predicted failure in the study group. Mean baseline body mass index was lower in cases than in controls (P = 0.06). Cases gained less weight during therapy (P = 0.01). Smear positivity at 2 months of therapy was strongly associated with failure (OR 11.7; 95%CI 2.4–57.5). No controls had positive smears at or after 3 months of therapy (OR [corrected] 144.9; 95%CI 8.4–2500). Nearly 75% of cases with isolates tested for susceptibility to first-line drugs had multidrug-resistant TB (MDR-TB).

CONCLUSION: A large proportion of failures on Category I therapy can be identified early. As three-quarters of patients with susceptibility results have MDR-TB, early referral for culture and drug susceptibility testing is critical for prompt initiation of appropriate therapy and improved outcomes.
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Keywords: multidrug-resistant tuberculosis; smear conversion; treatment failure

Document Type: Regular Paper

Affiliations: 1: Programa de Control de Tuberculosis, Direccion de Salud V Lima Ciudad, Lima, Peru 2: Partners In Health, Boston, Massachusetts, USA; and Harvard Medical School, Boston, Massachusetts, USA 3: Partners In Health, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; and Socios En Salud—Sucursal Peru, Lima, Peru

Publication date: January 1, 2004

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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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