Predictors of cure among HIV co-infected multidrug-resistant TB patients at Sizwe Tropical Disease Hospital Johannesburg, South Africa

Umanah, Teye Aniefiok; Ncayiyana, Jabulani; Nyasulu, Peter

doi:10.1093/trstmh/trv025

Cited by 14 publications

(20 citation statements)

References 35 publications

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“…Similarly, male gender also increases the risk of death by two times among MDR-TB patients in South Africa [22]. However, the present study found no significant association between gender and survival among patients with MDR-TB.…”

Section: Discussioncontrasting

confidence: 71%

Survival of smear-positive multidrug resistant tuberculosis patients in Witbank, South Africa: A retrospective cohort study

Olaleye

Beke

2016

Infectious Diseases

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Section: Discussioncontrasting

confidence: 71%

Survival of smear-positive multidrug resistant tuberculosis patients in Witbank, South Africa: A retrospective cohort study

Olaleye

Beke

2016

Infectious Diseases

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“…The study showed that time to MDR-TB treatment initiation was lower in the group diagnosed using the LPA-based algorithm compared to those diagnosed with the culture-based algorithm (50 and 66 days) which resulted in better treatment outcomes, both in terms of treatment success (65.2% vs 44.8%) and mortality (7.6% vs 15.9%) [32]. Prior to implementation of Xpert MTB/RIF as the first line diagnostic test, phenotypic DST and LPA were done on patients suspected of having DR-TB due to prior treatment failure, default, or contact with a person with known DR-TB [14]. As a result the groups of patients diagnosed in the previous algorithm may reflect a sicker population of patients with longer standing undiagnosed/untreated tuberculosis at higher risk of early mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Sizwe Tropical Disease Hospital (STDH), the inpatient treatment center, serves as a referral center for all DR-TB in Gauteng Province, where Johannesburg is located [14]. Prior to decentralization in 2011, all MDR-TB and XDR-TB patients in the province were treated at STDH; currently all XDR-TB patients are still treated there.…”

Section: Methodsmentioning

confidence: 99%

“…Prior to decentralization in 2011, all MDR-TB and XDR-TB patients in the province were treated at STDH; currently all XDR-TB patients are still treated there. Between January 2007 and December 2010 a total of 2005 MDR-TB patients were admitted to STDH [14]. Records for patients initiated onto treatment for MDR-TB and XDR-TB at STDH are entered directly into the national electronic DR-TB register, which is called EDRweb.…”

Section: Methodsmentioning

confidence: 99%

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Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa

et al. 2017

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BackgroundIn South Africa, roughly half of the drug-resistant TB cases diagnosed are reported to have been started on treatment. We determined the proportion of persons diagnosed with rifampicin resistant (RR-) TB who initiated treatment in Johannesburg after the introduction of decentralized RR-TB care in 2011.MethodsWe retrospectively matched adult patients diagnosed with laboratory-confirmed RR-TB in Johannesburg from 07/2011-06/2012 with records of patients initiating RR-TB treatment at one of the city’s four public sector treatment sites (one centralized, three decentralized). Patients were followed from date of diagnosis until the earliest of RR-TB treatment initiation, death, or 6 months’ follow-up. We report diagnostic methods and outcomes, proportions initiating treatment, and median time from diagnosis to treatment initiation.Results594 patients were enrolled (median age 34 (IQR 29–42), 287 (48.3%) female). Diagnosis was by GenoType MTBDRplus (Hain-Life-Science) line probe assay (LPA) (281, 47.3%), Xpert MTB/RIF (Cepheid) (258, 43.4%), or phenotypic drug susceptibility testing (DST) (30, 5.1%) with 25 (4.2%) missing a diagnosis method. 320 patients (53.8%) had multi-drug resistant TB, 158 (26.6%) rifampicin resistant TB by Xpert MTB/RIF, 102 (17.2%) rifampicin mono-resistance, and 14 (2.4%) extensively drug-resistant TB. 256/594 (43.0%) patients initiated treatment, representing 70.7% of those who were referred for treatment (362/594). 338/594 patients (57.0%) did not initiate treatment, including 104 (17.5%) who died before treatment was started. The median time from sputum collection to treatment initiation was 33 days (IQR 12–52).ConclusionDespite decentralized RR-TB treatment, fewer than half the patients diagnosed in Johannesburg initiated appropriate treatment. Offering treatment at decentralized sites alone is not sufficient; improvements in linking patients diagnosed with RR-TB to effective treatment is essential.

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“…Of these, 3368 were MDR-TB and HIV co-infected. Study duration varied from one year [13] to over eight years [16], with majority (n = 4) of the studies conducted over periods of three to four years [14,[22][23][24]. Six studies were conducted in South Africa [14,16,[22][23][24][25], one in Lesotho [13], one in Botswana [17] and one in Ethiopia [15].…”

Section: Study Characteristicsmentioning

confidence: 99%

Treatment outcomes and antiretroviral uptake in Multidrug-Resistant Tuberculosis and HIV coinfected Patients in Sub Saharan Africa. A Systematic Review and Meta-Analysis

Chem

Hout

Hope

2019

Preprint

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Background: Multidrug-resistant tuberculosis (MDR-TB) in HIV endemic settings is a major threat to public health. MDR-TB is a substantial and underreported problem in Sub-Saharan Africa (SSA), with recognised cases projected to increase with advancement in diagnostic technology. There is paucity of review evidence on treatment outcomes and antiretroviral (ART) uptake among MDR-TB patients with HIV in SSA. To address this gap a review of treatment outcomes in HIV patients co-infected with MDR-TB in the SSA region was undertaken. eligibility and data extracted. Random effect meta-analysis was conducted using STATA and Cochrane's review manager.Results: A total of 271 publications were identified of which nine fulfilled the inclusion criteria. Data was collected from 3368 MDR-TB and HIV co-infected patients from four SSA countries; South Africa (6), Lesotho (1), Botswana (1) and Ethiopia (1). The most common outcome was cure (34.9% cured in the pooled analysis), this was followed by death (18.1% in pooled analysis). ART uptake was high, at 83% in the pooled analysis. Cure ranged from 28.6 to 54.7% among patients on ART and from 22.2 to 57.7% among those not on ART medication. MDR-TB and HIV coinfected patients were less likely to be successfully treated than HIV negative MDR-TB patients (Risk Ratio = 0.87, 95% CI 0.97, 0.96).Conclusion: Treatment outcomes for MDR-TB and HIV co-infected patients do not vary widely from those reported globally. However, treatment success was lower among HIV positive MDR-TB patients compared to HIV negative MDR-TB patients. Prompt antiretroviral initiation and interventions to improve treatment adherence are necessary.

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Predictors of cure among HIV co-infected multidrug-resistant TB patients at Sizwe Tropical Disease Hospital Johannesburg, South Africa

Cited by 14 publications

References 35 publications

Survival of smear-positive multidrug resistant tuberculosis patients in Witbank, South Africa: A retrospective cohort study

Survival of smear-positive multidrug resistant tuberculosis patients in Witbank, South Africa: A retrospective cohort study

Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa

Treatment outcomes and antiretroviral uptake in Multidrug-Resistant Tuberculosis and HIV coinfected Patients in Sub Saharan Africa. A Systematic Review and Meta-Analysis

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