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Int J Tuberc Lung Dis. 2012 Feb;16(2):209-15. doi: 10.5588/ijtld.11.0401.

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

Author information

1
Health Systems Research Unit, Medical Research Council, Cape Town, South Africa. marian.loveday@mrc.ac.za

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.

PMID:
22236922
PMCID:
PMC3281510
DOI:
10.5588/ijtld.11.0401
[Indexed for MEDLINE]
Free PMC Article

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