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Infection. 2017 Dec;45(6):831-839. doi: 10.1007/s15010-017-1054-8. Epub 2017 Aug 4.

Outcomes of multidrug-resistant tuberculosis in Zambia: a cohort analysis.

Author information

1
Department of Disease Surveillance, Control and Research, Ministry of Health, Ndeke House, P. O. Box 30205, Lusaka, Zambia. nkapata@gmail.com.
2
Centre of Tropical Medicine and Travel Medicine, Division of Internal Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. nkapata@gmail.com.
3
Centre of Tropical Medicine and Travel Medicine, Division of Internal Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
4
Department of Epidemiology and Statistics, School of Public Health, University of Zambia, Lusaka, Zambia.
5
Tropical Diseases Research Centre, Ndola, Zambia.
6
Department of Disease Surveillance, Control and Research, Ministry of Health, Ndeke House, P. O. Box 30205, Lusaka, Zambia.
7
National TB Reference Laboratory, Lusaka, Zambia.
8
University Teaching Hospital, Lusaka, Zambia.
9
HerpeZ, University Teaching Hospital, Lusaka, Zambia.
10
Division of Infection and Immunity, Department of Infection, University College London, London, UK.
11
Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
12
Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

PURPOSE:

The purpose of this study was to establish a baseline for measuring the impact of the programmatic management of drug-resistant TB program by following up on outcomes of all patients diagnosed with multidrug-resistant tuberculosis in Zambia between 2012 and 2014.

METHODS:

A cohort study of all the MDR-TB patients diagnosed at the national TB reference laboratory from across Zambia. MDR-TB was diagnosed by culture and DST, whereas outcome data were collected in 2015 by patient record checks and home visits.

RESULTS:

The total number of patients diagnosed was 258. Of those, 110 (42.6%) patients were traceable for this study. There were 67 survivor participants (60.9%); 43 (39.1%) were deceased. Out of the 110 patients who were traced, only 71 (64.5%) were started on second-line treatment. Twenty-nine (40.8%) patients were declared cured and 16.9% were still on treatment; 8.4% had failed treatment. The survival rate was 20.2 per 100 person-years of follow-up. Taking ARVs was associated with a decreased risk of dying (hazard ratio 0.12, p = 0.002). Sex, age, marital status and treatment category were not important predictors of survival in MDR-TB patients.

CONCLUSIONS:

More than half of the patients diagnosed with MDR-TB were lost to follow-up before second-line treatment was initiated.

KEYWORDS:

Drug resistance; MDR-TB; Treatment outcome; Tuberculosis; Zambia

PMID:
28779436
DOI:
10.1007/s15010-017-1054-8
[Indexed for MEDLINE]

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