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Loss from Treatment for Drug Resistant Tuberculosis: Risk Factors and Patient Outcomes in a Community-Based Program in Khayelitsha, South Africa

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Listed:
  • Sizulu Moyo
  • Helen S Cox
  • Jennifer Hughes
  • Johnny Daniels
  • Leigh Synman
  • Virginia De Azevedo
  • Amir Shroufi
  • Vivian Cox
  • Gilles van Cutsem

Abstract

Background: A community based drug resistant tuberculosis (DR-TB) program has been incrementally implemented in Khayelitsha, a high HIV and TB burden community in South Africa. We investigated loss from treatment (LFT), and post treatment outcomes of DR-TB patients in this setting. Methodology: LFT, defined as interruption of treatment for ≥2 consecutive months was assessed among patients initiating DR-TB treatment for the first time between January 2009 and July 2011. Patients were traced through routine data sources to identify those who subsequently restarted treatment and those who died. Additional information on patient status and survival after LTF was obtained from community DR-TB counselors and from the national death registry. Post treatment outcomes were observed until July 2013. Results: Among 452 patients initiating treatment for the first time within the given period, 30% (136) were LFT, with 67% retention at 18 months. Treatment was restarted in 27 (20%) patients, with additional resistance recorded in 2/25 (8%), excluding two with presumed DR-TB. Overall, 34 (25%) patients died, including 11 who restarted treatment. Males and those in the age category 15-25 years had a greater hazard of LFT; HR 1.93 (95% CI 1.35-2.75), and 2.43 (95% CI 1.52-3.88) respectively. Older age (>35 years) was associated with a greater hazard of death; HR 3.74 (1.13- 12.37) post treatment. Overall two-year survival was 62%. It was lower (45%) in older patients, and was 92% among those who received >12 months treatment. Conclusion: LFT was high, occurred throughout the treatment period and was particularly high among males and those aged 15-25 years. Overall long term survival was poor. High rates of LFT should however not preclude scale up of community based care given its impact in increasing access to treatment. Further research is needed to support retention of DR-TB patients on treatment, even within community based treatment programs.

Suggested Citation

  • Sizulu Moyo & Helen S Cox & Jennifer Hughes & Johnny Daniels & Leigh Synman & Virginia De Azevedo & Amir Shroufi & Vivian Cox & Gilles van Cutsem, 2015. "Loss from Treatment for Drug Resistant Tuberculosis: Risk Factors and Patient Outcomes in a Community-Based Program in Khayelitsha, South Africa," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-13, March.
    • Handle: RePEc:plo:pone00:0118919
    DOI: 10.1371/journal.pone.0118919
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    References listed on IDEAS

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    1. Maeve K Lalor & Jane Greig & Sholpan Allamuratova & Sandy Althomsons & Zinaida Tigay & Atadjan Khaemraev & Kai Braker & Oleksander Telnov & Philipp du Cros, 2013. "Risk Factors Associated with Default from Multi- and Extensively Drug-Resistant Tuberculosis Treatment, Uzbekistan: A Retrospective Cohort Analysis," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-5, November.
    2. C. Fitzpatrick & K. Floyd, 2012. "Erratum to Systematic Reviewof the Cost and Cost Effectiveness of Treatment for Multidrug-Resistant Tuberculosis," PharmacoEconomics, Springer, vol. 30(1), pages 81-81, January.
    3. Christopher Fitzpatrick & Katherine Floyd, 2012. "A Systematic Review of the Cost and Cost Effectiveness of Treatment for Multidrug-Resistant Tuberculosis," PharmacoEconomics, Springer, vol. 30(1), pages 63-80, January.
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    Cited by:

    1. Lucia Jane Stevenson & Leigh Biagio-de Jager & Marien Alet Graham & De Wet Swanepoel, 2021. "Community-Based Ototoxicity Monitoring for Drug-Resistant Tuberculosis in South Africa: An Evaluation Study," IJERPH, MDPI, vol. 18(21), pages 1-14, October.
    2. Quan-Hoang Vuong & Ha Nguyen, 2016. "Patients’ contributions as a quid pro quo for community’s supports? Evidence from Vietnamese co-location clusters," Working Papers CEB 16-028, ULB -- Universite Libre de Bruxelles.

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