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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Uganda: A prospective cohort study
PLoS Medicine, Volume 8, No. 3, Article e1000427, Year 2011
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Description
Background: Each year, 10%-20% of patients with tuberculosis (TB) in low- and middle-income countries present with previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated. Methods and Findings: From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized retreatment regimen. Median time of follow-up was 21 months (interquartile range 12-33 months). A total of 29/148 (20%) HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval (CI) 1.10-5.22), HIV infection (2.16; 1.01-4.61), age (aOR for 10-year increase 1.59; 1.13-2.25), and duration of TB symptoms (aOR for 1-month increase 1.12; 1.04-1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome. HIV-infected individuals were more likely to die than HIV-uninfected individuals (p<0.0001). Multidrug-resistant TB at enrolment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR] 17.9; 6.0-53.4) and HIV-uninfected (14.7; 4.1-52.2) individuals. Other risk factors for death during follow-up among HIV-infected patients were CD4<50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4≥200; 3.0-18.8) and Karnofsky score <70 (2.1; 1.1-4.1); and among HIV-uninfected patients were poor adherence (missing half or more of doses) (3.5; 1.1-10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0-3.5). Conclusions: The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful outcomes. There is a need to evaluate new treatment strategies in these patients. © 2011 Jones-López et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3058098/bin/pmed.1000427.s001.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC3058098/bin/pmed.1000427.s002.pdf
Authors & Co-Authors
Jones-López, Edward C.
Unknown Affiliation
Ayakaka, Irene
Unknown Affiliation
Levin, Jonathan B.
Unknown Affiliation
Reilly, Nancy
Unknown Affiliation
Mumbowa, Francis
Unknown Affiliation
Dryden-Peterson, Scott L.
Unknown Affiliation
Nyakoojo, Grace
Unknown Affiliation
Fennelly, Kevin P.
Unknown Affiliation
Temple, Beth
Unknown Affiliation
Nakubulwa, Susan
Unknown Affiliation
Joloba, Moses Lutaakome
Unknown Affiliation
Okwera, Alphonse
Unknown Affiliation
Eisenach, Kathleen D.
Unknown Affiliation
McNerney, R.
Unknown Affiliation
Elliott, Alison M.
Unknown Affiliation
Ellner, Jerrold J.
Unknown Affiliation
Smith, Peter George
Unknown Affiliation
Mugerwa, Roy D.
Unknown Affiliation
Statistics
Citations: 91
Authors: 18
Affiliations: 14
Identifiers
Doi:
10.1371/journal.pmed.1000427
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative
Study Locations
Uganda