Effectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Uganda
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS medicine
Abstract
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 HIVinfected
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.
Description
Keywords
WHO, Recommended Retreatment Regimen (Category II), Tuberculosis, Uganda
Citation
Jones-López, E. C., Ayakaka, I., Levin, J., Reilly, N., Mumbowa, F., Dryden-Peterson, S., Nyakoojo, G., Fennelly, K., Temple, B., Nakubulwa, S., Joloba, M. L., Okwera, A., Eisenach, K. D., McNerney, R., Elliott, A. M., Ellner, J. J., Smith, P. G., & Mugerwa, R. D. (2011). Effectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Uganda: A prospective cohort study. PLoS Medicine, 8(3), 1-11. [e1000427]. https://doi.org/10.1371/journal.pmed.10004