Effectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Uganda

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dc.contributor.authorJones-López, Edward C.
dc.contributor.authorAyakaka, Irene
dc.contributor.authorLevin, Jonathan
dc.contributor.authorReilly, Nancy
dc.contributor.authorMumbowa, Francis
dc.contributor.authorDryden-Peterson, Scott
dc.contributor.authorNyakoojo, Grace
dc.contributor.authorFennelly, Kevin
dc.contributor.authorTemple, Beth
dc.contributor.authorNakubulwa, Susan
dc.contributor.authorJoloba, Moses L.
dc.contributor.authorOkwera, Alphonse
dc.contributor.authorEisenach, Kathleen D.
dc.contributor.authorMcNerney, Ruth
dc.contributor.authorElliott, Alison M.
dc.contributor.authorEllner, Jerrold J.
dc.contributor.authorSmith, Peter G.
dc.contributor.authorMugerwa, Roy D.
dc.date.accessioned2022-05-16T11:02:14Z
dc.date.available2022-05-16T11:02:14Z
dc.date.issued2011
dc.description.abstractEach 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.en_US
dc.identifier.citationJones-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.10004en_US
dc.identifier.urihttps://doi.org/10.1371/journal.pmed.10004
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/3240
dc.language.isoenen_US
dc.publisherPLoS medicineen_US
dc.subjectWHOen_US
dc.subjectRecommended Retreatment Regimen (Category II)en_US
dc.subjectTuberculosisen_US
dc.subjectUgandaen_US
dc.titleEffectiveness of the standard WHO recommended retreatment regimen (Category II) for tuberculosis in Kampala, Ugandaen_US
dc.typeArticleen_US
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