High rates of culture conversion and low loss to follow‑up in MDR‑TB patients managed at Regional Referral Hospitals in Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Abstract
Multi-drug resistant—tuberculosis (MDR-TB) is an emerging public health concern in Uganda. Prior to
2013, MDR-TB treatment in Uganda was only provided at the national referral hospital and two private-not-for profit
clinics. From 2013, it was scaled up to seven regional referral hospitals (RRH). The aim of this study was to measure
interim (6 months) treatment outcomes among the first cohort of patients started on MDR-TB treatment at the RRH in
Uganda.
Methods: This was a cross-sectional study in which a descriptive analysis of data collected retrospectively on a
cohort of 69 patients started on MDR-TB treatment at six of the seven RRH between 1st April 2013 and 30th June 2014
and had been on treatment for at least 9 months was conducted.
Results: Of the 69 patients, 21 (30.4%) were female, 39 (56.5%) HIV-negative, 30 (43.5%) resistant to both isoniazid
and rifampicin and 57 (82.6%) category 1 or 2 drug susceptible TB treatment failures. Median age at start of treatment
was 35 years (Interquartile range (IQR): 27–45), median time-to-treatment initiation was 27.5 (IQR: 6–89) days and
of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a median CD4 count of 206 cells/
microliter of blood (IQR: 113–364.5). Within 6 months of treatment, 59 (85.5%) patients culture converted, of which
45 (65.2%) converted by the second month and the other 14 (20.3%) by the sixth month; one (1.5%) did not culture
convert; three (4.4%) died; and six (8.8%) were lost-to-follow up. Fifty (76.8%) patients experienced at least one drug
adverse event, while 40 (67.8%) gained weight. Mean weight gained was 4.7 (standard deviation: 3.2) kilograms.
Conclusions: Despite MDR-TB treatment initiation delays, most patients had favourable interim treatment outcomes
with majority culture converting early and very few getting lost to follow-up. These encouraging interim outcomes
indicate the potential for success of a scale-up of MDR-TB treatment to RRH.
Description
Keywords
Multi-drug resistant tuberculosis, Regional referral hospitals
Citation
Martin, M. K., Paul, O. J., Sara, R., Hilary, A., Frank, M., Augustin, M. K., ... & Gladys, T. (2021). High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda. BMC Infectious Diseases, 21(1), 1-9. https://doi.org/10.1186/s12879-021-06743-y