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Adherence to National Guidelines, Treatment Follow-Up and Outcomes of Patients Treated for Multi-Drug Resistant Tuberculosis in Tanzania: A Six Year Retrospective Cohort Analysis and Qualitative Triangulation 2009-2015
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A1480 - Adherence to National Guidelines, Treatment Follow-Up and Outcomes of Patients Treated for Multi-Drug Resistant Tuberculosis in Tanzania: A Six Year Retrospective Cohort Analysis and Qualitative Triangulation 2009-2015
Author Block: E. S. Ngadaya1, G. D. Kimaro2, I. Lekule3, R. M. Kisonga4, G. Kagaruki5, R. Shemtandulo1, E. H. Sandi2, A. Kahwa1, A. Zumla6, N. Mnyambwa7, S. G. Mfinanga8; 1Muhimbili Medical Rsch Ctr, Natl Inst for Medical Rsch, Dar-Es-Salaam, Tanzania, United Republic of, 2National Institute for Medical Research, Dar Es Salaam, Tanzania, United Republic of, 3MDR TB, Kibong’oto Infectious disease hospital, P.o.Box 12 Sanya Juu, Moshi, Tanzania, United Republic of, 4Kibong’oto Infectious disease hospital, P.o.Box 12 Sanya Juu, Moshi, Tanzania, United Republic of, 5Tukuyu Medical Rsch Ctr, Natl Inst for Medical Rsch, Mbeya, Tanzania, United Republic of, 6Division of Infection and Immunity, University College London and National Institute for Health Research (NIHR) Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom, 7School of Life Sciences and Bioengineering, 5School of Life ScienNelson Mandela African Institution of Science and Technology, Arusha, Tanzania, United Republic of, 8Nimr Muhimbili Centre, Dar-Es-Salaam, Tanzania, United Republic of.
RATIONALE: The global emergence of multi-drug resistant tuberculosis (MDR-TB) is an important public health problem. In sub-Saharan Africa, National TB programs face major difficulties in making prompt diagnosis of drug resistance, rendering the toxic MDR-TB treatment regimen and follow-up of patients. OBJECTIVES: To determine adherence to national guidelines, treatment follow-up and treatment outcomes of MDR-TB patients in Tanzania. METHODS: We conducted a six-year (2009-2015) retrospective cohort analysis involving review of 471 MDR-TB patients’ records enrolled in treatment and in-depth interview of healthcare providers. RESULTS: Of the 471 MDR-TB patients registered for treatment since 2009, 319 (67.7%) were males. Of 222 MDR-TB patients who had treatment outcome results available; 181 (87.4%) had complete records; 102/222 (45.7%) cured, 67/222 (30.2%) died; 31/222 (14%) completed treatment; 20/222 (9%) defaulted and 2 (1%) patients failed second-line MDR-TB treatment. According to the records reviewed, nearly two-thirds, 130/222 (58.6%) MDR-TB patients had smear performed monthly for eight months while 90/222 (40.5%) had culture performed monthly for eight months. Drug Sensitivity Testing (DST) for second-line drugs was performed for only 7 patients in month one and one patient in month 2. None of the subsequent culture positive results (month 2-8) had DST results. Out of 302 patients diagnosed with GeneXpert MTB RIF Assay, 173 (57.3%) had MDR-TB treatment accorded based on GeneXpert results alone. Monthly culture was performed in 83 patients for 8 months; and those who had culture done at month 0 and 6, had an odds ratio (OR) of 3.6 (95 CI: 1.6-7.8) and 7.4 (95 CI: 3.4-16.4) respectively, of having favorable treatment outcome. CONCLUSION: Adherence to the National and World Health Organization (WHO) guidelines and DST for second-line drugs were below standard. Strategies are needed for evaluation and capacity building for patients’ follow-up, record keeping and DST for second-line drugs testing.
Author Block: E. S. Ngadaya1, G. D. Kimaro2, I. Lekule3, R. M. Kisonga4, G. Kagaruki5, R. Shemtandulo1, E. H. Sandi2, A. Kahwa1, A. Zumla6, N. Mnyambwa7, S. G. Mfinanga8; 1Muhimbili Medical Rsch Ctr, Natl Inst for Medical Rsch, Dar-Es-Salaam, Tanzania, United Republic of, 2National Institute for Medical Research, Dar Es Salaam, Tanzania, United Republic of, 3MDR TB, Kibong’oto Infectious disease hospital, P.o.Box 12 Sanya Juu, Moshi, Tanzania, United Republic of, 4Kibong’oto Infectious disease hospital, P.o.Box 12 Sanya Juu, Moshi, Tanzania, United Republic of, 5Tukuyu Medical Rsch Ctr, Natl Inst for Medical Rsch, Mbeya, Tanzania, United Republic of, 6Division of Infection and Immunity, University College London and National Institute for Health Research (NIHR) Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom, 7School of Life Sciences and Bioengineering, 5School of Life ScienNelson Mandela African Institution of Science and Technology, Arusha, Tanzania, United Republic of, 8Nimr Muhimbili Centre, Dar-Es-Salaam, Tanzania, United Republic of.
RATIONALE: The global emergence of multi-drug resistant tuberculosis (MDR-TB) is an important public health problem. In sub-Saharan Africa, National TB programs face major difficulties in making prompt diagnosis of drug resistance, rendering the toxic MDR-TB treatment regimen and follow-up of patients. OBJECTIVES: To determine adherence to national guidelines, treatment follow-up and treatment outcomes of MDR-TB patients in Tanzania. METHODS: We conducted a six-year (2009-2015) retrospective cohort analysis involving review of 471 MDR-TB patients’ records enrolled in treatment and in-depth interview of healthcare providers. RESULTS: Of the 471 MDR-TB patients registered for treatment since 2009, 319 (67.7%) were males. Of 222 MDR-TB patients who had treatment outcome results available; 181 (87.4%) had complete records; 102/222 (45.7%) cured, 67/222 (30.2%) died; 31/222 (14%) completed treatment; 20/222 (9%) defaulted and 2 (1%) patients failed second-line MDR-TB treatment. According to the records reviewed, nearly two-thirds, 130/222 (58.6%) MDR-TB patients had smear performed monthly for eight months while 90/222 (40.5%) had culture performed monthly for eight months. Drug Sensitivity Testing (DST) for second-line drugs was performed for only 7 patients in month one and one patient in month 2. None of the subsequent culture positive results (month 2-8) had DST results. Out of 302 patients diagnosed with GeneXpert MTB RIF Assay, 173 (57.3%) had MDR-TB treatment accorded based on GeneXpert results alone. Monthly culture was performed in 83 patients for 8 months; and those who had culture done at month 0 and 6, had an odds ratio (OR) of 3.6 (95 CI: 1.6-7.8) and 7.4 (95 CI: 3.4-16.4) respectively, of having favorable treatment outcome. CONCLUSION: Adherence to the National and World Health Organization (WHO) guidelines and DST for second-line drugs were below standard. Strategies are needed for evaluation and capacity building for patients’ follow-up, record keeping and DST for second-line drugs testing.
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