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Trébucq A, Schwoebel V, Kashongwe Z, Bakayoko A, Kuaban C, Noeske J, Hassane S, Souleymane B, Piubello A, Ciza F, Fikouma V, Gasana M, Ouedraogo M, Gninafon M, Van Deun A, Cirillo DM, Koura KG, Rieder HL. Treatment outcome with a short multidrug-resistant tuberculosis regimen in nine African countries. Int J Tuberc Lung Dis 2017; 22:17-25. [PMID: 29149917 DOI: 10.5588/ijtld.17.0498] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Nine countries in West and Central Africa. OBJECTIVE To assess outcomes and adverse drug events of a standardised 9-month treatment regimen for multidrug-resistant tuberculosis (MDR-TB) among patients never previously treated with second-line drugs. DESIGN Prospective observational study of MDR-TB patients treated with a standardised 9-month regimen including moxifloxacin, clofazimine, ethambutol (EMB) and pyrazinamide (PZA) throughout, supplemented by kanamycin, prothionamide and high-dose isoniazid during an intensive phase of a minimum of 4 to a maximum of 6 months. RESULTS Among the 1006 MDR-TB patients included in the study, 200 (19.9%) were infected with the human immunodeficiency virus (HIV). Outcomes were as follows: 728 (72.4%) cured, 93 (9.2%) treatment completed (81.6% success), 59 (5.9%) failures, 78 (7.8%) deaths, 48 (4.8%) lost to follow-up. The proportion of deaths was much higher among HIV-infected patients (19.0% vs. 5.0%). Treatment success did not differ by HIV status among survivors. Fluoroquinolone resistance was the main cause of failure, while resistance to PZA, ethionamide or EMB did not influence bacteriological outcome. The most important adverse drug event was hearing impairment (11.4% severe deterioration after 4 months). CONCLUSIONS The study results support the use of the short regimen recently recommended by the World Health Organization. Its high level of success even among HIV-positive patients promises substantial improvements in TB control.
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Affiliation(s)
- A Trébucq
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - V Schwoebel
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Z Kashongwe
- Bukavu University, Bukavu, Democratic Republic of Congo
| | - A Bakayoko
- Centre hospitalier universitaire (CHU) Treichville, Abidjan, Côte d'Ivoire
| | | | - J Noeske
- Independent Consultant, Yaoundé, Cameroon
| | | | | | | | - F Ciza
- Action Damien, Bujumbura, Burundi
| | - V Fikouma
- Bangui University, Bangui, Central African Republic
| | - M Gasana
- National Tuberculosis Programme, Kigali, Rwanda
| | | | - M Gninafon
- National Tuberculosis Programme, Cotonou, Benin
| | - A Van Deun
- Mycobacteriology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - D M Cirillo
- Emerging Bacterial Pathogens, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - K G Koura
- International Union Against Tuberculosis and Lung Disease, Paris, France, Unité mixte de Recherche 216, Institut de Recherche pour le Développement, Paris, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France
| | - H L Rieder
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Sawadogo M, Ciza F, Nzeyimana SD, Shingiro A, Ndikumana T, Demeulenaere T, Khogali M, Edginton M, Reid AJ, Kumar AMV, Harries AD. Effect of increased ART-CPT uptake on tuberculosis outcomes and associated factors, Burundi, 2009-2013. Public Health Action 2015; 5:214-6. [PMID: 26767173 DOI: 10.5588/pha.15.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/06/2015] [Indexed: 11/10/2022] Open
Abstract
We retrospectively examined 3579 records of human immunodeficiency virus infected tuberculosis (TB) patients diagnosed from January 2009 to June 2013 in 55 TB treatment facilities in Burundi, to demonstrate whether improvement of combined cotrimoxazole preventive therapy and antiretroviral therapy (ART) uptake was accompanied by improvement of treatment outcomes, and to describe associated factors. Treatment success rates increased from 71% to 80% (P < 0.001). While loss to follow-up and transfer-out rates declined significantly, death rates decreased modestly, and remained high, at 14%. ART uptake was worse in suburban areas and private for-profit institutions. World Health Organization targets could be achieved if peripheral health facilities were prioritised.
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Affiliation(s)
| | - F Ciza
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | - S D Nzeyimana
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | - A Shingiro
- National Antituberculosis Centre, Bujumbura, Burundi
| | - T Ndikumana
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | | | - M Khogali
- Médecins Sans Frontières, Operational Research Unit, Operational Centre Brussels, Luxembourg
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Public Health, Faculty of Health Sciences, University of Witwaterstand, Johannesburg, South Africa
| | - A J Reid
- Médecins Sans Frontières, Operational Research Unit, Operational Centre Brussels, Luxembourg
| | - A M V Kumar
- The Union, South-East Asia Regional Office, New Delhi, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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