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. 2010 Apr;14(4):413-9.

High treatment failure and default rates for patients with multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa, 2000-2003

J C M Brust  1 , N R Gandhi, H Carrara, G Osburn, N Padayatchi
Affiliations

High treatment failure and default rates for patients with multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa, 2000-2003

J C M Brust et al. Int J Tuberc Lung Dis. 2010 Apr.

Abstract

Setting: Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant public health threat in South Africa.

Objective: To describe treatment outcomes and determine risk factors associated with unfavorable outcomes among MDR-TB patients admitted to the provincial TB referral hospital in KwaZulu-Natal Province, South Africa.

Design: Retrospective observational study of MDR-TB patients admitted from 2000 to 2003.

Results: Of 1209 MDR-TB patients with documented treatment outcomes, 491 (41%) were cured, 35 (3%) completed treatment, 208 (17%) failed treatment, 223 (18%) died and 252 (21%) defaulted. Of the total number of patients with known human immunodeficiency virus (HIV) status, 52% were HIV-infected. Treatment failure, death and default each differed in their risk factors. Greater baseline resistance (aOR 2.3-3.0), prior TB (aOR 1.7), and diagnosis in 2001, 2002 or 2003 (aOR 1.9-2.3) were independent risk factors for treatment failure. HIV co-infection was a risk factor for death (aOR 5.6), and both HIV (aOR 2.0) and male sex (aOR 1.9) were risk factors for treatment default.

Conclusion: MDR-TB treatment outcomes in KwaZulu-Natal were substantially worse than those published from other MDR-TB cohorts. Interventions such as concurrent antiretroviral therapy and decentralized MDR-TB treatment should be considered to improve MDR-TB outcomes in this high HIV prevalence setting.

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Figures

Figure 1
Figure 1
MDR TB Treatment outcomes 2000–2003
Figure 2
Figure 2
MDR TB final treatment outcomes by year of diagnosis.
See this image and copyright information in PMC

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