Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2012 Feb;16(2):209-15.
doi: 10.5588/ijtld.11.0401.

Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa

M Loveday  1 , K Wallengren, A Voce, B Margot, T Reddy, I Master, J Brust, K Chaiyachati, N Padayatchi
Affiliations
Comparative Study

Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa

M Loveday et al. Int J Tuberc Lung Dis. 2012 Feb.

Abstract

Setting: In KwaZulu-Natal, South Africa, a setting endemic for tuberculosis (TB) and the human immunodeficiency virus (HIV), prolonged hospitalisation for the treatment of the growing number of multidrug-resistant TB (MDR-TB) patients is neither possible nor effective.

Objective: To compare early treatment outcomes in patients with MDR-TB with and without HIV co-infection at four decentralised rural sites with a central urban referral hospital.

Design: This is an operational, prospective cohort study of patients between 1 July 2008 and 30 November 2009, where culture conversion, time to culture conversion, survival and predictors of these outcomes were analysed.

Results: Of 860 patients with MDR-TB, 419 were at the decentralised sites and 441 at the central hospital. Overall, 71% were HIV co-infected. In the 17-month study period, there was a higher proportion of culture conversion at the decentralised sites compared with the centralised hospital (54% vs. 24%, P < 0.001, OR 3.76, 95%CI 2.81-5.03). The median time to treatment initiation was significantly shorter at the decentralised sites compared with the centralised hospital (72 vs. 93 days, P < 0.001). There was no significant difference in survival following treatment initiation.

Conclusion: In this study, early treatment outcomes suggest that decentralised care for MDR-TB patients is superior to that in a centralised setting.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

We declare that we have no conflicts of interest.

Figures

Figure I
Figure I
A map of KwaZulu-Natal showing the location of the centralised hospital and the four decentralised MDR-TB treatment sites
Figure II
Figure II
Schema of enrolment
Figure III
Figure III
Comparison of the time to culture conversion in MDR-TB patients treated at a centralised hospital and decentralised sites, 1 June 2008–30 November 2009
Figure IV
Figure IV
Comparison of the time to death in MDR-TB patients treated at a centralised hospital and decentralised sites, 1 June 2008–30 November 2009
See this image and copyright information in PMC

References

    1. Day C, Grey A. Health and Related Indicators. In: Fonn S, Padarath A, editors. South African Health Review. Durban: Health Systems Trust; 2010.
    1. Ramjee G, Coumi N, Dladla-Qwabe N, Ganesh S, Gappoo S, Govinden R. Experiences in conducting multiple community-based HIV prevention trials among women in KwaZulu-Natal, South Africa. AIDS Res Ther. 2010:7. - PMC - PubMed
    1. Abdool Karim S, Churchyard G, Abdool Karim Q, Lawn S. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet. 2009;374:921–33. - PMC - PubMed
    1. Basu S, Andrews JR, Poolman EM, et al. Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in rural South African district hospitals: an epidemiological modelling study. The Lancet. 2007;370:1500–7. - PMC - PubMed
    1. Perumal R, Padayatchi N, Stiefvater E. The whole is greater than the sum of the parts: Recognising missed opportunities for an optimal response to the rapidly maturing TB-HIV co-epidemic in South Africa. BMC Public Health. 2009;9:243. - PMC - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources