Diagnosis and interim treatment outcomes from the first cohort of multidrug-resistant tuberculosis patients in Tanzania

Abstract

Setting: Kibong'oto National Tuberculosis Hospital (KNTH), Kilimanjaro, Tanzania.

Objective: Characterize the diagnostic process and interim treatment outcomes from patients treated for multidrug-resistant tuberculosis (MDR-TB) in Tanzania.

Design: A retrospective cohort study was performed among all patients treated at KNTH for pulmonary MDR-TB between November 2009 and September 2011.

Results: Sixty-one culture-positive MDR-TB patients initiated therapy, 60 (98%) with a prior history of TB treatment. Forty-one (67%) were male and 9 (14%) were HIV infected with a mean CD4 count of 424 (±106) cells/µl. The median time from specimen collection to MDR-TB diagnosis and from diagnosis to initiation of MDR-TB treatment was 138 days (IQR 101-159) and 131 days (IQR 32-233), respectively. Following treatment initiation four (7%) patients died (all HIV negative), 3 (5%) defaulted, and the remaining 54 (89%) completed the intensive phase. Most adverse drug reactions were mild to moderate and did not require discontinuation of treatment. Median time to culture conversion was 2 months (IQR 1-3) and did not vary by HIV status. In 28 isolates available for additional second-line drug susceptibility testing, fluoroquinolone, aminoglycoside and para-aminosalicylic acid resistance was rare yet ethionamide resistance was present in 9 (32%).

Conclusion: The majority of MDR-TB patients from this cohort had survived a prolonged referral process, had multiple episodes of prior TB treatment, but did not have advanced AIDS and converted to culture negative early while completing an intensive inpatient regimen without serious adverse event. Further study is required to determine the clinical impact of second-line drug susceptibility testing and the feasibility of alternatives to prolonged hospitalization.

Figure 1. Patients referred to KNTH for MDR-TB treatment.

KNTH =  Kibong’oto National TB Hospital, Tanzania. MDR-TB =  multidrug-resistant tuberculosis. All patients had pulmonary TB.

Figure 2. Prevalence of medication related symptoms.

The prevalence of medication related symptoms during the inpatient intensive phase occurring at least once in an individual patient, as determined by percentage of total patients (N = 61).

Figure 3. Distribution of the time to sputum culture conversion.

Legend: Sputum was collected for culture prior to treatment initiation and monthly thereafter. Culture conversion was defined as the first of two consecutive months of negative cultures. Eight subjects were excluded as regular follow-up culture results were unavailable.