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. 2015 Mar 18;10(3):e0118919.
doi: 10.1371/journal.pone.0118919. eCollection 2015.

Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa

Sizulu Moyo  1 , Helen S Cox  2 , Jennifer Hughes  3 , Johnny Daniels  3 , Leigh Synman  3 , Virginia De Azevedo  4 , Amir Shroufi  3 , Vivian Cox  3 , Gilles van Cutsem  5
Affiliations

Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa

Sizulu Moyo et al. PLoS One. .

Abstract

Background: A community based drug resistant tuberculosis (DR-TB) program has been incrementally implemented in Khayelitsha, a high HIV and TB burden community in South Africa. We investigated loss from treatment (LFT), and post treatment outcomes of DR-TB patients in this setting.

Methodology: LFT, defined as interruption of treatment for ≥2 consecutive months was assessed among patients initiating DR-TB treatment for the first time between January 2009 and July 2011. Patients were traced through routine data sources to identify those who subsequently restarted treatment and those who died. Additional information on patient status and survival after LTF was obtained from community DR-TB counselors and from the national death registry. Post treatment outcomes were observed until July 2013.

Results: Among 452 patients initiating treatment for the first time within the given period, 30% (136) were LFT, with 67% retention at 18 months. Treatment was restarted in 27 (20%) patients, with additional resistance recorded in 2/25 (8%), excluding two with presumed DR-TB. Overall, 34 (25%) patients died, including 11 who restarted treatment. Males and those in the age category 15-25 years had a greater hazard of LFT; HR 1.93 (95% CI 1.35-2.75), and 2.43 (95% CI 1.52-3.88) respectively. Older age (>35 years) was associated with a greater hazard of death; HR 3.74 (1.13- 12.37) post treatment. Overall two-year survival was 62%. It was lower (45%) in older patients, and was 92% among those who received >12 months treatment.

Conclusion: LFT was high, occurred throughout the treatment period and was particularly high among males and those aged 15-25 years. Overall long term survival was poor. High rates of LFT should however not preclude scale up of community based care given its impact in increasing access to treatment. Further research is needed to support retention of DR-TB patients on treatment, even within community based treatment programs.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Retention on treatment: Patients remaining on treatment over the course of treatment (n = 393).
Fig 2
Fig 2. Post treatment outcomes of the patients lost from DR-TB treatment (January 2009-July 2013).
Fig 3
Fig 3. Survival post treatment: Overall, Duration of treatment before LFT, and Age at DR-TB diagnosis.
See this image and copyright information in PMC

References

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    1. World Health Organization. Multi drug resistant tuberculosis 2013 update. 2013. Available: www.who.int/tb/challenges/mdr/MDR_TB_FactSheet.pdf.

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