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http://hdl.handle.net/123456789/1850
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| Title: | Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study |
| Authors: | Jones-Lopez, Edward C.
Ayakaka, Irene
Levin, Jonathan
Reilly, Nancy
Mumbowa, Francis
Dryden-Peterson, Scott
Nyakoojo, Grace
Fennelly, Kevin
Temple, Beth
Nakubulwa, Susan
Joloba, Moses L.
Okwera, Alphonse
Eisenach, Kathleen D.
McNerney, Ruth
Elliott, Alison M.
Ellner, Jerrold J.
Smith, Peter G.
Mugerwa, Roy D. |
| Keywords: | Tuberculosis treatment
TB patients |
| Issue Date: | 22-Jul-2011 |
| Publisher: | Public Library of Science |
| Citation: | Jones-Lo´pez, E. C. et al. (2011). Effectiveness of the Standard WHO Recommended Retreatment Regimen (Category II) for Tuberculosis in Kampala, Uganda: A Prospective Cohort Study. PLoS Med, 8(3): 1-11 |
| Abstract: | Background: Each year, 10%–20% of patients with tuberculosis (TB) in low- and middle-income countries present with
previously treated TB and are empirically started on a World Health Organization (WHO)-recommended standardized
retreatment regimen. The effectiveness of this retreatment regimen has not been systematically evaluated.
Methods and Findings: From July 2003 to January 2007, we enrolled smear-positive, pulmonary TB patients into a
prospective cohort to study treatment outcomes and mortality during and after treatment with the standardized
retreatment regimen. Median time of follow-up was 21 months (interquartile range 12–33 months). A total of 29/148 (20%)
HIV-uninfected and 37/140 (26%) HIV-infected patients had an unsuccessful treatment outcome. In a multiple logistic
regression analysis to adjust for confounding, factors associated with an unsuccessful treatment outcome were poor
adherence (adjusted odds ratio [aOR] associated with missing half or more of scheduled doses 2.39; 95% confidence interval
(CI) 1.10–5.22), HIV infection (2.16; 1.01–4.61), age (aOR for 10-year increase 1.59; 1.13–2.25), and duration of TB symptoms
(aOR for 1-month increase 1.12; 1.04–1.20). All patients with multidrug-resistant TB had an unsuccessful treatment outcome.
HIV-infected individuals were more likely to die than HIV-uninfected individuals (p,0.0001). Multidrug-resistant TB at
enrolment was the only common risk factor for death during follow-up for both HIV-infected (adjusted hazard ratio [aHR]
17.9; 6.0–53.4) and HIV-uninfected (14.7; 4.1–52.2) individuals. Other risk factors for death during follow-up among HIVinfected
patients were CD4,50 cells/ml and no antiretroviral treatment (aHR 7.4, compared to patients with CD4$200; 3.0–
18.8) and Karnofsky score ,70 (2.1; 1.1–4.1); and among HIV-uninfected patients were poor adherence (missing half or more
of doses) (3.5; 1.1–10.6) and duration of TB symptoms (aHR for a 1-month increase 1.9; 1.0–3.5).
Conclusions: The recommended regimen for retreatment TB in Uganda yields an unacceptable proportion of unsuccessful
outcomes. There is a need to evaluate new treatment strategies in these patients. |
| URI: | http://dx.doi.org/10.1371/journal.pmed.1000427
http://hdl.handle.net/123456789/1850 |
| ISSN: | 1549-1277 |
| Appears in Collections: | Research Articles (Bio-Medical)
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| Joloba_Microbiology4.pdf | | 243Kb | Adobe PDF | View/Open |
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