Makerere University Research Repository >
College of Health Sciences >
School of Bio-Medical Sciences >
Research Articles (Bio-Medical) >
Please use this identifier to cite or link to this item:
|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.|
Joloba, Moses L.
Eisenach, Kathleen D.
Elliott, Alison M.
Ellner, Jerrold J.
Smith, Peter G.
Mugerwa, Roy D.
|Keywords: ||Tuberculosis treatment|
|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.|
|Appears in Collections:||Research Articles (Bio-Medical)|
Files in This Item:
All items in DSpace are protected by copyright, with all rights reserved.