Program Schedule

1698
Characteristics and Outcomes Among Patients with MDR-TB Treated in a Decentralized Community-based Treatment Program in Rural KZN, South Africa

Session: Poster Abstract Session: Mycobacterial Infections: DrugóResistance
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • IDWeek_1698.pdf (3.7 MB)
  • Background: In 2006, an epidemic of multidrug resistant tuberculosis (MDRTB), with extremely high mortality rates, was uncovered in rural KwaZulu-Natal, South Africa.  To address treatment delays and high rates of mortality and default at the single centralized provincial treatment facility, a decentralized MDRTB treatment program was established in 2008 in a rural district with high MDRTB prevalence.  Program components include an inpatient facility, outpatient clinic and community-based treatment provided by mobile teams. We evaluated treatment outcomes at this program.

    Methods: We reviewed the standardized Department of Health MDRTB treatment register to abstract data on demographics, diagnostics, and treatment outcomes among patients initiating MDRTB treatment between February 8, 2008 and December 18, 2013.

    Results: Of 718 registered MDRTB patients, median age was 35 years (IQR 29-43), 382 (53.2%) were female, and 596 (83.0%) were HIV positive.  MDRTB was the first TB diagnosis for 159 patients (22.1%).  Of 573 with available treatment outcomes, 294 (51.3%) completed treatment or were cured, 131 (22.9%) died, 33 (5.8%) failed treatment, and 82 (14.3%) had extensively-drug resistant TB (XDRTB) and were transferred to the provincial XDR-TB treatment facility.  Overall, only 33 (5.8%) defaulted. Mortality rates fluctuated over time with lowest rate of 10.9 deaths /100 person-years of treatment in 2008, rising to 50.7 in 2011, and declining to 38.2 in 2013.  HIV+ patients had a non-significant trend towards higher mortality; however mortality was significantly lower among those on ART (p<0.001).

    Conclusion: Low overall default rates support program effectiveness. Results in HIV+ patients support HIV/TB integration. The substantial proportion of MDRTB as initial TB diagnosis highlights the need for improved infection control in health care and community settings. Though low overall, fluctuations in mortality need further evaluation and may reflect changes in patient and TB program characteristics over time, including disease severity, improved case finding, earlier diagnosis, and increasing MDRTB program maturity. This review supports benefit of decentralization and community-based MDRTB treatment programs in high prevalence areas.

    Karen Jacobson, MPH1,2, Francois Eksteen, MD2,3, Anthony Moll, MBChB2,3, Gerald Friedland, MD, FIDSA4, Alois Mngadi, MD5, Lee-Megan Larkan5, Phumelele Mhlongo2 and Sheela Shenoi, MD, MPH4, (1)Icahn School of Medicine at Mount Sinai, New York, NY, (2)Philanjalo, Tugela Ferry, KwaZulu-Natal, South Africa, (3)Church of Scotland Hospital, Tugela Ferry, KwaZulu-Natal, South Africa, (4)Yale University School of Medicine, New Haven, CT, (5)Greytown M3 Hospital, Greytown, KwaZulu-Natal, South Africa

    Disclosures:

    K. Jacobson, None

    F. Eksteen, None

    A. Moll, None

    G. Friedland, None

    A. Mngadi, None

    L. M. Larkan, None

    P. Mhlongo, None

    S. Shenoi, None

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