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

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dc.contributor.authorMoyo, Sizuluen_ZA
dc.contributor.authorCox, Helen Sen_ZA
dc.contributor.authorHughes, Jenniferen_ZA
dc.contributor.authorDaniels, Johnnyen_ZA
dc.contributor.authorSynman, Leighen_ZA
dc.contributor.authorDe Azevedo, Virginiaen_ZA
dc.contributor.authorShroufi, Amiren_ZA
dc.contributor.authorCox, Vivianen_ZA
dc.contributor.authorVan Cutsem, Gillesen_ZA
dc.date.accessioned2015-11-18T07:04:35Z
dc.date.available2015-11-18T07:04:35Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: 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.en_ZA
dc.identifier.apacitationMoyo, S., Cox, H. S., Hughes, J., Daniels, J., Synman, L., De Azevedo, V., ... Van Cutsem, G. (2015). Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/15113en_ZA
dc.identifier.chicagocitationMoyo, Sizulu, Helen S Cox, Jennifer Hughes, Johnny Daniels, Leigh Synman, Virginia De Azevedo, Amir Shroufi, Vivian Cox, and Gilles Van Cutsem "Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/15113en_ZA
dc.identifier.citationMoyo, S., Cox, H. S., Hughes, J., Daniels, J., Synman, L., De Azevedo, V., ... & van Cutsem, G. (2015). Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa. PloS one, 10(3). doi:10.1371/journal.pone.0118919en_ZA
dc.identifier.ris TY - Journal Article AU - Moyo, Sizulu AU - Cox, Helen S AU - Hughes, Jennifer AU - Daniels, Johnny AU - Synman, Leigh AU - De Azevedo, Virginia AU - Shroufi, Amir AU - Cox, Vivian AU - Van Cutsem, Gilles AB - 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. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0118919 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa TI - Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa UR - http://hdl.handle.net/11427/15113 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15113
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0118919
dc.identifier.vancouvercitationMoyo S, Cox HS, Hughes J, Daniels J, Synman L, De Azevedo V, et al. Loss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africa. PLoS One. 2015; http://hdl.handle.net/11427/15113.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Medical Microbiologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Moyo et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherDrug therapyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherMultivariate analysisen_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherMulti-drug-resistant tuberculosisen_ZA
dc.titleLoss from treatment for drug resistant tuberculosis: risk factors and patient outcomes in a community-based program in Khayelitsha, South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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