Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa
| dc.contributor.advisor | Dheda, Keertan | en_ZA |
| dc.contributor.author | Pietersen, Gerbrecht Elizabeth | en_ZA |
| dc.date.accessioned | 2017-06-06T09:43:25Z | |
| dc.date.available | 2017-06-06T09:43:25Z | |
| dc.date.issued | 2017 | en_ZA |
| dc.description.abstract | Background: Recent gains in TB control in South Africa are being reversed by drug-resistant tuberculosis (MDR-TB and XDR-TB), which has a high mortality, is a threat to health care workers, and is prohibitively costly to treat. MDR-TB has been supplanted by XDR-TB, resistance beyond XDR-TB, and programmatically incurable TB. Short-term treatment-related outcomes of XDR-TB patients are known to be poor. However, there are no prospective data to inform longterm treatment-related outcomes, design of effective XDR-TB treatment regimens, and public health interventions required to interrupt transmission. In particular, the utility of certain costly drugs, e.g. capreomycin, for the treatment of XDR-TB remain unclear. There are also few data about how these characteristics differ in HIV-infected persons. Finally, little is known about the experiences of patients living with XDR-TB. This thesis aims to provide best practice evidence to promote drug-resistant TB control in high burden TB and HIV syndemic countries. Methods: We prospectively followed two cohorts of adult South African XDR-TB patients who received hospital and community treatment, which included a capreomycin and PAS-based regimen: (i) cohort A (n=107) from 3 provinces were diagnosed between August 2002 and February 2008 (retrospectively identified) and then prospectively followed up till August 2012; (ii) cohort B (n=273) from 2 provinces were prospectively identified between October 2008 and October 2012 and followed up till October 2014. Strain typing and drug susceptibility testing were performed and treatment-related outcomes were determined. In-depth interviews were conducted with therapeutically destitute patients from cohort B (n=12) and were home-discharged from hospital back to the community. | en_ZA |
| dc.identifier.apacitation | Pietersen, G. E. (2017). <i>Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/24499 | en_ZA |
| dc.identifier.chicagocitation | Pietersen, Gerbrecht Elizabeth. <i>"Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2017. http://hdl.handle.net/11427/24499 | en_ZA |
| dc.identifier.citation | Pietersen, G. 2017. Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa. University of Cape Town. | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Pietersen, Gerbrecht Elizabeth AB - Background: Recent gains in TB control in South Africa are being reversed by drug-resistant tuberculosis (MDR-TB and XDR-TB), which has a high mortality, is a threat to health care workers, and is prohibitively costly to treat. MDR-TB has been supplanted by XDR-TB, resistance beyond XDR-TB, and programmatically incurable TB. Short-term treatment-related outcomes of XDR-TB patients are known to be poor. However, there are no prospective data to inform longterm treatment-related outcomes, design of effective XDR-TB treatment regimens, and public health interventions required to interrupt transmission. In particular, the utility of certain costly drugs, e.g. capreomycin, for the treatment of XDR-TB remain unclear. There are also few data about how these characteristics differ in HIV-infected persons. Finally, little is known about the experiences of patients living with XDR-TB. This thesis aims to provide best practice evidence to promote drug-resistant TB control in high burden TB and HIV syndemic countries. Methods: We prospectively followed two cohorts of adult South African XDR-TB patients who received hospital and community treatment, which included a capreomycin and PAS-based regimen: (i) cohort A (n=107) from 3 provinces were diagnosed between August 2002 and February 2008 (retrospectively identified) and then prospectively followed up till August 2012; (ii) cohort B (n=273) from 2 provinces were prospectively identified between October 2008 and October 2012 and followed up till October 2014. Strain typing and drug susceptibility testing were performed and treatment-related outcomes were determined. In-depth interviews were conducted with therapeutically destitute patients from cohort B (n=12) and were home-discharged from hospital back to the community. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa TI - Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa UR - http://hdl.handle.net/11427/24499 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/24499 | |
| dc.identifier.vancouvercitation | Pietersen GE. Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/24499 | en_ZA |
| dc.language.iso | eng | en_ZA |
| dc.publisher.department | Department of Medicine | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.subject.other | Medicine | en_ZA |
| dc.subject.other | Epidemiology, | en_ZA |
| dc.title | Molecular epidemiology, susceptibility profiles, outcomes and transmission dynamics in patients with extensively drug-resistant tuberculosis (XDR-TB) in two provinces of South Africa | en_ZA |
| dc.type | Doctoral Thesis | |
| dc.type.qualificationlevel | Doctoral | |
| dc.type.qualificationname | PhD | en_ZA |
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Thesis | en_ZA |