title: Efficacy of an unsupervised ambulatory treatment regimen for smear-negative pulmonary tuberculosis and tuberculous pleural effusion in Malawi.
abstract: METHODS
  Queen Elizabeth Central Hospital, Blantyre, and Zomba Central Hospital, Zomba, Malawi.
  
  
  OBJECTIVE
  To evaluate treatment outcome of unsupervised ambulatory treatment (2R3H3Z3/2TH[EH]/4H) in Blantyre and 'standard' treatment (1STH[SEH]/11TH[EH]) in Zomba in human immunodeficiency virus (HIV) seropositive and seronegative patients with smear-negative pulmonary tuberculosis (PTB) and pleural TB.
  
  
  METHODS
  All patients with smear-negative and pleural TB registered between 1 April and 31 December 1995 were assessed for enrolment in the study. Study patients were followed up and 12-month treatment outcomes were recorded.
  
  
  RESULTS
  A total of 434 patients, 296 with smear-negative PTB and 138 with pleural TB, were enrolled: 366 (84%) of patients were HIV-positive; 220 (51%) completed treatment, and 144 (33%) died by 12 months. In patients from Blantyre and Zomba, baseline characteristics were similar, apart from older age in those from Zomba, and the proportion of patients who completed treatment and who died were similar. In both sites, significantly higher case fatality rates were found in older patients, HIV-positive patients and patients with pulmonary parenchymal lung disease.
  
  
  CONCLUSIONS
  Unsupervised ambulatory treatment evaluated in this study had an efficacy similar to that of 'standard' treatment. For operational reasons, however, it will not be recommended for widespread use in Malawi's National Tuberculosis Control Programme.
authors.affiliation: College of Medicine, Chichiri, Blantyre, Malawi.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.forename: D S
authors.initials: DS
authors.lastname: Nyangulu
authors.forename: H
authors.initials: H
authors.lastname: Banda
authors.forename: C
authors.initials: C
authors.lastname: Kang'ombe
authors.forename: L
authors.initials: L
authors.lastname: Van der Paal
authors.forename: J R
authors.initials: JR
authors.lastname: Glynn
authors.forename: V R
authors.initials: VR
authors.lastname: Subramanyam
authors.forename: J J
authors.initials: JJ
authors.lastname: Wirima
authors.forename: F M
authors.initials: FM
authors.lastname: Salaniponi
authors.forename: D
authors.initials: D
authors.lastname: Maher
authors.forename: P
authors.initials: P
authors.lastname: Nunn
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014396:Tuberculosis, Pleural / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control
chemical_list: D000995:Antitubercular Agents