High treatment failure and default rates for patients with multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa, 2000-2003.
METHODS
Multidrug-resistant tuberculosis (MDR-TB) has emerged as a significant public health threat in South Africa.


OBJECTIVE
To describe treatment outcomes and determine risk factors associated with unfavorable outcomes among MDR-TB patients admitted to the provincial TB referral hospital in KwaZulu-Natal Province, South Africa.


METHODS
Retrospective observational study of MDR-TB patients admitted from 2000 to 2003.


RESULTS
Of 1209 MDR-TB patients with documented treatment outcomes, 491 (41%) were cured, 35 (3%) completed treatment, 208 (17%) failed treatment, 223 (18%) died and 252 (21%) defaulted. Of the total number of patients with known human immunodeficiency virus (HIV) status, 52% were HIV-infected. Treatment failure, death and default each differed in their risk factors. Greater baseline resistance (aOR 2.3-3.0), prior TB (aOR 1.7), and diagnosis in 2001, 2002 or 2003 (aOR 1.9-2.3) were independent risk factors for treatment failure. HIV co-infection was a risk factor for death (aOR 5.6), and both HIV (aOR 2.0) and male sex (aOR 1.9) were risk factors for treatment default.


CONCLUSIONS
MDR-TB treatment outcomes in KwaZulu-Natal were substantially worse than those published from other MDR-TB cohorts. Interventions such as concurrent antiretroviral therapy and decentralized MDR-TB treatment should be considered to improve MDR-TB outcomes in this high HIV prevalence setting.
Brust
J C M
JC
Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York 10467, USA. jcb26@columbia.edu
Gandhi
N R
NR
Carrara
H
H
Osburn
G
G
Padayatchi
N
N
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult; D016903:Drug Monitoring
D000995:Antitubercular Agents