title: Ambulatory multi-drug resistant tuberculosis treatment outcomes in a cohort of HIV-infected patients in a slum setting in Mumbai, India.
abstract: BACKGROUND
  India carries one quarter of the global burden of multi-drug resistant TB (MDR-TB) and has an estimated 2.5 million people living with HIV. Despite this reality, provision of treatment for MDR-TB is extremely limited, particularly for HIV-infected individuals. Médecins Sans Frontières (MSF) has been treating HIV-infected MDR-TB patients in Mumbai since May 2007. This is the first report of treatment outcomes among HIV-infected MDR-TB patients in India.
  
  
  METHODS
  HIV-infected patients with suspected MDR-TB were referred to the MSF-clinic by public Antiretroviral Therapy (ART) Centers or by a network of community non-governmental organizations. Patients were initiated on either empiric or individualized second-line TB-treatment as per WHO recommendations. MDR-TB treatment was given on an ambulatory basis and under directly observed therapy using a decentralized network of providers. Patients not already receiving ART were started on treatment within two months of initiating MDR-TB treatment.
  
  
  RESULTS
  Between May 2007 and May 2011, 71 HIV-infected patients were suspected to have MDR-TB, and 58 were initiated on treatment. MDR-TB was confirmed in 45 (78%), of which 18 (40%) were resistant to ofloxacin. Final treatment outcomes were available for 23 patients; 11 (48%) were successfully treated, 4 (17%) died, 6 (26%) defaulted, and 2 (9%) failed treatment. Overall, among 58 patients on treatment, 13 (22%) were successfully treated, 13 (22%) died, 7 (12%) defaulted, two (3%) failed treatment, and 23 (40%) were alive and still on treatment at the end of the observation period. Twenty-six patients (45%) experienced moderate to severe adverse events, requiring modification of the regimen in 12 (20%). Overall, 20 (28%) of the 71 patients with MDR-TB died, including 7 not initiated on treatment.
  
  
  CONCLUSIONS
  Despite high fluoroquinolone resistance and extensive prior second-line treatment, encouraging results are being achieved in an ambulatory MDR-T- program in a slum setting in India. Rapid scale-up of both ART and second-line treatment for MDR-TB is needed to ensure survival of co-infected patients and mitigate this growing epidemic.
authors.affiliation: Médecins Sans Frontières, Mumbai, India. msfocb-asia-epidemio@brussels.msf.org
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.forename: Helen S
authors.initials: HS
authors.lastname: Cox
authors.forename: Bhanumati
authors.initials: B
authors.lastname: Varghese
authors.forename: Chiara
authors.initials: C
authors.lastname: Montaldo
authors.forename: Esdras
authors.initials: E
authors.lastname: Da Silva
authors.forename: Homa
authors.initials: H
authors.lastname: Mansoor
authors.forename: Joanna
authors.initials: J
authors.lastname: Ladomirska
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sotgiu
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Migliori
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pontali
authors.forename: Peter
authors.initials: P
authors.lastname: Saranchuk
authors.forename: Camilla
authors.initials: C
authors.lastname: Rodrigues
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D023801:Directly Observed Therapy; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents