title: Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa.
abstract: METHODS
  In KwaZulu-Natal, South Africa, a setting endemic for tuberculosis (TB) and the human immunodeficiency virus (HIV), prolonged hospitalisation for the treatment of the growing number of multidrug-resistant TB (MDR-TB) patients is neither possible nor effective.
  
  
  OBJECTIVE
  To compare early treatment outcomes in patients with MDR-TB with and without HIV co-infection at four decentralised rural sites with a central urban referral hospital.
  
  
  METHODS
  This is an operational, prospective cohort study of patients between 1 July 2008 and 30 November 2009, where culture  conversion, time to culture conversion, survival and predictors of these outcomes were analysed.
  
  
  RESULTS
  Of 860 patients with MDR-TB, 419 were at the decentralised sites and 441 at the central hospital. Overall, 71% were HIV co-infected. In the 17-month study period, there was a higher  proportion of culture conversion at the decentralised sites compared with the centralised hospital (54% vs. 24%, P < 0.001, OR 3.76, 95%CI 2.81-5.03). The median time to treatment initiation was significantly shorter at the decentralised sites compared with the centralised  hospital (72 vs. 93 days, P < 0.001). There was no significant difference in survival following treatment initiation.
  
  
  CONCLUSIONS
  In this study, early treatment outcomes suggest that decentralised care for MDR-TB patients is superior to that in a centralised setting.
authors.affiliation: Health Systems Research Unit, Medical Research Council, Cape Town, South Africa. marian.loveday@mrc.ac.za
authors.forename: M
authors.initials: M
authors.lastname: Loveday
authors.forename: K
authors.initials: K
authors.lastname: Wallengren
authors.forename: A
authors.initials: A
authors.lastname: Voce
authors.forename: B
authors.initials: B
authors.lastname: Margot
authors.forename: T
authors.initials: T
authors.lastname: Reddy
authors.forename: I
authors.initials: I
authors.lastname: Master
authors.forename: J
authors.initials: J
authors.lastname: Brust
authors.forename: K
authors.initials: K
authors.lastname: Chaiyachati
authors.forename: N
authors.initials: N
authors.lastname: Padayatchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006760:Hospitalization; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents