Intensive-phase treatment outcomes among hospitalized multidrug-resistant tuberculosis patients: results from a nationwide cohort in Nigeria.
BACKGROUND
Nigeria is faced with a high burden of Human Immunodeficiency Virus (HIV) infection and multidrug-resistant tuberculosis (MDR-TB). Treatment outcomes among MDR-TB patients registered across the globe have been poor, partly due to high loss-to-follow-up. To address this challenge, MDR-TB patients in Nigeria are hospitalized during the intensive-phase(IP) of treatment (first 6-8 months) and are provided with a package of care including standardized MDR-TB treatment regimen, antiretroviral therapy (ART) and cotrimoxazole prophylaxis (CPT) for HIV-infected patients, nutritional and psychosocial support. In this study, we report the end-IP treatment outcomes among them.


METHODS
In this retrospective cohort study, we reviewed the patient records of all bacteriologically-confirmed MDR-TB patients admitted for treatment between July 2010 and October 2012.


RESULTS
Of 162 patients, 105(65%) were male, median age was 34 years and 28(17%) were HIV-infected; all 28 received ART and CPT. Overall, 138(85%) were alive and culture negative at the end of IP, 24(15%) died and there was no loss-to-follow-up. Mortality was related to low CD4-counts at baseline among HIV-positive patients. The median increase in body mass index among those documented to be underweight was 2.6 kg/m2 (p<0.01) and CD4-counts improved by a median of 52 cells/microL among the HIV-infected patients (p<0.01).


CONCLUSIONS
End-IP treatment outcomes were exceptional compared to previously published data from international cohorts, thus confirming the usefulness of a hospitalized model of care. However, less than five percent of all estimated 3600 MDR-TB patients in Nigeria were initiated on treatment during the study period. Given the expected scale-up of MDR-TB care, the hospitalized model is challenging to sustain and the national TB programme is contemplating to move to ambulatory care. Hence, we recommend using both ambulatory and hospitalized approaches, with the latter being reserved for selected high-risk groups.
Zankli Medical Centre, Abuja, Nigeria; Liverpool School of Tropical Medicines, Pembroke Place, Liverpool, United Kingdom.
Olanrewaju
O
Oladimeji
Médecins Sans Frontières (MSF), Operational Research Unit, Luxemburg, Luxemburg.
Petros
P
Isaakidis
National Tuberculosis and Leprosy Control Unit, Federal Ministry of Health, Abuja, Nigeria.
Olusegun J
OJ
Obasanya
Damien Foundation Belgium, Nigeria Project, Ibadan, Nigeria.
Osman
O
Eltayeb
Médecins Sans Frontières (MSF), Operational Research Unit, Luxemburg, Luxemburg.
Mohammed
M
Khogali
Médecins Sans Frontières (MSF), Operational Research Unit, Luxemburg, Luxemburg.
Rafael
R
Van den Bergh
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
Ajay M V
AM
Kumar
Centre for International Health, University of Bergen, Bergen, Norway.
Sven Gudmund
SG
Hinderaker
Tuberculosis and Leprosy Control Program, Federal Capital Territory, Abuja, Nigeria.
Saddiq T
ST
Abdurrahman
Zankli Medical Centre, Abuja, Nigeria.
Lovett
L
Lawson
Liverpool School of Tropical Medicines, Pembroke Place, Liverpool, United Kingdom.
Luis E
LE
Cuevas
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D009549:Nigeria; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination