title: Programmatic treatment outcomes in HIV-infected and uninfected drug-resistant TB patients in Khayelitsha, South Africa.
abstract: BACKGROUND
  South Africa has high burdens of HIV, TB and drug-resistant TB (DR-TB, rifampicin-resistance). Treatment outcome data for HIV-infected versus uninfected patients is limited. We assessed the impact of HIV and other factors on DR-TB treatment success, time to culture conversion, loss-from-treatment and overall mortality after second-line treatment initiation.
  
  
  METHODS
  A retrospective cohort analysis was conducted for patients initiated on DR-TB treatment from 2008 to 2012, within a community-based, decentralised programme in Khayelitsha, South Africa.
  
  
  RESULTS
  Among 853 confirmed DR-TB patients initiating second-line treatment, 605 (70.9%) were HIV infected. HIV status did not impact on time to sputum culture conversion nor did it impact treatment success; 48.1% (259/539) and 45.9% (100/218), respectively (p=0.59). In a multivariate model, HIV was not associated with treatment success. Death during treatment was higher among HIV-infected patients, but overall mortality was not significantly higher. HIV-infected patients with CD4 <=100 cells/ml were significantly more likely to die after starting treatment.
  
  
  CONCLUSIONS
  Response to DR-TB treatment did not differ with HIV infection in a programmatic setting with access to antiretroviral treatment (ART). Earlier ART initiation at a primary care level could reduce mortality among HIV-infected patients presenting with low CD4 counts.
authors.affiliation: Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa msfocb-khayelitsha-drtb-epi@brussels.msf.org.
authors.forename: Erika
authors.initials: E
authors.lastname: Mohr
authors.affiliation: Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa.
authors.forename: Vivian
authors.initials: V
authors.lastname: Cox
authors.affiliation: Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa.
authors.forename: Lynne
authors.initials: L
authors.lastname: Wilkinson
authors.affiliation: Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa.
authors.forename: Sizulu
authors.initials: S
authors.lastname: Moyo
authors.affiliation: Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa.
authors.forename: Johnny
authors.initials: J
authors.lastname: Daniels
authors.affiliation: Médecins Sans Frontières (MSF), Khayelitsha, Cape Town, South Africa.
authors.forename: Odelia
authors.initials: O
authors.lastname: Muller
authors.affiliation: University of Cape Town, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa.
authors.forename: Helen
authors.initials: H
authors.lastname: Cox
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: ART; DR-TB; HIV; Programmatic treatment outcomes